Dry Eyes

What is dry eye?

Dry eye (also called dry eye disease or dry eye syndrome) happens when either your eyes do not make enough tears or the tears you have are not working properly and evaporate too quickly. Tears are more than just “water” – they contain oil, water and mucus layers that work together to keep the surface of your eye smooth, moist and clear.​

When this tear film is out of balance, the surface of the eye can become dry, inflamed and sensitive. This can affect your comfort through the day and can sometimes cause fluctuating or blurred vision, especially when reading or using screens.​

Common symptoms

Dry eye can feel different from person to person, but typical symptoms include:​

• A feeling of dryness, grittiness or “sand” in the eyes.​
• Burning, stinging or soreness.​
• Red, tired‑looking eyes, especially later in the day.​
• Watery eyes (the eye reacts to dryness by producing reflex tears that do not stay on the surface well).​
• Blurred or fluctuating vision that improves when you blink.​
• Sensitivity to wind, air‑conditioning, smoke or bright light.​
• Difficulty with contact lens wear.​

Symptoms often worsen when:​

• Reading, driving or using screens for long periods.
• In air‑conditioned or heated rooms.
• In windy, dry or smoky environments.

Why does dry eye happen?

There are two main ways dry eye develops, and many people have a mixture of both:​

• Not enough tears (aqueous‑deficient dry eye): The tear glands do not produce enough fluid. This can be linked to ageing, hormone changes (including menopause), certain autoimmune diseases (such as Sjögren’s syndrome or rheumatoid arthritis), or some medications.​
• Tears evaporate too quickly (evaporative dry eye): The oily layer of the tears, produced by glands in the eyelids (meibomian glands), is poor or blocked, so tears dry out too fast. This is often associated with eyelid inflammation (blepharitis) and meibomian gland dysfunction.​

Other factors that can contribute include:​

• Ageing – tear production naturally decreases with age.
• Hormonal changes, especially in women.
• Medical conditions like arthritis, thyroid disease, diabetes and autoimmune diseases.
• Medications such as antihistamines, some antidepressants, blood pressure tablets, acne treatments and birth control pills.
• Long periods of screen use with reduced blinking.
• Contact lens wear.
• Previous eye surgery (for example, laser vision correction or cataract surgery).
• Dry or windy climates, indoor heating, air‑conditioning, smoke and dust.

How is dry eye diagnosed?

A thorough eye examination is important to confirm dry eye and identify what type you have.​

Your eye‑care professional may:

• Ask about your symptoms, general health, medications and daily activities.​
• Examine your eyelids and the front of your eyes with a microscope (slit lamp).​
• Use special dyes (such as fluorescein) to check how quickly your tears break up and whether there are dry patches on the eye surface.​
• Measure tear quantity and quality, sometimes with simple strips of paper (Schirmer test) or imaging devices that assess the tear film and oil glands.​

Understanding the cause helps guide a more effective, personalised treatment plan.​

Treatment options

Dry eye is usually a long‑term (chronic) condition, but it can almost always be managed successfully with a combination of lifestyle changes and medical treatments. Treatment is often stepped up gradually depending on how severe your symptoms are.​

1. Self‑care and lifestyle changes

These are the foundation of dry eye management:​

• Take regular breaks from screens (for example, the “20–20–20 rule”: every 20 minutes, look at something 20 feet away for 20 seconds).
• Remember to blink fully and often when concentrating.
• Avoid direct airflow from fans, air‑conditioning or heaters blowing into your eyes.
• Use a humidifier in very dry indoor environments.
• Wear wrap‑around glasses or sunglasses outdoors to protect from wind and dust.
• Stop smoking and avoid smoky or dusty places where possible.
• Maintain a balanced diet rich in omega‑3 fatty acids (such as oily fish or supplements, if your doctor agrees).​

These changes help support a healthier tear film and reduce day‑to‑day irritation.​

2. Lubricating drops, gels and ointments

Artificial tears are usually the first medical treatment:​

• Daytime: lubricating drops or gels to keep the eyes moist and more comfortable.
• Night‑time: thicker gels or ointments can protect the eyes while you sleep.

Preservative‑free products are often recommended, especially if you use drops more than 4–6 times daily or have sensitive eyes. You may need to try a few different types to find what feels best for you.​

3. Treating eyelid and oil‑gland problems

If your eyelid oil glands are blocked or inflamed, you may need:​

• Warm compresses or eye masks to soften the oils in the glands.
• Lid hygiene – gentle cleaning of the eyelid margins to remove crusts and bacteria.
• In‑office treatments such as thermal pulsation or other device‑assisted therapies to unblock oil glands.​
• Short courses of oral antibiotics (such as doxycycline) in some cases to improve oil quality and reduce inflammation.​

Improving the oil layer of the tears helps slow evaporation and can significantly reduce symptoms.​

4. Anti‑inflammatory and tear‑stimulating treatments

Because inflammation plays a key role in many cases of dry eye, your specialist may recommend:​

• Short courses of mild steroid eye drops to calm flares of inflammation.
• Prescription drops such as cyclosporine or lifitegrast, which help reduce inflammation and allow the eye to produce better tears over time.​
• Tear‑stimulating tablets or nasal spray in selected patients.​

These treatments are usually used for moderate to severe dry eye or when standard lubricants are not enough.​

5. Protecting and preserving tears

To help your natural or artificial tears stay on the eye longer, options include:​

• Tiny plugs (punctal plugs) placed in the tear drainage ducts to slow tear drainage.
• Moisture chamber glasses or goggles to trap humidity around the eyes.
• Special bandage or scleral contact lenses that create a protective reservoir of fluid over the eye surface in severe cases.​

For very severe dry eye that does not respond to other treatment, custom‑made drops from your own blood (autologous serum drops) may be considered in specialist centres.​