Dry Eye Prevention and Recognizing Risk Factors: Shahzad Mian, MD

Dry eye disease affects an estimated 5% to 8% of the population, with risk climbing significantly after age 65, yet the condition remains widely misunderstood and often goes unrecognized, according to Shahzad Mian, MD, chair of the Department of Ophthalmology and Visual Sciences at the University of Michigan Medical School and director of the W.K. Kellogg Eye Center. Dry Eye Awareness Month, observed each July, aims to help close that gap.

This raises the question of what dry eye disease is and how it affects patients’ vision and what they can do to address this condition that impacts a significant share of the overall population. In an interview with The American Journal of Managed Care® (AJMC®), Mian broke down the demographic and environmental factors that raise dry eye risk, the most common symptoms patients report, and practical strategies for prevention and relief.

This transcript has been lightly edited for clarity.

AJMC: What is dry eye and how can it affect a patient's vision?

Mian: Dry eye is a condition generally referring to somebody who has decreased tear production, including people who have poor quality tear film, which results in their tear film evaporating too quickly. As a result, they have poor quality tear film or not enough tear film, which causes the surface of the eye to not be smooth enough, which can affect their vision. Most common symptoms people present are burning, stinging, tearing, itching, and a scratchy sensation in their eyes. Often it manifests with other risk factors. Contact lens wearers might find they are more intolerant of their contact lenses when they have dry eye.

Many times, patients may present with fluctuating vision, finding that their vision gets worse as the day goes on. By the time they're about to go to bed, they can't function and keep their eyes open, having an eye-fatigue phenomenon.

AJMC: How prevalent is dry eye in the general population?

Mian: Dry eye disease is very common. When we look at large overall studies, it's estimated to be between 5% and 8%. Broken down, there are demographic factors that increase the risk for dryness.² Patients who are over the age of 65 have a 20% risk increase, and patients who are under the age of 18 have less than 5%. It does depend on risk factors, and age is the most common. With age, the risk of having dry eye disease goes up because people don't make enough tears and their quality of tear film decreases with increased evaporation of the tear film.³

We also know that women are at a much higher risk for having dry eye disease. Especially post-menopausal women, who are 2 times more likely to have dry eye disease compared with age-matched men. Other factors include contact lens use, which can increase risk for dry eye symptoms and presentation. Additionally, certain medications can increase the risk of having dry eye symptoms.

We also have environmental factors. If you live in an area that is very dry in terms of humidity in the air, then you're more likely to have irritation. In Michigan,⁴ we're having the smog effect from fires in Canada and Minnesota that further aggravate people's eye symptoms, making them drier. There are also some genetic factors and autoimmune conditions that also increase the risk, but they're less likely.

AJMC: What is the best method of addressing dry eye disease for patients?

Mian: There are many things people can do to help themselves when they have dry eye symptoms. One of the most important is being aware and recognizing that you're experiencing dry eye disease. Many people do use over-the-counter lubricating eye drops, and that's perfectly fine, especially if you have the classic symptoms of irritation, foreign body sensation, and fluctuating vision, which gets worse as the day goes on. The use of over-the-counter drops can help improve symptoms and make one more comfortable.

We also find that a lot of patients, especially when they're older, have issues with their tear film evaporating too quickly, which is related to them having blepharitis, a condition where the eyelids are inflamed. There are oily glands in the lid margin that get plugged up, and they don't secrete the proper healthy oil that protects the tear film and prevents it from evaporating. Warm compresses help with that by taking a washcloth soaked in warm water and gently massaging the eyelids. Many options are available online as well; you can get masks that heat in the microwave and put them on as they retain heat for a longer period and can help reduce that inflammation. It's important to be careful not to put anything too hot on the eyelids, which can burn the skin. The skin around the eyes is very sensitive.

I always remind people when they're sitting in a car and their air conditioner or heater is blowing towards their face that they're going to experience more dry eye symptoms. If you are biking outdoors or riding a bike, that wind blowing in your eyes is going to make your eyes drier, so it's good to wear eye protection. Sunglasses or goggles can help reduce that burden. For many people, especially in the wintertime, it's helpful to have humidifiers, as they can help improve the quality of air in the room and help have fewer symptoms associated with dry eye disease.

There are many medications that are available to treat dry eyes. We have a whole different class of medications that can help improve tear production and reduce inflammation associated with the tear film for dry eye. We also have procedures that can help stimulate more tear production and reduce debris or plugging of the oily glands. We take advantage of all those opportunities for treating patients with dry eye disease.

References

1. McCann P, Abraham AG, Mukhopadhyay A, et al. Prevalence and incidence of dry eye and meibomian gland dysfunction in the United States: a systematic review and meta-analysis. JAMA Ophthalmol. 2022;140(12):1181-1192. doi:10.1001/jamaophthalmol.2022.4394
2. Hasan AZI. Dry eye syndrome risk factors: a systemic review. Saudi J Ophthalmol. 2022;35(2):131-139. doi:10.4103/1319-4534.337849
3. Sharma A, Hindman HB. Aging: a predisposition to dry eyes. J Ophthalmol. 2014;2014:781683. doi:10.1155/2014/781683
4. Marchi J. Whose eyes are most at risk during poor air quality? Here's what Metro Detroit eye doctor says. ClickOnDetroit. Published July 18, 2026. Updated July 21, 2026. Accessed July 22, 2026. https://www.clickondetroit.com/news/local/2026/07/18/whose-eyes-are-most-at-risk-during-poor-air-quality-heres-what-metro-detroit-eye-doctor-says/