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Burning eyes are one of the most common reasons for seeing an eye doctor. Usually it is not dangerous, but when it comes back every day it is exhausting, affects concentration and makes screen work difficult. On this page we explain what causes burning, how to recognise a situation that needs urgent attention, and what to do when drops no longer help.
When to see a doctor straight away: a chemical getting into the eye (rinse immediately with running water for at least a quarter of an hour and go to the emergency department); an eye injury or a suspected foreign body; a sudden drop in vision; severe pain; a red eye with strong sensitivity to light; contact lens wearers with burning, pain and redness (take the lenses out and get seen the same day); heavy discharge with swollen eyelids; blisters or a rash around the eye.
Why does the eye burn?
The surface of the eye is covered by a thin tear film that protects the cornea (the clear window at the front of the eye) and the conjunctiva (the clear membrane that covers the white of the eye). When this film is unstable, or when something irritates the surface of the eye, the sensory nerves in the cornea send a burning signal. This is a very sensitive alarm system, so even a small change in the tear film can feel like real burning.
The common causes
Dry eye
This is the leading cause of chronic burning. When tears evaporate too quickly or there are not enough of them, they become concentrated, irritate the surface of the eye and trigger inflammation. The burning is usually accompanied by a gritty feeling, tired eyes and blurring that improves with blinking. It gets worse in front of screens, in air conditioning, in wind and on flights. A full explanation is in the guide Dry eye: what it is and when you need a specialist.
Meibomian glands and inflammation of the eyelid margins
The meibomian glands (tiny oil glands in the eyelid margins) secrete the oily layer that stops tears from evaporating. When they are blocked or secrete thick oil (MGD), tears evaporate quickly, and the faulty oil itself is also irritating. This is often accompanied by blepharitis (inflammation of the eyelid margins): red, slightly swollen eyelids, scales at the base of the lashes and a sticky feeling in the morning. In some people the Demodex mite, a tiny parasite that lives in the lash follicles, is also involved.
A typical sign: the burning is stronger in the morning, right after waking up.
Rosacea
People with rosacea of the facial skin (redness on the cheeks and nose, visible blood vessels) often also have eyelid inflammation and burning eyes. Sometimes the eyes are affected even before the skin. See ocular rosacea.
Drops with preservatives
Preservatives in drops, especially benzalkonium chloride (BAK), can damage the cells of the eye surface with frequent use. This is particularly common in people who have used glaucoma drops for years, or who put in lubricating drops many times a day. Sometimes the drops that are supposed to bring relief are part of the problem. Read more about preservative-free drops.
Allergy
In eye allergy, itching is usually the main symptom, together with tearing, redness and swollen eyelids. There is often also a runny nose and sneezing. Allergy and dryness can occur together, and some allergy medicines taken by mouth actually increase dryness.
Contact lenses
Contact lenses split the tear film into two thin layers and increase evaporation. Burning that builds up during the day and forces you to take the lenses out early is a common sign of dryness. Burning with pain and redness is a different story, and needs an immediate examination because of the risk of a corneal infection.
Environment, screens and medicines
- Dry, air-conditioned air, smoke, dust, wind and chlorine in swimming pools.
- Long periods of screen work, during which blinks become rare and incomplete.
- Make-up, creams and make-up removers that get into the eye, and eyeliner that blocks the openings of the meibomian glands.
- Medicines that cause dryness, such as antihistamines, some antidepressants and isotretinoin medicines for acne. Do not stop a medicine without consulting the doctor who prescribed it.
After eye surgery and with hormonal changes
Vision-correction surgery and cataract surgery cut some of the corneal nerves, so they can cause dryness and burning in the months after surgery. In most people this improves with time, but in some the symptoms persist. People who had dryness even before surgery are at higher risk, so it is worth treating dryness before a planned operation.
Hormonal changes, especially the menopause, also affect the tear glands and the meibomian glands. Many women describe burning and dryness that start or get worse during this period.
Burning in one eye only
Dryness and blepharitis usually affect both eyes. Burning in one eye only, especially if it is new and accompanied by redness, discharge or pain, raises suspicion of a foreign body, an infection or another problem, and warrants a quick examination.
What the accompanying symptoms can suggest
Burning eyes almost never come on their own. What comes with the burning, and the time of day when it gets worse, helps work out where it comes from.
Burning and itchy eyes
When there is itching too, the two common causes are allergy and inflammation of the eyelid margins. In allergy, the itching is especially marked in the inner corner of the eye, gets worse in certain seasons or around animals and dust, and often comes with a runny nose and sneezing. In blepharitis, especially when the Demodex mite is involved, the itching is felt along the eyelid margins and at the base of the lashes, and tends to be stronger in the morning.
During the slit lamp examination, the doctor looks at the base of the lashes (sleeve-like scales around the lash suggest Demodex), the openings of the meibomian glands and the conjunctiva, including the conjunctiva under the upper eyelid, where allergy sometimes leaves small bumps. The distinction matters, because the treatment is different: in allergy the allergic reaction is treated, and in blepharitis the eyelid margins are treated, for example with eyelid margin cleaning with BlephEx. Sometimes both are present. Read more on the blepharitis page. When itching is the main symptom, see the page on itchy eyes.
Watery and burning eyes
It sounds contradictory, but dry eye is one of the common causes of watery eyes. When the surface of the eye is irritated, the lacrimal gland responds with a flood of watery tears (reflex tears) that wash the eye for a moment, but do not stay on it and do not repair the tear film, so the burning comes back. If the tears come with discharge, marked redness or pain, other causes need to be considered. Basic information on excessive tearing is in the guide on the Mitzmutz site.
Burning in the morning or at the end of the day?
Burning that is especially strong right after waking up fits blocked meibomian glands and blepharitis, but also eyelids that do not close fully during sleep. In that case part of the cornea stays exposed all night and dries out, and sometimes no one at home notices. Read more about eyelids that do not close during sleep.
Burning that builds up during the day and peaks in the evening fits better with dryness caused by increased evaporation or by a lack of tears: through the day, in front of screens, in air conditioning and with contact lenses, the tear film breaks up faster. How the types of dryness are told apart is explained in the guide Dry eye: what it is and when you need a specialist, and if you put in drops many times during the day, it is worth reading about preservative-free drops.
In some people the burning is there both in the morning and in the evening, which is a sign that several factors are at work together.
What can you do at home?
- Preservative-free lubricating drops. They bring relief and dilute irritating substances. There are many types, for example drops with hyaluronic acid.
- Warm compresses and eyelid hygiene, when there are signs of meibomian gland problems or blepharitis. Heat helps melt the thick oil in the glands. See warm compresses for the eyes.
- Screen habits: short breaks, full and deliberate blinking, and a screen placed slightly below eye level.
- Environment: directing the air conditioning away from your face, a humidifier in a dry room, sunglasses in the wind.
- Contact lenses: shorter wearing hours, and during a period of burning, stopping for a while.
Do not put essential oils, tea bags or home-made solutions on the eye or eyelids. They can irritate the eye even more, and there is no evidence that they help.
When is it worth getting examined?
If the burning lasts several weeks despite these steps, if you need drops many times a day, or if the burning affects your work and sleep, it is worth being examined by an eye doctor who specialises in dry eye.
The examination establishes exactly what is causing the burning:
- A symptom questionnaire and questions about medicines, drops and contact lenses.
- An examination with a slit lamp (a microscope for examining the eye).
- A yellow dye (fluorescein) that shows how long the tear film stays stable (TBUT), and whether there is damage to the surface of the eye.
- A Schirmer test to measure the quantity of tears.
- An examination of the meibomian glands, the eyelid margins and the base of the lashes, including a search for signs of Demodex.
More details are on the dry eye testing page.
Treatment aimed at the cause
When the cause is known, it can be treated, rather than just soothing the burning:
- When the meibomian glands are blocked: meibomian gland expression at the clinic, and sometimes IPL treatment (broad-spectrum pulsed light, not a laser), especially when there is also rosacea.
- When there is blepharitis with scales or Demodex: eyelid margin cleaning with BlephEx.
- When there are not enough tears: punctal plugs.
- When there is significant inflammation: the eye doctor may prescribe anti-inflammatory drops for a limited period or for the long term, as needed.
In many patients, a combination of home care and targeted treatment at the clinic may bring significant relief, even if the symptoms do not always disappear completely.
If you have already tried several types of drops and the burning persists, we have put together the common reasons for this, and the next steps in order, on the page dry eye that is not improving with drops.
Want a basic explanation first?For basic information on dry eye symptoms and diagnosis: the guide on the Mitzmutz site
Frequently asked questions
Why do my eyes burn especially in the morning?
Burning that is worse in the morning often fits inflammation of the eyelid margins and blocked meibomian glands, or eyelids that do not close fully during sleep. Burning that gets worse towards the evening fits better with dryness from a lack of tears and with screen work.
Can burning eyes be caused by the drops themselves?
Yes. Preservatives in drops, especially with frequent use, can irritate the surface of the eye. If you use drops a lot, it is better to switch to preservative-free drops.
What should I do if a chemical gets into my eye?
Rinse the eye immediately with plenty of running water, for at least a quarter of an hour, with the eyelids open as wide as possible, and go straight to the emergency department. Do not wait for pain to appear.
Are burning and itching the same thing?
Not always. Marked itching, especially in the corners of the eyes and in certain seasons, suggests allergy. Burning and a gritty feeling fit better with dryness and eyelid inflammation. Sometimes there is a combination of both.
Why do my eyes water and burn if I have dryness?
When the surface of the eye is dry and irritated, the lacrimal gland responds with a flood of watery tears (reflex tears). They do not stay on the eye and do not replace a stable tear film, so the burning comes back. Watery, burning eyes together are a common picture in dry eye, but tears with discharge, marked redness or pain warrant an examination.
Home care not enough? We can look into it.
At the dry eye clinic in Haifa we find out what is causing the dryness and build a personal treatment plan.
Sources
- Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017;15(3):276-283.
- Nichols KK, Foulks GN, Bron AJ, et al. The International Workshop on Meibomian Gland Dysfunction: executive summary. Invest Ophthalmol Vis Sci. 2011;52(4):1922-1929.
- Amescua G, Akpek EK, Farid M, et al. Blepharitis Preferred Practice Pattern®. Ophthalmology. 2019;126(1):P56-P93.
- Baudouin C, Labbé A, Liang H, Pauly A, Brignole-Baudouin F. Preservatives in eyedrops: the good, the bad and the ugly. Prog Retin Eye Res. 2010;29(4):312-334.
- Cronau H, Kankanala RR, Mauger T. Diagnosis and management of red eye in primary care. Am Fam Physician. 2010;81(2):137-144.
The information on this site is general only. It is not medical advice and does not replace an examination by an eye doctor.