Did you know that one of the symptoms of dry eyes is watery eyes? Confusing, huh? The term dry eyes is really a misnomer, says Dr. Katherine Hill. She is an optometrist who specializes in dry eye issues at Eyecare Medical Group in Portland, Maine.

Dr. Katherine Hill/dry eyes

A better or more descriptive term, in Dr. Hill’s opinion, is dysfunctional tear syndrome.

Dry eye doesn’t really explain what going on. It’s the tears’ inability to do their job, which is to adequately and consistently hydrate, nourish, and protect the surface of the eye from the environment. Tears are a remarkably complex system. Their quality comes from the oil glands in the upper and lower lids, and the quantity or water volume comes from the lacrimal gland beneath the upper lid.

Katherine Hill, OD, Eyecare Medical Group

If you had never heard of oil or lacrimal glands before or would like to know where they are located, here’s a helpful illustration.

Dry eyes lacrimal glands

Don’t blink back those tears

Blinking is key to healthy tears. When you blink your eyes it causes a muscular contraction that releases oil from the meibomian glands into the tears. If we don’t blink frequently enough our tears end up being deficient in oil and that’s when we can develop dry eyes.

The average person blinks about 15 to 20 times a minute. Anytime we are concentrating, such as when reading or driving, we blink about half the normal rate. If you’re on an electronic device like the laptop I’m using to write this blog post, you blink about one-fifth the normal rate.

I don’t know about you, but I am guilty of staring at the screen for quite a long time, especially when I’m working. What I, and maybe you, should start doing is taking regular blink breaks. Stop what we’re doing or staring at about every 20 minutes or so. Close our eyes all the way for 2 seconds, open them for two seconds. Do this about 20 times. It’s called conscious blinking.

It kind of works like windshield wipers. When you only do partial blinks it’s like a wiper that can only go so far. We’re left with the bottom portion of the eye exposed to the environment, not getting rewetted. So, if every 20 or 30 minutes, especially when we’re in the zone, we can do some slow, long, gentle and deliberate blinks. we’ll help rehydrate the surface of the eye and utilize those important oils.

Dr. Hill

Common symptoms

You might think it would be easy to recognize if your tears are underperforming because a common symptom IS dry eyes. However, that’s not always the case. Here’s a list of other common symptoms:

  • General feeling of irritation in the eyes
  • Gritty feeling
  • Itchiness
  • Feeling like there is something in your eye
  • Light sensitivity
  • Blurred vision
  • Redness
  • Watery eyes

So … that last sign — watery eyes. How can your eyes be dry and watery at the same time?

It’s the body’s attempt to compensate for an unhealthy tear film that’s evaporating too quickly and it’s not very effective. It’s confusing when you’re experiencing it because you don’t feel like your eyes are dry.

Basically, we have two types of tears. We have maintenance tears — with each blink we get a thick, oily, nutrient dense tear that protects the surface of the eye. And then we have reflex tearing. You got poked in the eye or experience emotional crying, which produces a high volume of salty tears. Our eyes only hold about two tears at a time, so they will inevitably be rolling down our cheeks.

The maintenance tearing is kind of the sprinkler system that is constantly going and the reflex tearing is more like a fire hose. When the sprinkler system fails, when the maintenance tearing isn’t doing its job properly, the brain says flush the eyes, and the reflex tearing kicks in because it’s trying to protect the surface of the eye.

Dr. Hill

During an eye exam, a doctor might notice the tearing and recognize it as a symptom of dry eyes, but oftentimes patients insist their eyes are anything but dry.

Why do eyes become chronically dry?

There are several things that can prevent our tears from doing their job and making our eyes get too dry:

  • The environment (indoors and out)
  • Certain medications, such as antihystamines
  • Diseases that affect your body’s ability to make tears, including rheumatoid arthritis, Sjogren’s syndrome, thyroid issues, allergies, rosacea, and autoimmune conditions.
  • Age (we produce fewer tears as we age)
  • Hormonal changes, such as menopause or when you’re taking hormone replacements
  • Screen time
  • Compromised diets
  • Skin and eyecare products
  • Poor eye hygiene
  • Inflammation
  • Eyelids that are unable to close all the way

How to keep your tears healthy

Conscious blinking is a good start toward healthier tears, but Dr. Hill has more suggestions. Just as we should practice good dental hygiene to keep our gums healthy, we also need to practice good eye hygiene to keep our lids and tears healthy.

It’s not that nice to think of, but we’re supposed to be covered with bacteria and microbes that live in balance with the oils of our skin. Natural flora. If the balance is upset, it can increase inflammation and also plaque buildup at base of eyelashes right near the opening of the oil glands. You want to remove what should not be there without stripping the oils. You don’t want to kill the good and the bad bacteria.

Dr. Hill

Never put on harsh soaps or cleansers. Use a clean washcloth, warm water, and appropriate lid hygiene products. Dr. Hill prefers a hypochlorous acid spray. It sounds scary but it’s a natural bleach that your skin makes, and It dissolves plaque and removes debris without stripping oils and bacteria. You can spray it on your eyelids and let it air dry or use a lint-free cotton pad to apply. Do it once a day.

Ingredients in many makeup products are a big issue when it comes to eye health, as well as in makeup remover, lotions, and serums.

Regulation is horribly lacking in this arena, it hasn’t been updated in nearly 40 years. We allow a lot of ingredients and chemicals that are actually illegal in other countries because they have no right being used on a skin, let alone around the eyes. Alcohol and formaldehyde, for instance, are found in many products, both things we really don’t want around our eyes.

Dr. Hill

With so little regulation, when it comes to the world of makeup the burden falls on the consumer, so use due diligence and choose products that are clean, meaning they don’t contain toxic ingredients. One way to check is to look at the Environmental Working Group’s Safe Skin Deep page where you can search different brands, products, and ingredients.

Even if you pay a lot of money for a product or it’s ophthalmologist approved you can’t trust that it’s safe, and also, if it’s a clean product it might still not be right for you.

There’s a lot of trial and error in finding the right makeup and skincare products. It could be clean but you could be sensitive to particular dyes or preservatives. You have to figure out what brand is right for you. I recommend water-based cosmetics.

Dr. Hill

You also have to remove makeup every night with either warm water or a simple oil-based formula. Again, always check the ingredients.

Makeup remover, I’d say is the single biggest offending agent in the daily regimen of most people because it’s alcohol based. Then you read that list of ingredients and you’re getting down to 20 ingredients, many unpronounceable.

And, of course, you feel like you’re doing the right thing. You’re removing your makeup nightly. Isn’t that what you’re supposed to do? Only the alcohol is stripping the oils and the bacteria is blooming and, in a way, you’re also callousing the lid margin. Cells accumulate and contribute to the obstruction of the glands.

Dr. Hill

Another big contributor to dry eye issues is anti-aging or anti-wrinkle products that typically contain retinol, which is a vitamin derivative. It’s natural, healthy, effective at minimizing pores, and shrinking oil glands, but not good for your eyes.

You can buy very expensive, very nice eye creams with instructions to put on your eyelids once/twice a day. The problem, says Dr. Hill, is that the retinol damages the margin of the eyelid and oil production, compromising the health of your tears.

Contacts and eye solutions

What you put in your eyes can also damage the health of your tears. Contacts, for instance, can act like a sponge and absorb the tears and leave the surface dry. It can happen even when they fit well and are replaced on a regular basis.

Contacts will inherently alter the natural physiology of the tear exchange. It doesn’t mean you can’t wear them, but you need to understand what’s going on. I don’t recommend wearing them all day every day. It’s important to let the eyes breathe naturally without the lenses in place.

Dr. Hill

You can use lubricating or rewetting drops, but make sure they are specifically approved for contact lens wear. Avoid harsh preservatives, which tend to be found in multi-use bottles. You’re putting the drops in your eye to wet them, but the preservatives are exacerbating the dryness! Instead, Dr. Hill recommends opting for preservative-free single-use vials that have just a few drops in them.

Drops that claim to relieve redness also contain harsh preservatives along with medicine that can dry out and irritate the eyes. If you use them for more than a few days you can also have rebound redness. They’ll be redder than they were in the first place. Instead of grabbing for something to get rid of the redness, find out why they’re red. There’s a reason and it’s probably dryness.

Dr. HIll/dry eye patient

Eye exam

Dr. Hill says about 40% of the time, people see her at their doctor’s recommendation. For a variety of reasons, they don’t realize that their eyes are not producing tears the way they should. With a closer look, she can tell.

When we assess the health of the eyes we can use a dye that stains the tear film and allows us to visualize the thickness, the stability, and how quickly the tears evaporate. You can touch the lids and express the glands to determine the quality of the oil coming out and how much pressure it takes for that oil to come out. You also assess the closure of the lids, the blink function — all of these things are indicators. And then, of course, also talking to the patient and hearing what their symptoms are.

Dr. Hill


Advanced treatments, such as intense pulse-light therapy and radio-frequency gland expression that are done in the office can restore the health of tears.

The more severe, the more valuable these treatments are, but also, the earlier we can intervene the better outcomes we get. Young people with environmental exposure would benefit from advanced treatments at the start because it improves things on a cellular level in a way we can’t otherwise achieve. They rejuvenate the glands, activate the mitochondria, which are the powerhouses of the cells, and improve the underlying sources of inflammation. Unfortunately, they not covered by insurance right now. Otherwise, we use medicated drops, oral medications, and adjust environment, habits, and routines, all of which are valuable and important, only not always as effective.

Dr. Hill

In closing and for more information

Dry eye disease is one of the most common conditions that affect the eyes. It is estimated that 50 million Americans deal with it and primarily because of environmental issues that number is likely to rise. While dry eyes may sound simple, it is a complex and often poorly understood condition.

If you would like more information about dry eyes or dysfunctional tear syndrome, visit Eyecare Medical Group’s website.