Decreased Tear Production
What Causes Decreased Tear Production?
Various factors can lower tear production, from natural aging to specific health issues and lifestyle habits. Understanding these causes can help you and your eye doctor identify why your eyes may feel dry and guide the most effective treatment plan.
As you get older, the lacrimal glands that produce your tears can shrink or work less efficiently, leading to fewer tears. This is a primary reason why decreased tear production is more common in people over 50, and women are often affected more than men due to hormonal changes that occur with menopause. The tear glands naturally lose some of their function over time, which means the amount and quality of tears can decline gradually as part of the aging process.
Certain health problems can damage tear glands and reduce tear flow significantly. Autoimmune diseases like Sjögren's syndrome, which specifically targets moisture-producing glands, and rheumatoid arthritis are common culprits. Other conditions that can affect tear production include diabetes, thyroid disorders such as hyperthyroidism and hypothyroidism, and inflammatory conditions like blepharitis or ocular rosacea. If you have been diagnosed with any of these conditions, your risk of developing dry eyes is higher, and regular monitoring is important.
Some common medicines, such as antihistamines, decongestants, certain antidepressants, beta-blockers for blood pressure, and some hormone replacement therapies, can lower tear production as a side effect. If you take any of these medications regularly, talk with your provider about alternatives if dry eyes become a concern. Additionally, environmental factors like dry air from heating or air conditioning, wind, smoke, and low humidity can cause tears to evaporate faster, leaving your eyes feeling dry and irritated even if you produce a normal amount of tears.
Hormone shifts that occur during menopause, pregnancy, or due to thyroid disorders can affect tear gland function and lead to less tear production. Because hormones help regulate the lacrimal and meibomian glands, any imbalance can disrupt the process and contribute to dryness. Many women notice their eyes becoming drier after menopause, and this connection is well-documented in medical research.
The oil glands in your eyelids, known as meibomian glands, produce the oily layer of your tear film that prevents evaporation. When these glands become blocked or produce poor-quality oil, the tear film becomes unstable and evaporates too quickly, causing a type of dry eye even if your tear quantity is normal. This condition, called meibomian gland dysfunction, is one of the most common contributors to dry eye symptoms and often requires specific treatments like warm compresses or specialized in-office procedures.
Additional causes of decreased tear production can include a range of issues that affect the eyes or the body's overall health. These factors may contribute to or worsen existing dryness.
- Previous eye surgeries such as LASIK or cataract surgery, which can temporarily disrupt corneal nerves that signal tear production
- Nerve damage affecting tear secretion, for example from facial nerve palsy or other neurological conditions
- A deficiency in Vitamin A, which is essential for maintaining a healthy eye surface and supporting tear production
- Chronic inflammation of the eyelids or the surface of the eye from conditions like chronic blepharitis
- Prolonged contact lens wear, which can reduce corneal sensitivity and disrupt the natural tear film
- Incomplete blinking, often caused by staring at screens, which prevents proper tear distribution across the eye
Symptoms of Decreased Tear Production
When your eyes do not produce enough tears, you may notice a range of uncomfortable signs that can interfere with your daily life. Recognizing these symptoms early can help you find relief faster and prevent further irritation or damage to the eye surface.
You might feel a gritty, sandy, or scratchy sensation in your eyes, as if something is stuck under your eyelid. Other common symptoms include redness, stinging, burning, or mild pain. Your vision may become blurry, especially when reading or using a computer for extended periods, and you may notice increased sensitivity to light and wind. Some people also experience heavy or tired eyelids, and mucus may collect in or around the eyes.
Dry eye symptoms can make everyday activities difficult and tiring, affecting your quality of life. You might find it hard to drive at night due to glare and blurred vision, work on a computer for long periods without discomfort, or wear contact lenses comfortably. Reading, watching television, and being outdoors in windy conditions can all become challenging when your eyes do not have enough moisture, leading to eye strain, headaches, and fatigue.
Sometimes, eyes respond to significant dryness by producing an excess of watery tears in an attempt to protect themselves. This reflex tearing is the body's way of trying to lubricate the eyes, but these tears lack the proper balance of water, oil, and mucus to provide lasting relief. As a result, your eyes may water excessively, especially in cold or windy weather, yet still feel dry and uncomfortable underneath.
If you experience sharp pain, constant eye redness that does not improve, thick discharge, vision that does not clear with blinking, or a feeling of something in your eye that will not go away, you should seek professional help promptly. These symptoms can indicate a more serious issue, such as an infection, corneal abrasion, or damage to the eye's surface that requires immediate attention to prevent complications.
How is Decreased Tear Production Diagnosed?
Our ophthalmologists at ReFocus Eye Health Cheshire use simple, painless tests and a review of your medical history to measure tear flow and check eye health. These quick evaluations help guide the most effective treatment plan tailored to your specific needs.
A basic eye exam using a slit lamp microscope allows your doctor to examine the surface of your eyes in detail and look for signs of dryness, inflammation, or damage. The slit lamp provides a magnified view of your cornea, conjunctiva, and eyelids, helping to identify dry spots, thinning of the tear film, or other abnormalities that may be contributing to your symptoms.
The Schirmer test is a common way to measure how much tears your eyes produce. During this test, a small strip of special filter paper is placed under your lower eyelid for about five minutes. The paper absorbs your tears, and the amount of moisture is then measured. A result of less than 10 millimeters is generally considered below normal and may indicate decreased tear production. This simple test helps your provider understand if you are making enough tears or if the problem lies elsewhere.
In addition to quantity, your tear quality and how long tears stay on your eye before evaporating are important factors. The Tear Film Breakup Time test measures how quickly your tears evaporate after a blink. Your doctor will place a small amount of harmless dye, usually fluorescein, in your eye and ask you to blink a few times. Using a blue light, they can then watch how long it takes for dry spots to appear on your cornea. A breakup time of less than 10 seconds usually indicates tear instability and suggests that your tears are evaporating too quickly.
Your provider may also examine the oil glands in your eyelids to see if they are blocked or not producing enough oil. By gently pressing on the eyelids and observing the quality and flow of the oils released, your doctor can determine if meibomian gland dysfunction is contributing to your dry eye. Advanced imaging techniques, such as meibography, can provide detailed pictures of your glands to assess their health and function.
Sharing details about your overall health, medications you take, and your daily work or home environment gives your provider important clues about the potential cause of your dry eyes. Information about your diet, screen time, contact lens use, and any systemic conditions like arthritis or diabetes helps ensure your diagnosis and treatment plan are comprehensive and address all contributing factors.
Treatment Options for Decreased Tear Production
Many effective treatments can boost tear production, add moisture, and protect your eyes from further dryness. At ReFocus Eye Health Cheshire, our ophthalmologists can recommend options ranging from simple home remedies to advanced medical procedures, all personalized to your specific condition.
Artificial tears are a safe and easy first step for mild dryness, providing temporary relief by supplementing your natural tears. Popular brands include Refresh, Systane, Blink, and TheraTears, and they come in different formulations for various types of dryness. Choosing preservative-free drops is recommended if you need to use them more than four times a day, as preservatives can irritate your eyes with frequent use. Some people also benefit from using thicker lubricating gels or ointments at bedtime to keep their eyes moist overnight.
For more persistent dryness, prescription medications can help reduce inflammation and increase your natural tear production. Eye drops like cyclosporine, sold under the brand name Restasis, work by calming inflammation in the tear glands, allowing them to produce more tears over time. Lifitegrast, known as Xiidra, targets a different inflammatory pathway to improve tear production and reduce symptoms. A nasal spray called varenicline, marketed as Tyrvaya, stimulates a nerve in your nose to signal your tear glands to produce more tears naturally. Newer options like Miebo, which contains perfluorohexyloctane, specifically target the oil layer of your tears to reduce evaporation. These medications may take several weeks to show their full effect, so patience and consistent use are important.
Small changes in your daily routine can make a big difference in managing dry eye symptoms. Using a humidifier in your home or office, especially during winter months, adds moisture to the air and helps slow tear evaporation. Taking frequent breaks from screens by following the 20-20-20 rule, which means looking at something 20 feet away for 20 seconds every 20 minutes, reduces eye strain and encourages more complete blinking. Applying warm compresses to your eyelids for 10 minutes once or twice a day can help unclog blocked meibomian glands and improve the quality of your tear film. Wearing wraparound sunglasses outdoors protects your eyes from wind and sun, and staying well-hydrated by drinking plenty of water supports overall tear production. Omega-3 fatty acid supplements, found in fish oil or flaxseed oil, may also help improve meibomian gland function.
For more severe or stubborn cases, your doctor may suggest advanced in-office treatments. Punctal plugs are tiny, painless devices inserted into the tear ducts in the corners of your eyelids to block drainage, which keeps tears on the surface of your eye longer and provides more lubrication. These can be temporary or permanent, depending on your needs. Intense Pulsed Light therapy, also known as IPL, uses gentle pulses of light to reduce inflammation around the eyelids and improve meibomian gland function, and it has shown excellent results for patients with meibomian gland dysfunction. Other treatments like TearCare or iLux apply controlled heat and pressure directly to the eyelids to melt blockages in the oil glands and restore healthy tear film. In the most severe cases, custom prosthetic contact lenses called scleral lenses can be fitted to vault over your cornea and create a fluid-filled reservoir that keeps your eye constantly moist. Autologous serum eye drops, made from your own blood, contain natural growth factors and proteins that promote healing and are used for very severe dry eye that does not respond to other treatments.
If an underlying medical condition like Sjögren's syndrome, rheumatoid arthritis, or thyroid disease is contributing to your dry eyes, working with your primary care doctor or specialist to manage that condition can significantly improve your eye symptoms. Sometimes adjusting medications that cause dryness or treating eyelid inflammation with antibiotics or steroid drops can also provide relief.
Preventing Decreased Tear Production
Adopting healthy eye habits can lower your risk of developing dry eyes and help keep your vision comfortable for years to come. Simple daily practices and awareness of triggers are key components of prevention, and they can make a real difference in maintaining your eye health.
Blink fully and frequently, especially when using a screen, to spread tears evenly across your eyes and prevent them from drying out. Many people blink less often or incompletely when concentrating on digital devices, which leads to faster tear evaporation. Make a conscious effort to blink more, and follow the 20-20-20 rule to give your eyes regular breaks. Staying well-hydrated by drinking enough water throughout the day also supports overall tear production and keeps your body's moisture levels balanced.
Eating a balanced diet rich in nutrients can support your eye health and improve tear quality. Incorporate foods high in omega-3 fatty acids like salmon, mackerel, sardines, walnuts, and flaxseeds to improve meibomian gland function and reduce inflammation. Also include leafy greens such as spinach and kale, colorful vegetables, and eggs for vitamins A, C, D, and E, which support the health of the ocular surface and tear production. Some people find that taking a daily omega-3 supplement helps reduce their dry eye symptoms over time.
Protect your eyes from environmental irritants that can worsen dryness. Try to limit exposure to smoke, dust, pollen, and dry, windy conditions whenever possible. Using a high-quality air purifier indoors can help remove allergens and irritants from the air. Choosing hypoallergenic makeup and removing it gently each night can also help reduce irritation around the eyes. If you use contact lenses, consider switching to daily disposable lenses or lenses specifically designed for dry eyes, and always follow proper hygiene practices.
Seeing an eye care provider for yearly comprehensive eye exams is crucial for catching early signs of dryness before they become severe. Whether you are located in Cheshire, Southington, Wallingford, or anywhere in the Greater New Haven area, regular check-ups allow for timely intervention and help you maintain healthy, comfortable tear production. Early detection and treatment can prevent complications and keep your eyes feeling their best.
Frequently Asked Questions
Here are some common questions about decreased tear production to help you understand and manage this condition with confidence.
Decreased tear production is one of the main causes of dry eye syndrome, but it is not the only one. Dry eye can also happen if your tears evaporate too quickly due to poor tear quality, especially when the oil layer is insufficient. Both types of dry eye cause similar symptoms like dryness, irritation, and blurred vision, and an accurate diagnosis is key to targeting the right treatment for your specific situation.
Over-the-counter artificial tears offer immediate, temporary relief that lasts a few hours, while prescription treatments like Restasis or Xiidra may take several weeks to a few months for their full effect to be felt as they work to reduce inflammation and restore natural tear production. Lifestyle changes like using a humidifier or taking omega-3 supplements can begin to help within a few days to weeks. In-office procedures like punctal plugs provide relief almost immediately, while treatments like IPL may require a series of sessions over several weeks.
Yes. Staring at digital screens, whether computers, tablets, or smartphones, significantly reduces your blink rate, sometimes by as much as 50 percent or more. This means tears are not spread evenly across your eye surface, which speeds up tear evaporation and can worsen dry eye symptoms. Taking regular breaks, consciously blinking more often, and positioning your screen slightly below eye level can help mitigate this effect and keep your eyes more comfortable.
Preservative-free artificial tears are recommended if you need to use drops more than four times a day or if you have sensitive eyes or allergies. Preservatives like benzalkonium chloride can cause irritation, redness, and even damage to the eye surface with frequent use, so preservative-free options are safer and more comfortable for long-term management. They typically come in single-use vials to maintain sterility without the need for preservatives.
Yes, refractive surgeries like LASIK, PRK, and even cataract surgery can temporarily disrupt the corneal nerves that signal tear production, often leading to temporary dryness that can last several weeks to a few months. For most patients, this resolves on its own as the nerves heal, but some may require ongoing dry eye management with artificial tears or other treatments. Your surgeon will typically screen for dry eye before surgery and provide preventive treatments if needed.
Meibomian gland dysfunction, or MGD, occurs when the oil glands in your eyelids become blocked or produce poor-quality oil. This oil is essential for forming the outer layer of your tear film, which prevents tears from evaporating too quickly. MGD is a leading cause of evaporative dry eye, even when your tear quantity is normal. It is often treated with warm compresses, lid hygiene, omega-3 supplements, and in-office procedures like IPL or meibomian gland expression to restore proper gland function.
Contact lenses can absorb natural tears from your eye surface and disrupt the tear film, which can worsen dryness and discomfort. Some lens materials are more breathable and retain less water than others, making them better for people with dry eyes. If you have dry eyes, your provider may recommend daily disposable lenses, special lenses designed for dry eye sufferers, or scleral lenses that vault over the cornea and create a fluid reservoir to keep your eyes moist all day.
Staying properly hydrated is important for all bodily functions, including producing tears. While drinking more water alone may not resolve chronic dry eye, dehydration can certainly worsen symptoms and reduce your overall tear volume, so maintaining adequate fluid intake throughout the day is beneficial. Aim for at least eight glasses of water daily, and more if you are active or in a dry environment.
Allergies cause inflammation that can disrupt tear gland function and worsen dry eye symptoms by making your eyes red, itchy, and irritated. Antihistamines used to treat allergies, whether taken orally or as eye drops, can also have a drying effect on the eyes. Managing allergies effectively with appropriate treatments, avoiding allergens when possible, and using preservative-free artificial tears can help improve eye comfort during allergy season.
You should seek immediate medical attention if you experience sudden severe eye pain, significant vision loss that does not improve, a thick or colored discharge from your eyes, or extreme redness with swelling. These could be signs of a serious infection, corneal ulcer, or corneal damage that requires prompt treatment to prevent permanent vision loss. If you have any concerns about your symptoms, it is always better to err on the side of caution and contact your eye care provider.
Taking Care of Your Eyes at ReFocus Eye Health Cheshire
With the right care and treatment, most causes of decreased tear production can be managed effectively, allowing you to enjoy clear and comfortable vision every day. Our ophthalmologists are here to provide personalized care and help you find the best solutions for your unique needs, so you can get back to doing the things you love without the frustration of dry, irritated eyes.
Efficient care. All my questions answered completely. Friendly staff. Thorough exam by my Ophthalmologist.
Rie Cohen
A smooth visit from check-in to check-out. The staff was very pleasant and Dr Swan is a phenomenal physician. One of Connecticut’s best!
Gerorge Merriam
The entire process was efficient, professional and friendly. The facility was welcoming and very clean. Not sure what else you can ask for!
Roman J. Zaharko
This was my first time at this office of Refocus. It was a good experience. Dr. Oropesa did my exam after Jose did the prep exam. Both were very professional. I would recommend this office.
Nan Tussing
Quickest I have ever been in and out of an eye appointment and everyone was very friendly! Dr. Swan is the best!!
Diana Rogers
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