If your eyes burn, sting, water excessively, or feel like there’s sand in them every time you blink, something is disrupting the delicate balance of your tear film. But “dry eye” isn’t one disease with one cause — it’s a complex condition with dozens of potential triggers, and most patients have more than one factor at play.
Understanding what’s actually causing your dry eye is the single most important step toward finding lasting relief. Eye drops can mask symptoms for a few minutes, but they do nothing to address the underlying disease process. That’s why every patient at the 1-800-Dry-Eyes Therapy Center receives a comprehensive diagnostic evaluation — including Meibography, tear breakup time analysis, and osmolarity testing — so Dr. Shira Kresch can identify the exact type and cause of your dry eye before building your treatment plan.
Below is a comprehensive guide to the most common causes of dry eye disease. Each section links to a dedicated page where you can learn more about that specific cause and how we treat it.
Before diving into specific causes, it helps to understand that dry eye disease generally falls into two categories — and many patients have a combination of both.
Evaporative dry eye accounts for up to 86% of all dry eye cases. It occurs when the oily (lipid) layer of the tear film is deficient or abnormal, causing tears to evaporate far too quickly from the surface of the eye. The most common cause is Meibomian Gland Dysfunction (MGD) — a condition where the tiny oil-producing glands in your eyelids become blocked, inflamed, or damaged. Without a healthy oil layer sealing the tear film, your tears break down in seconds instead of minutes, leaving the cornea exposed and irritated.
Aqueous deficient dry eye occurs when the lacrimal glands simply don't produce enough of the watery (aqueous) component of your tears. This can be caused by aging, autoimmune conditions like Sjögren's syndrome, medications, radiation therapy, or damage to the lacrimal glands. The result is an overall low volume of tears that can't adequately lubricate the eye, even if the oil layer is functioning normally.
Many patients — especially those with moderate to severe symptoms — have a mixed mechanism dry eye, meaning both evaporative and aqueous deficiency are contributing. That’s why a thorough diagnostic workup is essential: the treatment for evaporative dry eye is fundamentally different from the treatment for aqueous deficiency, and getting it wrong means your symptoms won’t improve.
Meibomian Gland Dysfunction is the number one cause of dry eye disease worldwide. Your eyelids contain roughly 30–40 Meibomian glands per lid, and their job is to produce the thin layer of oil (meibum) that coats the surface of your tear film and prevents evaporation. When these glands become clogged with thickened, waxy secretions — or worse, begin to atrophy and die — the oil layer breaks down and your tears evaporate in seconds. The result is chronic burning, stinging, redness, and fluctuating vision that no amount of artificial tears can permanently fix.
MGD is progressive. The longer it goes undiagnosed and untreated, the more permanent gland loss occurs. Advanced imaging with Meibography allows us to visualize your glands directly and assess how much damage has occurred. Treatments like IPL, Radiofrequency, and LLLT are specifically designed to unclog, stimulate, and restore Meibomian gland function before irreversible loss occurs.
Demodex mites are microscopic parasites that live in human eyelash follicles and Meibomian glands. While a small population of Demodex is normal, an overgrowth triggers a chronic inflammatory response called Demodex blepharitis. Symptoms include crusty, flaky debris at the base of the lashes (called cylindrical dandruff or collarettes), persistent redness, itching, a feeling of something crawling on the lids, and progressive Meibomian gland damage. Demodex infestations become more common with age and are frequently found in patients who have been unsuccessfully treating “dry eye” for years without anyone looking for the underlying cause.
IPL therapy is particularly effective against Demodex because the light energy directly targets and destroys the mites and their eggs within the follicles and glands — something that lid scrubs and tea tree oil products can only partially accomplish.
Anterior blepharitis is inflammation of the outer eyelid margin, typically at the base of the eyelashes. It can be caused by bacterial overgrowth (staphylococcal blepharitis) or seborrheic dermatitis. The chronic inflammation disrupts the tear film, irritates the ocular surface, and often coexists with Meibomian Gland Dysfunction. Patients typically notice red, swollen lid margins, crusty debris on the lashes, and worsening dry eye symptoms in the morning.
Rosacea is a chronic inflammatory skin condition that most people associate with facial redness and flushing. But up to 60% of rosacea patients also develop ocular rosacea, which causes persistent eye redness, burning, light sensitivity, visible blood vessels on the eyelids, and recurring styes or chalazia. Ocular rosacea directly inflames the Meibomian glands and eyelid margins, making it a major contributor to evaporative dry eye. Many patients are treated for “dry eye” for years without anyone identifying the underlying rosacea.
IPL therapy was originally developed for dermatological rosacea, and its ability to reduce inflammation, close abnormal blood vessels, and calm the ocular surface makes it one of the most effective treatments for ocular rosacea-related dry eye.
LASIK, PRK, SMILE, and other corneal refractive procedures work by reshaping the cornea to correct vision. In the process, corneal nerves are severed — and these nerves play a critical role in stimulating tear production. When they’re disrupted, the feedback loop between the cornea and the lacrimal glands is broken, resulting in reduced tear production and a dry, irritated ocular surface. For most patients, post-LASIK dry eye is temporary and resolves within 3–6 months as the nerves regenerate. But for a significant minority, the dryness becomes chronic and can persist for years.
If you’re experiencing persistent dry eye months or years after LASIK, advanced treatments like IPL, RF, and LLLT can address the underlying inflammation and gland dysfunction that developed in the wake of surgery. For severe cases, scleral lenses can provide a constant reservoir of moisture over the cornea throughout the day.
→ Learn More About Dry Eye After LASIK → Scleral Lenses for Post-LASIK Dry Eye
Cataract surgery is one of the most commonly performed procedures in the world, and dry eye is its most frequent complication. The corneal incisions, exposure to microscope light during the procedure, the use of antiseptic drops, and the disruption of corneal nerves all contribute to post-operative dryness. In patients who already had undiagnosed dry eye or MGD before surgery, the symptoms often become significantly worse afterward. If you’re planning cataract surgery, or if your eyes have been dry since your procedure, a dedicated dry eye evaluation can identify the problem and get you on the right treatment.
Orbital or head/neck radiation therapy can cause severe, long-lasting dry eye by permanently damaging the lacrimal glands, Meibomian glands, and the conjunctival goblet cells that produce the mucin layer of the tear film. Radiation-induced dry eye is often aqueous deficient and can be among the most challenging forms to treat. Patients who have undergone radiation should be monitored proactively for dry eye symptoms, and early intervention with in-office treatments and specialty lenses can prevent significant ocular surface damage.
Dry eye isn’t always a local problem — sometimes it’s a symptom of a systemic disease that’s affecting the entire body. Autoimmune conditions are among the most common systemic causes of severe, chronic dry eye.
Sjögren’s syndrome is an autoimmune disorder in which the immune system attacks the body’s moisture-producing glands, including the lacrimal glands (which produce tears) and the salivary glands (which produce saliva). The result is severe dryness of the eyes and mouth, often accompanied by joint pain, fatigue, and other systemic symptoms. Sjögren’s-related dry eye tends to be aqueous deficient and can be quite severe, requiring aggressive treatment with a combination of in-office therapies, prescription medications, and often scleral lenses to maintain ocular surface health.
Systemic lupus erythematosus (SLE), rheumatoid arthritis, scleroderma, and other autoimmune diseases can all cause or worsen dry eye through chronic systemic inflammation that affects tear production and ocular surface health. Patients with these conditions are also at higher risk for secondary Sjögren’s syndrome. If you have an autoimmune condition and are experiencing dry eye symptoms, a specialist evaluation can determine whether your eyes need targeted treatment beyond what your rheumatologist is managing systemically.
GVHD is a serious complication that can occur after bone marrow or stem cell transplants, in which the donor immune cells attack the recipient’s tissues — including the lacrimal glands, Meibomian glands, and conjunctiva. Ocular GVHD causes some of the most severe dry eye we see in clinical practice. These patients often require a multi-layered approach including IPL, autologous serum tears, and custom scleral lenses to maintain comfort and protect the cornea.
Diabetes affects nearly every system in the body, and the eyes are no exception. Diabetic patients are significantly more likely to develop dry eye due to a combination of factors: reduced corneal nerve sensitivity (diabetic neuropathy), decreased tear secretion, chronic low-grade inflammation, and changes to the Meibomian glands. Because diabetes also increases the risk of other serious eye conditions like diabetic retinopathy, maintaining a healthy ocular surface is especially important for diabetic patients.
Both hyperthyroidism and hypothyroidism can contribute to dry eye. The most dramatic presentation is thyroid eye disease (Graves’ ophthalmopathy), an autoimmune condition associated with Graves’ disease that causes inflammation, swelling, and sometimes protrusion of the eyeballs (proptosis). When the eyes protrude, the lids can’t close fully, leading to severe exposure-related dryness and corneal damage. Even patients with well-controlled thyroid conditions may experience chronic dry eye due to the metabolic and hormonal changes affecting tear production.
Hormones play a direct role in tear production. Androgens, estrogen, and progesterone all influence the lacrimal glands, Meibomian glands, and the inflammatory environment of the ocular surface. When hormone levels shift — whether due to aging, pregnancy, menopause, or medication — dry eye is a common consequence. This is a major reason why dry eye disease disproportionately affects women.
Menopause causes a significant decline in androgens, estrogen, and progesterone — all of which are involved in maintaining healthy tear production and Meibomian gland function. Post-menopausal women are among the highest-risk groups for dry eye disease. The relationship between hormone replacement therapy (HRT) and dry eye is complex: some studies suggest HRT may help, while others indicate it can actually worsen symptoms. What’s clear is that menopausal dry eye requires a personalized approach that considers the patient’s full hormonal, medical, and ocular picture.
The hormonal fluctuations of pregnancy — particularly the surge in progesterone — can reduce tear production and alter the composition of the tear film. Many pregnant women experience blurry vision, contact lens intolerance, burning, and increased light sensitivity, especially during the first and third trimesters. These symptoms often persist through breastfeeding. While most pregnancy-related dry eye resolves after hormonal levels stabilize, patients with pre-existing dry eye may find that pregnancy triggers a more lasting exacerbation.
Hormonal contraceptives — including birth control pills, patches, vaginal rings, and hormonal IUDs — alter the body’s balance of progesterone and estrogen. These hormonal shifts can decrease tear production and contribute to dry eye symptoms, particularly in women who are already predisposed. If you’ve noticed that your eyes became drier after starting or switching contraceptives, it’s worth mentioning to both your gynecologist and your eye care provider.
Women are roughly twice as likely as men to develop dry eye disease. The reasons are primarily hormonal: women have lower baseline levels of androgens (which support Meibomian gland function and tear production), and they undergo multiple major hormonal transitions throughout their lives — menstrual cycles, pregnancy, breastfeeding, perimenopause, and menopause — each of which can trigger or worsen dry eye. Additionally, autoimmune conditions like Sjögren’s syndrome are far more prevalent in women.
Dozens of commonly prescribed and over-the-counter medications can contribute to dry eye as a side effect. These medications work through various mechanisms — reducing tear production, altering tear composition, decreasing corneal sensitivity, or causing systemic dehydration — and the effect is often dose-dependent. If you’re taking any of the following categories of medication and experiencing dry eye symptoms, it’s essential to let your eye care provider know.
Important: Never stop or change a prescribed medication because of dry eye symptoms without consulting your prescribing physician. Instead, bring the information to your dry eye evaluation so Dr. Kresch can factor it into your treatment plan.
When you’re focused on a screen — whether it’s a computer, phone, or tablet — your blink rate drops by as much as 60–70%. Normal blinking occurs roughly 15–20 times per minute, but during concentrated screen use, that can fall to just 3–4 times per minute. Each blink spreads a fresh layer of tears across the cornea, so fewer blinks means longer periods of tear film exposure and evaporation. Over time, this chronic under-blinking leads to Meibomian gland stagnation, tear film instability, and full-blown dry eye disease. In the age of remote work and constant screen use, digital-related dry eye has become one of the fastest-growing causes we see in our clinic.
Contact lenses sit directly on the tear film, and their presence disrupts the natural tear-cornea interaction. Soft lenses can absorb moisture from the tear film, leaving the lens surface and the cornea drier over time. Poor lens hygiene, overwear, and sleeping in lenses accelerate ocular surface inflammation and MGD. Many patients who are told they “can’t wear contacts anymore” actually have an underlying dry eye problem that, once treated, allows them to wear lenses comfortably again. For patients with severe dry eye who still need lens correction, scleral lenses are often the best option — they vault over the cornea and actually improve dry eye by bathing the eye in fluid all day.
→ Learn More About Contact Lenses and Dry Eye → Scleral Lenses for Dry Eye
Your environment plays a significant role in dry eye symptoms. Low humidity, high wind, intense sunlight, high altitude, and extreme temperatures (both hot and cold) all accelerate tear evaporation. Indoors, forced-air heating and air conditioning create artificially dry environments that strip moisture from the ocular surface. Michigan winters are particularly challenging — the combination of cold, dry outdoor air and constantly running indoor heating systems creates a months-long assault on your tear film. Patients often notice their dry eye symptoms peak between November and March.
Seasonal and perennial allergies trigger an inflammatory cascade on the ocular surface that disrupts the tear film and damages the conjunctival cells responsible for mucin production. The relationship between allergies and dry eye is a vicious cycle: allergic inflammation worsens dryness, and a compromised tear film makes the eyes more vulnerable to allergens. To complicate things further, many people treat their allergies with antihistamines — one of the most common medications that cause dry eye. If your eyes are worst during allergy season, it’s important to address both the allergic and the dry eye components.
The foods you eat directly influence inflammation levels throughout your body, including your eyes. Diets high in processed foods, refined sugars, and omega-6 fatty acids promote systemic inflammation that exacerbates dry eye. Conversely, omega-3 fatty acids — found in fatty fish, flaxseed, and quality supplements — have well-documented anti-inflammatory properties that support healthy tear production and Meibomian gland function. Dehydration, excessive caffeine, and alcohol consumption also contribute to reduced tear volume.
Chronic stress triggers the release of cortisol and other inflammatory mediators that can disrupt tear production and destabilize the tear film. Stress also promotes behaviors that worsen dry eye — poor sleep, increased screen time, skipped meals, dehydration, and reduced blinking. While stress alone rarely causes dry eye, it’s a powerful amplifier of existing symptoms and often explains why patients experience flare-ups during particularly demanding periods.
Age is one of the strongest risk factors for dry eye disease. Tear production naturally decreases as we get older, and the Meibomian glands progressively lose function over time — a process that accelerates after age 50. The conjunctival goblet cells that produce the mucin layer of the tear film also decline with age. By the time many patients reach their 60s and 70s, multiple components of the tear film are compromised simultaneously. Age-related dry eye is often compounded by other factors on this page — medications, systemic diseases, hormonal changes — making it a multifactorial condition that requires a comprehensive treatment approach rather than a single solution.
Every case of dry eye has a cause. Often more than one. The only way to find lasting relief is to identify what’s driving your symptoms and treat it directly. At the 1-800-Dry-Eyes Therapy Center in Southfield, MI, Dr. Shira Kresch uses advanced diagnostic imaging to pinpoint the root cause of your dry eye — then builds a customized treatment plan using IPL, Radiofrequency, LLLT, and specialty lenses to deliver real, measurable improvement.
We serve patients from Southfield, Birmingham, Royal Oak, Troy, Farmington Hills, West Bloomfield, Bloomfield Hills, Oak Park, Berkley, Novi, Livonia, Detroit, and communities throughout Metro Detroit.
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