One of the most common questions I get from patients is why do my eyes burn? This comes from people of all ages and walks of life, however; I do notice that with increased age and screen time, it is a more common concern. There are 5 main reasons that this occurs.
Dry Eye
When I initially tell patients this is a sign of dry eye, their response is that their eyes are not dry. In fact they water all the time. I then explain that dry eye is a misnomer. Dry eye describes symptoms, your eyes are not actually dry. Most dry eyes are a result of a lack of oil production from your eyelids. This causes an unstable tear film and “evaporative” dry eye. This leads to symptoms of your eyes burn, needing to blink to make things clear, or watery eyes among other things.
Why does this lead to burning? The simple answer is the tear film is a protective barrier for your eye. When it is unstable, your eyes are exposed to the environment and wind, dust, and debris can irritate the eyes. If not addressed over time the cornea becomes compromised (much like your hands when you wash them constantly in the winter) and this leads me to my next point.
Preservatives
Once the cornea is compromised, we often try to use drops to help. If the cornea has been compromised due to an unstable tear film, the drops are going to burn when they initially go in because they have preservatives in them. This is akin to having your hand burn when you initially put lotion on or when you use hand sanitizer.
If your tear film is normal, but you have to use other prescription eye drops, ointment, or are using artificial tears, the preservatives in these can also cause burning to a normal healthy eye. Each drop has its own concentration and type of preservative. We need to be aware of what is in the things we put in or near our eyes.
Screen time
Another cause of burning is excess screen time. When we are on screens, we tend to stare. This causes our blink rate to be cut in half and when we do blink, it is a half blink. This leads to meibomian gland dysfunction and, you guessed it, an unstable tear film and evaporative dry eye.
Think about it, when we spend a lot of time on screens we tend to have to blink frequently to clear up our vision. Additionally, how often do we sit back in our chairs and rub our eyes? We are essentially trying to get our eyelids to secrete the oil layer of the tear film.
I always recommend blink breaks and using the 20-20-20 rule. That is every 20 minutes take 20 seconds and look 20 feet away.
CPAP / Incomplete lid closure / Night time issues
If you find that your symptoms or the burning tends to be worse in the morning. I would say that there is a good chance your eyes are being exposed to the environment during sleep. This can be from numerous things including but not limited to: a ceiling fan blowing on your eyes, an incomplete eyelid closure, or possibly the use of a CPAP machine that is blowing air into your eyes as you sleep.
All of these will build over time and make your symptoms worse. Patients often state that vision is blurry when they wake up, but tends to improve over the course of the day. If anyone has ever told you that you sleep with your eyes open, your fan blows directly on your face, or you use a CPAP, I would recommend applying a thicker gel or ointment before going to sleep.
Allergy / UV Exposure
For all of you outdoor adventure warriors allergy and UV exposure can make your eyes burn. Allergies will often be associated with itching and watery eyes. Puffiness and redness will also enter the picture and a good antihistamine and mast cell stabilizing drop will help you relieve yourself of your symptoms.
In addition to allergies, sun exposure can cause UV keratitis or essentially sunburn to your eyes. This usually has a delayed onset of 6 to 12 hours from being outside. I often see this in people who spend the weekend on water or outdoors skiing or snowboarding.
BONUS: Makeup
You guessed it, wearing it can enhance our natural beauty, but if you are using the wrong type, applying it in the wrong places, or not properly removing it, your eyes are not going to be happy with you. The biggest culprit in regards to makeup is eyeliner on the waterline or excess mascara that is not properly removed. The makeup itself is irritating to the eyes. And, if you are using the wrong type it is loaded with preservatives and eye irritants. This can lead to red irritated eyes and eyelids and you guessed it, making your eyes burn!
Dry Eye Evaluation
There you have it my friends, the 5 (plus a bonus) most common reasons your eyes are burning. If you read the list, you may realize that 1 or more apply to you. The more boxes you check the worse your eyes are going to feel. I have a plethora of tips and tricks to help resolve these issues, but we will save that for another article. In the meantime, if you feel you want a more precise diagnosis, I always recommend getting a dry eye evaluation (click here to schedule) and we can customize a therapy for you and your eyes.