Stress does not cause dry eye, but it does make it worse. Screens, poor sleep and insufficient hydration form a cycle worth breaking.
Yes, there is a connection between stress, anxiety and dry eye, and it is something many patients notice in their daily lives: dry eye symptoms tend to fluctuate and, frequently, worsen during periods of greater tension, fatigue or nervousness. Although stress alone is not the main cause of dry eye, it does act as a factor that aggravates symptoms and is worth taking into account.
There are several mechanisms that help explain this connection. On one hand, stress and anxiety disrupt the autonomic nervous system, which regulates involuntary functions of the body, including tear production. In situations of sustained tension, this balance is altered and lacrimal secretion can be affected. On the other hand, anxious states are often accompanied by habits that promote dryness: we spend more hours in front of screens, we sleep less or more poorly, we blink less when we are concentrating or under tension, and we sometimes neglect general hydration by drinking less fluids.
Sleep plays a key role here. Sleeping too little or badly prevents the ocular surface from recovering adequately overnight, so a poor run of sleep — very common during periods of anxiety — often translates into drier, more uncomfortable eyes the following day. It is a self-reinforcing cycle: ocular discomfort creates irritability, and that irritability combined with stress amplifies the perception of symptoms.
It is also worth noting that some treatments for anxiety and depression, such as certain anxiolytics and antidepressants, have reduced tear production among their side effects, which can contribute to dry eye. This does not mean that medication should be stopped, but it is a relevant detail that the ophthalmologist should be aware of in order to adjust the ocular treatment accordingly.
The practical recommendation is twofold: take care of the lifestyle factors within our control (sleep, hydration, screen breaks, conscious blinking) and, if symptoms persist, consult an ophthalmologist. Identifying all the factors that influence each individual case, including those related to stress and sleep, is what makes it possible to manage dry eye effectively.