Dry eye disease (aka keratoconjunctivitis sicca) is a multifactorial disease characterized by a tear film lacking enough water (aqueous deficient dry eye disease) or lacking the ability to prevent evaporation of the tears (evaporative dry eye disease), or a combination of the two (mixed dry eye disease). Dry eye disease consists of two vicious cycles, one of which is within the other. The outer cycle consists of tear instability, which results in tear hyperosmolarity (too much salt in the tears relative to the amount of water). This hyperosmolarity results in corneal and conjunctival cell death, causing inflammation. The inflammation exacerbates tear instability, causing the cycle to spiral downward. Though the cycle can begin at any step in this process, all of these elements contribute to dry eye symptoms. Within the cycle of dry eye disease is the cycle of meibomian gland dysfunction (MGD). Tear film instability causes changes in the natural flora which populate the meibomian glands, resulting in the release of toxins. These toxins cause the eyelids to become enflamed, which in turn causes the lipid composition of the tear film to change- furthering instability of the tear film. Thus, dry eye disease and meibomian gland dysfunction tend to go hand-in-hand. Patients with dry eye disease may experience several potential symptoms, including burning, foreign body sensation, redness, a gritty or sandy sensation, excess tearing, light sensitivity, blurred or fluctuating vision, and intolerance of contact lenses. Although the cycle of dry eye disease remains the same, there are numerous potential causes of the condition. Meibomian gland dysfunction, as discussed above, is a leading cause. Underlying medical conditions such as Sjögren’s disease, lupus erythematosus, rheumatoid arthritis, thyroid disease, and more can cause or exacerbate dry eye disease. Environmental factors such as exposure to excess wind, A/C, fans, prolonged use of a computer or other electronic device, use of harmful skin products, and dry air may exacerbate dry eye disease. Mechanical factors such as incomplete blink, nocturnal lagophthalmos (incomplete closure of the lids during sleep), and exophthalmos (protruding eyes) can cause dry eye disease. Certain medications including antihistamines, antidepressants, hormone replacement therapy, hypertension drugs, and more may lead to dry eye disease. As we age, our chance of developing dry eye disease increases - in fact dry eyes are a common symptom of menopause. It is important to determine the cause of your dry eye in order to treat the root cause, not just the symptoms. Luckily, there are a wide range of dry eye treatments available, including lid hygiene, nutraceuticals (Omega 3 fish oil), artificial tears, ointment, intense pulsed light therapy (IPL), Lipiflow pulsating thermal treatment, Bruder eye mask heat treatment, manual expression of meibomian glands, radiofrequency (RF) with or without microneedling, punctal occlusion (punctal plugs or Lacrifill), prescription eye drops (Cequa, Restasis, Xiidra, steroids, among others), oral medications, nasal medications (Tyrvaya), and diet modification. Your doctor will work with you to determine the best treatment option available for your specific needs.