When you start experiencing dry eye symptoms—that classic dryness, itchiness, stinging, and redness—it's understandable that you'd assume it's your tears that are to blame. But it might be more complicated than that. In some cases, dry eye issues could actually be stemming from seemingly unrelated eyelid conditions.
Here's why it actually makes sense.
Your eyelids help keep your eyes lubricated in a few important ways.
There are two major ways that your eyelids help keep your eyes lubricated, Lora Glass, M.D., assistant professor of ophthalmology and director of Medical Student Education in ophthalmology at Columbia University Irving Medical Center, tells SELF. "One is to coat the eye," she says, which is accomplished via blinking. When you blink, the eyelid actually spreads tears across the eye and directs the solution into small holes called puncta that essentially drain away excess liquid.
The other way eyelids help is with the actual production of your tears, Dr. Glass says, which are protected by a three-layer film. "Tear film is not one thing, it's a multilayered entity and the eyelid helps produce some of the layers," she says. In particular, the meibomian glands (which sit right at the eyelid margins) are responsible for producing a complex layer of lipids (fats) that helps prevent your tears from evaporating too quickly.
If there's an issue with either one of those processes, you might experience dry eye.
When there's an issue with the eyelid, it's not uncommon to also have dry eye symptoms.
Anatomical issues can affect the eyelid's ability to distribute tears and leave parts of the eyeball exposed and vulnerable to evaporation, Dr. Glass explains. Those issues might include some sort of congenital defect, which is "extraordinarily rare," Dr. Glass says. More commonly, people notice that the skin of their lower eyelids becomes a bit looser and may droop naturally as they age.
They might also notice that their upper and lower eyelids don't meet as closely as they used to thanks to cosmetic surgery in the area or certain autoimmune conditions, such as thyroid eye disease, which may cause the eyes to bulge, or Sjogrens disease, which often affects the moisturizing glands in your eyes.
Aside from anatomical issues, any inflammation or clogging of the meibomian glands can prevent the production of that lipid layer in the tear film, Dr. Glass says. That, in turn, causes the tear film to dry out more quickly than it would otherwise, resulting in dry, irritated eyes. So, if you're someone who is prone to blepharitis or styes, for instance, it wouldn't be surprising for you to also have dry eyes.
If your eyelid issue is actually responsible for your dry eyes, that could have an impact on your treatment plan.
There are a few telltale signs that your eyelids are at the root of your dry eye issues. According to Dr. Glass, you might notice:
- Your eyelids look different to you. Maybe your lower lids are a bit droopier, for instance.
- You can see more of the white of your eyes than you used to.
- You tend to experience blepharitis, styes, or other eye inflammation frequently.
- You don't close your eyes all the way when you sleep (this is often caught by a partner, Dr. Glass says).
Experiencing any of these symptoms—especially if you also have dry eye symptoms—is a reason to check in with your eye doctor, Dr. Glass says. If your eyelid does end up being to blame for your dry eye issues, your doctor may be able to more effectively treat both conditions by targeting the eyelid first.
But the exact treatment plan depends on the specific issue you're dealing with. If it's down to blepharitis, for example, you might be instructed to regularly use warm compresses to help heat up the clogged lipids. "The oil should look like olive oil sitting on the counter—a little bit yellow, very see-through," Dr. Glass says. "But if it gets clogged up it looks white and hard, like olive oil in the fridge." So, warming it up consistently should help melt the oil back to its normal consistency. There are also a variety of over-the-counter options you can try to get rid of any crustiness that could be clogging things up and prescription medications to treat inflammation, she says.
However, if your issue is more anatomical and related to aging or previous surgery, lubricating medicines or a surgical procedure may be required to correct it, depending on the severity of your symptoms.
In the case of an autoimmune condition, treating the underlying condition may gradually help the eye issues without other treatment, Dr. Glass says. When it comes to thyroid eye disease, for instance, "there’s a period of worsening and then there's a period of improvement," she says. "An eyelid that might be really retracted or really high might get closer to or even normalized over the course of a year or two." Then you can start using lubricating methods or other treatments to stabilize your symptoms before deciding if surgery is necessary.
Above all, it's important to check in with your doctor if you're dealing with any persistent eye issues—even if the underlying cause isn't obvious.