How Stress Can Worsen Dry Eye, and 6 Tips for Coping

“Stress can worsen dry eye in several ways,” says Catherine Heyman, OD, the founding dean and an associate professor at the school of optometry at High Point University in North Carolina. “It can influence inflammation, tear production, pain sensitivity, sleep, and daily habits,” she says.

How Does Stress Affect Dry Eye Symptoms?

During stressful periods, people tend to spend more time on screens, blink less often, sleep worse, and become less consistent with their usual dry-eye treatment, Dr. Heyman says. That can make symptoms even more noticeable.

“The relationship can become cyclical; stress worsens dry eye, and persistent eye discomfort creates additional stress,” she says.

Inflammation is one of the main mechanisms connecting stress and dry eye symptoms, Heyman says. “Inflammation is a central component of many forms of dry-eye disease,” she says. When the tear film becomes unstable, it can irritate and damage the ocular surface, triggering an inflammatory response, says Heyman.

“Additionally, chronic stress can affect the immune and nervous systems in ways that amplify inflammation or make it harder for the eye’s surface to return to a healthy, stable state,” she says. Stress is rarely the sole cause of dry eye, but it can intensify an inflammatory cycle that’s already underway, adds Heyman.

“Stress can also change how intensely dry eye discomfort is felt because it can change the way the nervous system processes discomfort, making burning, stinging, grittiness, light sensitivity, or eye pain feel more intense,” she says.

That doesn’t mean the symptoms are imagined: The ocular surface and the nervous system are closely connected, and both can shape how dry eye feels day to day, says Heyman.

Hormones play a role, too. “There’s been a lot of research done on this, and more recently we’ve learned that some of the hormones that go up with stress can make dry eye worse,” says Beth Friedland, MD, an emeritus professor of research and an adjunct clinical professor in the department of ophthalmology at the University of North Carolina School of Medicine in Chapel Hill.

“Cortisol, for example, is a hormone we need to keep our daily rhythms in tune, and it can be affected by stress, which in turn can make dry eye worse,” she says.

Sleep is part of the equation as well, says Dr. Friedland. “We do know that there is a correlation between poor sleep and worsening dry eye syndrome,” she says.

Dry Eye and Stress: 6 Tips for Coping

Small changes in your habits and environment can ease bothersome dry eye symptoms. Here are six expert-backed ways to interrupt the dry eye–stress cycle.

1. Make Sure You’re Following Your Dry-Eye Care Routine

When stress throws off your usual dry eye treatment habits, getting back to the basics is the first step, Heyman says. “Use preservative-free artificial tears as directed, take regular screen breaks, practice complete blinking, stay hydrated, prioritize sleep, and continue any recommended warm compresses and eyelid hygiene,” she says.

2. Watch Your Screen Time During Stressful Stretches

Screen time is a common link between stress and dry eye, Friedland says. “One of the biggest examples is computer and digital activity, computer and phone, and things like that,” she says. “Because we’re staring at screens, we don’t blink as often, and that can worsen dry eye. And depending on what someone is doing on the computer, that can also be related to stress, so you have a vicious cycle going on there.”

People also tend to reach for screens more often during stressful periods, Heyman says. That’s all the more reason to keep up with the screen breaks and complete-blinking tactics outlined above during such stretches.

3. Protect Your Eyes From Dry, Moving Air

Small environmental changes can also make a difference, Heyman says. “It may help to limit [eye exposure to] direct airflow, use a humidifier when appropriate, and reduce contact-lens wear during a flare-up,” she says.

Everyday conditions matter, too, says Friedland. “Low humidity can affect dry eye, and a lot of people complain of it during dry spells, between the heat and the lack of moisture in the air, especially if they’re indoors a lot in an air-conditioned environment that [also] doesn’t have enough humidity,” she says.

4. Support Your Sleep and Keep Up Your Hydration

Since poor sleep and dry eye can feed off each other, a few habits can help on both fronts, Friedland says. “Make sure that [you] are well hydrated and have good electrolyte balance,” she says. Getting enough omega-3 fatty acids, through food or a supplement, can also help with dry eye and may help with sleep as well, she says.

The nighttime airflow you’re exposed to is worth a look too, Heyman says. “Airflow from a fan, heating or air-conditioning vents, sleeping with the eyelids partially open, and leakage from a CPAP mask may increase overnight tear evaporation,” she says.

5. Prioritize Stress Relief

Direct stress management may also help, Heyman says. “Stress-management strategies such as exercise, brief relaxation exercises, mindfulness, and protecting time for sleep may complement dry-eye treatment, but they should not replace medical care,” she says.

6. Track Your Patterns, and Know When to Call Your Doctor

Pay attention to timing to identify what’s driving a flare, Heyman says. “Symptoms may worsen during demanding work periods, major life changes, travel, illness, poor sleep, or other stressful situations, and then improve when the stress subsides,” she says. Keeping a brief symptom diary can help you spot those connections, she says.

“Patients should never stop or change a prescribed medication on their own,” Heyman says. If a new medication for anxiety, depression, or sleep seems to coincide with worsening symptoms, she says, it’s worth mentioning that to both the prescribing provider and an eye doctor. It’s often possible for them to adjust your dry-eye treatment plan without disrupting an important mental health medication.

“If symptoms are persistent, recurrent, or interfering with work, sleep, or daily activities, an eye care professional can evaluate the underlying causes and recommend more advanced treatment,” she says, which may include prescription anti-inflammatory drops, therapies for the eyelids’ oil glands, or other specialty procedures.