Dry Eye in Alpharetta: Why Your Eye Drops Stopped Working

At a glance: Eye drops often stop working because they add moisture for a few minutes while the cause of your dry eye keeps going. For most people the problem is not too few tears. It is tears that evaporate too fast because the oil glands in the eyelids are not working well.

"I've tried every drop at the drugstore." I hear it almost every week. Drops can help, but they are a bandage. To feel better for good, we need to find out why your eyes are dry.

What is dry eye, really?

Your tear film has three layers that work together: a thin mucus layer that helps tears stick to the eye, a watery layer that keeps the surface moist, and an oil layer on top that slows evaporation. Dry eye happens when that system gets out of balance. Your eyes may feel gritty, burning, scratchy, tired or heavy. Vision may blur and then clear when you blink. And yes, dry eyes can water. More on that below.

The two main types

Evaporative dry eye is the most common type. Tiny oil glands along the eyelid edges, called meibomian glands, make the oil layer. When they clog or the oil thickens, tears evaporate too quickly, even if you make plenty of them. This is called meibomian gland dysfunction, or MGD.

Aqueous-deficient dry eye means the eyes do not make enough of the watery part of tears. It is more common with age and with some autoimmune conditions, such as Sjögren's syndrome.

Many people have a mix of both, which is one reason a single drop rarely fixes everything.

Why did my eye drops stop working?

• The drop doesn't match your type. A watery drop can't replace missing oil.
• Redness-relief drops backfire. Drops that "get the red out" shrink blood vessels, and the redness can come back worse when they wear off. They do not treat dryness.
• Preservatives irritate. If you use drops many times a day, preservatives can bother a sensitive eye. Preservative-free drops are gentler.
• The cause got worse. More screen time, a new medicine, hormone changes or a new contact lens can tip things further out of balance.

What makes dry eye worse?

• Screens. We blink less, and less completely, when we stare at a phone or computer. Read more in our post on screen time and your eyes.
• Contact lenses. Lenses sit in the tear film and can make it less stable, especially late in the day.
• Age and hormones. Tear production tends to drop with age, and menopause is a common trigger.
• Medicines. Antihistamines, some antidepressants, some blood pressure medicines and isotretinoin can dry the eyes. Never stop a medicine on your own; talk to your doctor.
• Air flow. Ceiling fans, car vents, heat and air conditioning all speed up evaporation.

What helps at home

• Warm compresses. Gentle heat on closed lids for several minutes softens thickened oil in the glands.
• Lid hygiene. Clean along the lash line daily with a lid cleanser your doctor recommends.
• Blink breaks. Every 20 minutes, look away from your screen and do a few slow, full blinks.
• The right drop. If you use drops more than a few times a day, ask about preservative-free options.
• Aim air away from your face. Redirect vents and fans. A bedroom humidifier helps some people.

How we evaluate dry eye at Reimbold Eye Group

A real dry eye workup looks at more than how your eyes feel. Depending on your symptoms, our testing can include staining to show damaged surface cells, meibography (infrared pictures of the oil glands), tear osmolarity to measure tear quality, tear volume, and a check of how well your glands express oil. Then we build a plan for your type of dry eye.

Beyond home care, treatment may include prescription anti-inflammatory drops such as cyclosporine (Restasis or Cequa) or lifitegrast (Xiidra), treatment for eyelid inflammation, or punctal plugs, tiny plugs that keep your own tears on the eye longer. For severe dry eye, scleral lenses hold a pool of fluid over the eye all day. Learn more on our dry eye page.

Dry eye is usually a long-term condition. The goal is to manage it well so you feel comfortable and see clearly.

Call us right away or go to the emergency room for sudden vision loss, a curtain or shadow over your vision, new flashes of light or a sudden shower of floaters, severe eye pain with nausea or halos, or a chemical splash in the eye.

Frequently asked questions

Why are my eyes watery if I have dry eye?

When the surface gets dry and irritated, it signals the eye to make reflex tears. Those tears are mostly water without the oil needed to stay on the eye, so they spill over and the surface stays dry underneath.

Can I use eye drops every day?

Many lubricating drops are safe for daily use. If you need them more than a few times a day, ask about preservative-free drops, and avoid using redness-relief drops regularly.

Can dry eye be cured?

For most people, dry eye is managed over time rather than cured. With the right plan, most people feel much more comfortable.

Is dry eye worse during menopause?

Hormone changes during menopause are a common trigger. If your eyes started bothering you around that time, mention it at your exam.

Visit Reimbold Eye Group in Alpharetta

You don't have to keep buying drop after drop. Book online or call 770-776-9000. We are at 4180 Old Milton Pkwy 1-D, Alpharetta, GA 30005, open Tuesday to Thursday 10 am to 6 pm, Friday 9 am to 5 pm and Saturday 9 am to 2 pm.