It’s more appropriate to think of “salty eyes” not as an independent condition in itself, but as a possible outcome of several problems affecting the tear film released by the multiple glands surrounding the eyes.
Each of these glands (which we will cover below in more detail) produces a component of the tear film, and when one or more of them are adversely affected, the composition of the tear film is thrown off balance as a result.
In some cases of glandular dysfunction, but not all, this means that tear salinity is higher than usual, as evidenced by stinging eyes and even the formation of residual salt crystals.
Salty eyes can often be treated with over-the-counter products, but in more serious cases of glandular damage and/or dysfunction, surgery and other more drastic corrective methods may need to be considered.
Here we will review the primary causes and treatment approaches for salty eyes.
What Causes Salty Eyes?
In order for tears to evaporate when they are supposed to (specifically, not prematurely), both the lacrimal and meibomian glands have to work together.
The lacrimal glands are responsible for producing the salt-water component of tears, and the meibomian gland produces the oily layer, which is what keeps the tears from evaporating too quickly.
If the meibomian glands are not producing a sufficient amount of oil, then the ocular surface will dry up too quickly between blinks.
The ensuing irritation and dryness will then prompt the body to overproduce tear film, which, given the current state of meibomian gland underproduction, worsens this disparity (between the oily and aqueous layers) in the tear film.
The result is an influx of salty tear film that overflows from the eye and leaves tiny salt deposits in and around the eyelids.
This condition is often referred to as epiphora, which, in addition to the imbalance of tear film layer production just described, can be caused by faulty drainage of the eye and environmental irritants as well.
Like epiphora and other conditions affecting the tear film of the eye, there is more than one way to arrive at the epidemic-level issue of dry eye.
Whatever the mechanism is, whether that’s excessive screen use, lack of blinking, glandular damage or dysfunction, environmental irritants, or what have you, a common end result is hyperosmolarity of the tear film.
Also applicable to other bodily fluids like blood, hyperosmolarity refers to an elevated concentration of salt, sugar (glucose), and other constituents of said bodily fluids, usually caused by the leaching out of the water from the fluid.
In the case of the tear film, when water is leached out as part of the pathogenesis of dry eye disease, we are left with an increase in the relative proportion of the salt layer.
Hence, the outcome is similar to epiphora in that the patient is left with saltier tears (though the overall volume of tears produced is generally lower in dry eye disease).
In some cases of dry eye disease, especially when the eyes are experiencing heightened irritation, this means stinging, salty eyes with the possibility of salt crystals in and around the affected area.
Though these two mechanisms (epiphora and dry eye disease) represent the majority of cases of salty eye, there is a range of isolated issues like hormone imbalances, autoimmune diseases, allergic reactions, and mechanical injuries that can influence the composition of the tear film towards hyperosmolarity.
Some of these issues go away on their own, some can be reversed with medication or surgical intervention, and some are treated but never fully cured.
Speaking of treatments, depending on how the patient arrived at the issue, there are many treatment options of various levels of invasiveness (from eye drops to surgery) available to either reverse or manage salty eye.
Common Treatment Approaches for Salty Eyes
In every case of establishing the proper treatment approach for salty eye, the key determinant is the underlying pathophysiology: what’s not working?
If the patient is experiencing meibomian gland dysfunction – causing salty tears via underproduction of oil – due to physical obstructions in the gland, then a surgical procedure may remedy the problem.
The Maskin Meibomian Gland Intraductal Probe, a procedure developed by Steven L. Maskin, MD, will enter the obstructed meibomian gland to remove blockages.
In successful cases, this allows the meibomian gland to produce the requisite amount of oil to balance out the tear film and prevent premature evaporation and/or salty tears.
There are similar surgical interventions available for lacrimal gland blockage, but if you’re experiencing salty tears, it’s highly unlikely the lacrimal gland is blocked.
If your dry eye disease is a function of your work habits, diet, immune system irregularities, or other factors not generally treated with surgery, then many eye doctors will recommend eye drops.
Over-the-Counter Eye Drops
Especially in the case of dry eye disease, it’s very important to use a completely preservative-free eye drop with a potent moisturizing effect; this will balance out the hyperosmolarity while relieving the irritated tissue.
A perfect example of such a product is Rain eye drops, which are highly recommended for their 100% preservative-free formulation.
Rain uses carboxymethylcellulose to moisturize and protect dry, irritated eyes, and without preservatives, there’s a drastically lower chance of exacerbating the very symptoms you’re trying to treat.
Your dependence on eye drops depends on the underlying physiology as well; if reversing your dry eye disease is a matter of changing lifestyle habits, then eye drops may only be needed on a temporary basis.
In many cases, patients keep a supply on hand just in case symptoms flare-up, or if they are unable to reverse the dry eye disease due to work and other constraints (screen time, etc.).
Prescription Eye Drops
Situated between surgery and over-the-counter eye drops, in some cases, eye doctors will recommend prescription eye drops and/or ointments to use that may offer different/additional benefits over OTC products when it comes to managing dry/salty eye symptoms.
Two commonly prescribed products in this vein include Restasis and Xiidra, which are generally used in moderate to severe cases of dry eye when surgery is not indicated.
These products contain potent anti-inflammatory compounds and are engineered to support the body’s natural ability to produce (healthy) tears.
Though they are widely used and generally well-tolerated, these products are significantly more expensive than OTC eye drops (often several hundred dollars a month depending on insurance coverage).