Dry Eye Syndrome

Dry Eye Syndrome: Causes, Symptoms, and Treatment Options in San Antonio

Dry eye syndrome is one of the most common eye conditions in the United States, affecting an estimated 16 million Americans — and many more who have symptoms but have never received a formal diagnosis. Despite being widespread, dry eye is frequently undertreated, either because patients attribute their symptoms to allergies or aging, or because they don’t realize that effective medical treatment options exist.

At River City Eye Associates in San Antonio, Dr. Hager evaluates and manages dry eye as part of comprehensive ophthalmologic care, with a focus on identifying the underlying cause of each patient’s symptoms and developing an individualized treatment plan.

What Is Dry Eye Syndrome?

Dry eye syndrome — also called dry eye disease or keratoconjunctivitis sicca — occurs when the eye’s tear film is insufficient or unstable, resulting in inadequate lubrication of the ocular surface. A healthy tear film is not simply water; it is a complex three-layer structure consisting of an outer lipid (oil) layer, a middle aqueous (water) layer, and an inner mucin layer that adheres the tears to the eye surface. Disruption of any one of these layers can lead to dry eye symptoms.

There are two primary mechanisms of dry eye. Aqueous deficient dry eye occurs when the lacrimal glands produce insufficient tear volume. Evaporative dry eye — the more common form, accounting for the majority of cases — occurs when tears evaporate too quickly, most often due to dysfunction of the meibomian glands, the tiny oil-secreting glands along the eyelid margins. Many patients have a combination of both mechanisms.

Symptoms of Dry Eye

Dry eye symptoms are variable and can range from mildly annoying to significantly disruptive to daily life. Common symptoms include a persistent sensation of dryness, grittiness, or a foreign body sensation in one or both eyes; burning or stinging; redness; blurred vision that fluctuates or temporarily clears with blinking; light sensitivity; and eye fatigue, particularly with prolonged reading or screen use.

One of the most counterintuitive symptoms of dry eye is excessive tearing or watery eyes. This occurs because chronic ocular surface irritation triggers a reflex tearing response — the eye floods with watery tears in reaction to dryness, but these reflex tears lack the complex composition needed to properly lubricate the eye and provide only temporary relief.

Symptoms are often worse in low-humidity environments, in air conditioning or heat, during air travel, with prolonged screen use, and in windy conditions. Contact lens wearers are disproportionately affected, and dry eye is one of the most common reasons patients discontinue contact lens wear.

Risk Factors for Dry Eye

While dry eye can affect people of any age, certain factors increase the likelihood of developing the condition. These include age — the risk increases significantly after age 50 — female sex, particularly after menopause; autoimmune conditions such as Sjögren’s syndrome, rheumatoid arthritis, and lupus; thyroid disorders; a history of LASIK or other corneal refractive surgery; prolonged screen use; low-humidity environments; and use of certain medications including antihistamines, decongestants, antidepressants, blood pressure medications, and hormone therapy.

San Antonio’s climate — characterized by hot, dry summers, strong winds, and significant seasonal allergen burden — creates an environment that exacerbates dry eye symptoms for many residents.

Dry Eye Diagnosis and Evaluation

Dry eye evaluation at River City Eye Associates begins with a comprehensive history of symptoms, including their severity, duration, and relationship to environmental or activity-related triggers. Dr. Hager examines the ocular surface, tear film, and eyelid margins using slit lamp biomicroscopy to assess the quantity and quality of tear production, the health of the meibomian glands, and the degree of any ocular surface inflammation or staining.

Accurate diagnosis is important because dry eye treatment is most effective when it targets the specific underlying mechanism — and what works for aqueous deficient dry eye differs from what works for meibomian gland dysfunction-driven evaporative dry eye.

Treatment Options

Dry eye treatment is a spectrum, and the appropriate approach depends on the severity and type of disease. Mild dry eye is often managed effectively with over-the-counter artificial tear drops — preservative-free formulations are preferable for frequent use. Omega-3 fatty acid supplementation (high-quality fish oil or flaxseed oil) has meaningful evidence supporting its role in improving tear film stability and meibomian gland function over time.

For moderate to severe dry eye, prescription options include anti-inflammatory eye drops such as cyclosporine ophthalmic emulsion (Restasis) or lifitegrast (Xiidra), which target the underlying inflammatory component of chronic dry eye disease rather than simply supplementing tears. These medications typically require four to six weeks of consistent use before meaningful improvement is noted, and several months for full effect.

Meibomian gland dysfunction — the most common driver of evaporative dry eye — responds to eyelid hygiene measures including warm compresses, lid massage, and eyelid scrubs that help unclog the gland openings and restore normal oil flow. In-office procedures targeting the meibomian glands are available at some practices for patients who do not respond adequately to conservative measures.

Punctal plugs — tiny devices inserted into the tear drainage openings at the inner corner of the eyelids — can reduce tear drainage and increase the residence time of the natural tear film on the ocular surface, providing meaningful relief for patients with aqueous deficient dry eye.

When to See an Ophthalmologist for Dry Eye

Patients who have been managing dry eye symptoms with over-the-counter drops without adequate relief, those whose symptoms are interfering with work or daily activities, and those who experience blurred vision, light sensitivity, or recurrent eye redness should seek evaluation by an ophthalmologist. Untreated chronic dry eye can cause cumulative damage to the ocular surface and, in severe cases, affect vision quality.

At River City Eye Associates, dry eye evaluation is included as part of comprehensive eye care. To schedule an appointment with Dr. Aaron Hager at our San Antonio clinic, call 210-930-2015.