I'm in my 20s and I have dry eye and it has significantly affected my life. I wish I had known about it when I was younger.

Some background: eyes are lubricated by the tear firm which consists of three layers: inner mucous layer, an aqueous solution layer, and an outer lipid layer (meibum). The mucous layer is the thinnest and keeps the tear film to your eye. The aqueous solution is released from the lacrimal gland and makes up the bulk of the tear film. Meibum is secreted from meibomian glands in the eyelids every time you blink and keeps the tear film from evaporating. With a healthy tear film you should be able to keep your eyes open for at least 30 seconds before you start feeling a burning sensation. If you don't have a stable tear film you will start to feel a burning sensation much sooner and this is what is known as "dry eye". Dry eye and can be caused by a deficiency in any of the three layers and is usually categorized into two main categories: aqueous-deficient dry eye and evaporate dry eye. Aqueous-deficiency dry eye is usually caused by systemic diseases such as autoimmune diseases (e.g. rosacea, lupus, Sjogren's syndrome) that prevent the lacrimal gland from producing tears and from the statistics that I've seen this accounts for about 20% of dry eye cases. Evaporate dry eye is caused by a deficient lipid layer which is usually caused by meibomian gland dysfunction and accounts for the majority of dry eye cases.

There's not a lot known about what causes meibomian glands to malfunction but some theories are that: inflammation causes them to get blocked, autoimmune diseases attack the tissues, hormone imbalance causes deficient secretions, harsh environments cause inflammation which causes them to get blocked, and contact lenses interferes with blinking rates and the mechanics of blinking. Once meibomian gland dysfunction starts, it often starts a vicious cycle which causes inflammation which causes more blockages which causes more inflammation. Blockage of the meibomian glands eventually (think several years) leads to meibomian gland atrophy where the glands start shriveling up and die, starting from the back. Healthy glands are normally about 10 mm long but over time they will become truncated and eventually completely atrophy (known as "gland drop out"). This process is also seen to a lesser degree in elderly people, and especially postmenopausal women.

I started wearing contact lenses when I was a young teenager, and also as a young teenager, I spend an unhealthy amount of time staring at computer screens. A few years later my contact lenses started to become uncomfortable and I switched contact lens brands and cleaning solutions and I was able to continue wearing them for another couple of years. Eventually it got to the point where I couldn't tolerate wearing them because they were just too uncomfortable. I figured this was normal because lots of people complain about their contact lens comfort, and I attributed it to living in a dry climate and spending lots of time on the computer. But then, even with wearing glasses I started noticing that my eyes were uncomfortable. I started waking up with red, gritty eyes. I went to my optometrist and told him about this and he simply gave me some eye drops and told me to put them in before bed and whenever I felt dry eyes. But over the years problem only got worse. I had to constantly blink, and my eyes were always bloodshot. This is when I started to seriously investigate dry eyes.

I went to an optometrist seeking for help who told me about some things I could try such as warm compresses (which I was already doing) and blinking exercises. I also went to an ophthalmologist who basically told me that lots of people have dry eye and bluntly told me "I deal with people who are about to lose their eyesight, and you are not going to lose your eyesight because of this" and prescribed me a short course of corticosteroid drops. I saw a couple more optometrists who were of no help, before I decided to seek a dry eye specialist in another city, who looked at my meibomian glands and confirmed what I feared the worst: my meibomian glands were in very bad health. I was only in my 20s, and my meibomian glands had already truncated to about 25% of their original length. (You can see how healthy glands are supposed to look compared to unhealthy, truncated glands: http://www.clemsoneye.com/Portals/0/meibomian_glands.png)

I found a supportive optometrist in my city who is sympathetic and willing to try different treatments with me. So far I have tried the following:

* Lubricating eye drops: I take preservative-free drops every day but they only offer limited short term relief. I've also tried lubricating gels but I find that they clog my glands even more and cause more discomfort. I only use them in emergencies when I'm willing to trade off short term comfort for more misery (they will unbalance up my tear film for several days).

* Warm compresses: Applies heat to your eyelids to unclog the glands. I do this once every few days but if I do it any more I will end up with more inflammation which makes my symptoms worse.

* Corticosteroids: They do seem to reduce inflammation but doctors won't prescribe these for more than a few weeks at a time because they cause high intraocular pressure.

* Tetracycline antiobiotics: Low dose tetracycline antibiotics (usually doxycycline, minocycline) are taken off-label to reduce inflammation. I've been taking these on and off for months at a time for the last 5 years. I believe it helps my comfort but my optometrist warns me to not stay on long term, but I will continue taking these for the rest of my life because at this point I don't care if long-term antiboitic use destroys my kidneys and liver.

* Restasis: An eyedrop that helps primary for aqueous-deficient dry eye. I've been on this for a while as well and I will continue to take it even thought I don't think it helps much. It's normally very expensive but luckily my insurance covers it.

* Lipiflow: A treatment where a machine places a cup on your eyeball and applies heat and massages the inside of your eyelids. I spent $1500 out of pocket on this and it was just as effective as my next item.

* Manual expressions: Using forceps my optometrist squeezes my eyelids to force meibum out of my glands to keep it from clogging and stagnating. This helps short term, but it can only be done so frequently because it can cause long-term tissue damage. I purchased my own forceps and (probably to the horror of my optometrist, I never told him) I do this myself.

* Controlling environment: Having a humidifier helps me a lot and I keep the relative humidity above 80%. Being in a dry environment such as airplanes is very uncomfortable and whacks my tear film out of balance for days.

* Moisture chambers: Essentially, these are air-tight goggles that prevent moisture from evaporating from your eyes. They do help but I hate having to wear them and I don't wear them in public, but I will probably have to eventually.

* Eye exercises: I consciously blink hard several times, every 30 minutes. It helps a bit.

Overall, my symptoms have only marginally improved. My life has become miserable because of this and my social life and professional life have suffered. I don't enjoy going out anymore because I hate being in dry environments where it causes my symptoms to get worse. Just being in a dry environment for a couple hours will disrupt my tear film for days after. It has caused me depression and I considered ending my life at one point.

There is a lot unknown about this disease. Nobody can tell me why my glands got into such bad shape, but I believe wearing contact lenses and using the computer, and having bad blinking hygiene contributed a lot to it and I see that even most optometrists have been clueless and are only now learning about dry eye because of its increasing prevalence. Because it's not understood well, there's not much support for sufferers of dry eyes. The immediate reaction of optometrists upon hearing a complaint about dry eye is "here, try this brand of sample drops that they sent to my clinic". Insurance doesn't cover treatments and I've incurred thousands of dollars in out-of-pocket expenses, and had to take significant time off from work to seek specialists and treatments.

Looking back, here's what I wish I had done:

* Not wear contact lenses, especially when on the computer for 12+ hours a day

* Blink regularly and consciously when using a computer

* Investigated sooner about dry eye when I started experiencing symptoms (it is not normal to have dry eye)

* Spend more time outside

Perhaps how previous generations were taught about oral hygiene and the importance of brushing teeth, future generations will be taught about ocular hygiene and the importance of blinking exercises and health of eyelids.