How stress, eye strain and dry eye are related

Dry eye syndrome is a common disease of the ocular surface that can be influenced by multiple factors. Beyond environmental factors or age, the relationship between sustained stress, eye strain and tear film dysfunction is increasingly being recognised.

Many patients report that their eye discomfort worsens during periods of greater emotional tension or mental overload. This association is not coincidental.

Dry eye is an inflammatory disease

Dry eye is not simply a matter of “not having enough tears”. It is a complex disorder involving:

• Tear film instability.
• Inflammation of the ocular surface.
• Dysfunction of the Meibomian glands in many cases.

Inflammation plays a central role, and stress can modulate this inflammatory response.

How stress affects the ocular surface

Sustained stress activates the sympathetic nervous system and the hormonal stress axis. Prolonged activation can contribute to:

• Changes in the regulation of tear secretion.
• An increase in inflammatory mediators.
• Greater ocular sensitivity.

The result is a more reactive and vulnerable ocular surface.

In predisposed individuals, stress is not always the initial cause, but it can clearly be an aggravating factor.

Eye strain and muscle tension

Eye strain is not just a matter of optics. Prolonged concentration on precision tasks or mental overload can lead to:

• Tension in the periocular muscles.
• Reduced blink frequency.
• Incomplete blinking.

Blinking is essential for distributing tears evenly. When blinking is reduced, the tear film becomes unstable and evaporation increases.

A self-reinforcing cycle

In many cases, a circular pattern develops:

Stress → less blinking and increased inflammation → dry eye symptoms → persistent discomfort → more worry and tension.

Breaking this cycle requires addressing both the ocular surface and the triggering factors.

Common symptoms when stress and eye strain are involved

Patients commonly report:

It is common for the discomfort to be more intense at the end of the day or during periods of high emotional demands.

What can help improve the situation

The approach should be individualised.

Measures for the ocular surface

• Use of artificial tears appropriate for the type of dry eye.
• Anti-inflammatory treatments when indicated.
• Assessment of Meibomian gland function.

General measures

• Improving the quality of rest.
• Stress-management techniques.
• Visual breaks during tasks requiring high concentration.
• Conscious blinking.

In some cases, a specific examination of the ocular surface may be necessary to correctly classify the type of dry eye.

When to seek medical advice

Specialist assessment is recommended if:

• Symptoms are persistent.
• There is pain or photophobia.
• Vision fluctuates frequently.
• Occasional use of lubricants is not sufficient.

An accurate diagnosis makes it possible to distinguish between evaporative dry eye, aqueous-deficient dry eye or mixed forms, and to adjust treatment accordingly.

In conclusion, stress and eye strain can affect tear film stability and worsen dry eye syndrome. Understanding this relationship allows for a more comprehensive approach, addressing not only the ocular surface but also the factors that influence it.

Dr Rubén Delgado, ophthalmologist at Barraquer Ophthalmology Centre