Dry eye is common, but it’s not simple. Dry eye is a complex, multifactorial disease in which inflammation, imbalances, and loss of regulation of the components of the tear film (oily layer, gel-like mucin layer and watery aqueous layer) and neuro-sensory issues contribute to the symptoms with dry eye (feelings of dryness, grittiness, fluctuating vision and poorer quality vision). Like with any health condition, patients experiencing dry eye often want to understand why this is happening—especially when nothing in their overall health or routine seems to have changed. For years, I’ve explained that “dryness leads to inflammation on the surface of the eye, and inflammation worsens dryness—so we have to break the cycle.” In fact, many of our prescription treatments for dry eye specifically target inflammation. But understandably, when patients hear “inflammation,” they want to know what’s actually causing it. Interestingly, dry eye may be more than a local eye problem—it can be a signal of low-grade, systemic inflammation tied to broader health patterns.

 

Is my diet contributing to my dry eye?

Maybe. Patients with metabolic syndrome—a cluster of conditions including central obesity, insulin resistance, and elevated cholesterol—also tend to have increased levels of circulating inflammatory markers. This chronic inflammation can impair the lacrimal gland (which produces the watery, aqueous part of the tear film) and the meibomian glands (which secrete the oily layer of the tear film). But a person doesn’t need to be diagnosed with metabolic syndrome to experience low-grade systemic inflammation related to their food choices. Diets high in refined carbohydrates (think white flour and processed sugar) and saturated fats (like butter, cheese, red meat, and full-fat dairy) have also been linked to increased inflammation. 

There is also evidence that diets rich in fiber and vitamins A, C, and E are associated with a lower incidence of dry eye. Vitamin A from carrots has long been linked to eye health, but polyphenols—plant compounds abundant in colorful fruits and vegetables—also have anti-inflammatory and antioxidant effects. In the 2010s, the eye care world embraced omega-3 supplements for dry eye, based on studies showing that diets higher in omega-3s were associated with less severe dry eye disease than those high in omega-6. You don’t necessarily need supplements to improve your omega-3 to omega-6 ratio. Foods like fatty fish, flaxseed, chia seeds, walnuts, and canola oil tip the balance toward omega-3s, while processed and packaged foods, fried foods, and oils like corn, soybean, sunflower, and safflower push it toward omega-6s. To date, no studies have directly compared whether changing your diet or taking supplements is more effective.

If you do choose to take an omega-3 supplement for dry eye, look for one that provides long-chain omega-3s (EPA and DHA) in the re-esterified triglyceride (rTG) form. In clinical studies, PRN De3 Dry Eye Omega Benefits® was used. Additional brands that meet similar quality criteria (as of this writing) include Nordic Naturals Ultimate Omega® and MacuHealth TG Omega-3®. Others exist—just make sure your supplement is third-party tested for purity and potency.

To sum up: your diet may be contributing to your dry eye. But dietary recommendations are rarely black and white. For example, the American Heart Association recommends using the oils noted above associated with a poor omega 6:omega 3 ratio — corn, soybean, sunflower, and safflower oils — in place of saturated fats and considers them cardioprotective. The field of nutritional medicine is complex and rapidly evolving—and undoubtedly, we’re still learning.

Reasonable Food Choices to Help Dry Eyes:

• Reduce or eliminate white flour and refined sugars

• Limit processed & packaged foods

• Increase intake of healthy fats from fatty fish, olive and canola oil, avocados, flaxseeds, chia seeds and walnuts

• Include and abundance of leafy greens and colorful vegetables in your meals, and choose whole fruits

Are restless nights contributing to my dry eye?

Yes. Sleep deprivation can reduce secretion of the aqueous (watery) component of tears, cause tears to break up more quickly, and increase tear osmolarity (saltiness), which can irritate the eye surface and trigger inflammation. Aim for 7–9 hours of sleep each night. If you have unexplained daytime sleepiness (e.g. you are getting your 8 hours, but you’re still feeling the urge to nap during the day), please talk to your primary care provider. Sleep apnea is linked not only to both poor sleep and dry eye, but also poor quality of life, increased risk of car accidents, heart disease and strokes.

To improve sleep quality (and support ocular surface health), try the following:

• Avoid screens for at least 1–2 hours before bed

• Keep your bedroom cool, dark, and quiet—cool temperatures have been shown to improve sleep quality

• Avoid caffeine and alcohol in the evening

• Stick to a consistent sleep-wake schedule, even on weekends

• Consider using a humidifier, and try to avoid air-conditioning or forced-air heating, which can dry out the eyes overnight

Gee, thanks Dr. Dale… But can I just put in some artificial tears?

Sure—but let’s not stop there. A lot of what I’ve shared may not sound groundbreaking. We all know we should eat more leafy greens, cut back on sugar, and get enough rest. But I think it helps to reframe how we think about dry eye. It’s not just a local eye problem—it can be a signal of your body’s overall health. Sometimes it’s an early warning from a high-screen, low-sleep lifestyle; other times, it’s tied to more complex metabolic or autoimmune conditions.
I’ve been on my own journey to make healthier choices, and I’ll be the first to admit—it’s not always easy or consistent to do the “right” thing (or even to figure out what the right thing is, especially when it comes to nutrition). But I’ve seen how these lifestyle changes affect not just dry eye, but also conditions like glaucoma, macular degeneration, and diabetic eye disease.
Dry eye is usually a chronic, progressive condition. But our bodies have a remarkable capacity to heal. So yes—use the artificial tears. But also take a moment to notice what else might be triggering the need for them. Supporting your eyes may start with your tear drops—but it doesn’t have to end there.

If you’re dealing with dry eyes, schedule an appointment with one of our doctors. We’ll assess your overall eye health and discuss advanced treatment options that go beyond artificial tears and lifestyle changes—so you can get lasting relief and protect your long-term vision.