Dry eyes (also known as dry eye disease or DED) are one of the most common issues people come to us with.
Many people live with discomfort, gritty or burning sensations, watery eyes, or blurred vision that comes and goes.
But they shouldn’t have to. It’s uncomfortable and frustrating.
That’s why we’ve written this guide, to help you understand:
- > What dry eyes are (and the science behind them)
- > The different types of dry eye and what causes them
- > The role of conditions like menopause and rosacea
- > The latest treatments available, from eye drops to in-practice therapies
- > What lifestyle changes can make a difference
Hopefully, after you’ve read everything, you’ll have a better idea of what causes dry eye and what you can do to treat them.
So let’s start at the very beginning…
What actually is a dry eye?
In simple terms, a dry eye occurs when your eyes don’t produce enough tears, or the tears evaporate too quickly.
This usually happens because one or more layers of the tear film (oil, water, or mucus) aren’t functioning properly.
The tear film and how it works
Your eyes are protected by a thin coating of moisture called the tear film. It keeps the surface of your eyes smooth, nourished, and free from infection.
The tear film has three layers:
| Layer | Function | Made by |
| Oil (lipid) layer | Slows down evaporation | Meibomian glands in the eyelids |
| Water (aqueous) layer | Keeps the eyes hydrated and delivers nutrients | Lacrimal glands near the eyes |
| Mucus (mucin) layer | Helps spread the tear film evenly | Goblet cells in the conjunctiva |
If any of these layers are missing or not working well, that’s what causes your eyes to dry out and lead to grittiness, inflammation, discomfort, or blurred vision.
The different types of dry eye
Dry eye disease is not just one condition. There are two main types, and many people experience a mix of both.
Evaporative dry eye
This is the most common type. It happens when the oil layer is weak or missing, so tears evaporate too quickly. The most common cause is meibomian gland dysfunction, where the oil-producing glands in your eyelids become blocked or inflamed.
Aqueous-deficient dry eye
This occurs when the tear glands do not produce enough of the watery part of the tears. This may be due to:
- > Age-related changes
- > Autoimmune conditions (such as Sjogren’s syndrome)
- > Hormonal changes (such as those during menopause)
- > Nerve damage following surgery
- > Certain medications
Both types can cause similar symptoms, but they are treated differently.
Other causes of dry eye you might not expect
Dry eye can be caused or made worse by a wide range of factors. Some of these may not seem directly related to the eyes, but they can have a real impact.
- > Extended screen use can reduce blinking and lead to dryness
- > Rosacea, especially when it affects the eyelids, can block oil glands
- > Hormonal changes during menopause may reduce tear production
- > Blepharitis, a common inflammation of the eyelids, often coexists with dry eye
- > Thyroid eye disease can affect the way the eyelids and tear glands function
- > Contact lens use may increase evaporation
- > Certain medications such as antihistamines, antidepressants, and decongestants can reduce tear production
- > Autoimmune diseases like lupus or rheumatoid arthritis can affect tear glands
- > Environmental factors such as wind, smoke, and air conditioning can dry the eyes out
In many cases, more than one factor is involved.
What dry eye symptoms feel like
You may have dry eye if you notice any of the following:
- > A gritty, sandy, or scratchy feeling in your eyes
- > Burning or stinging
- > Redness
- > Blurred or fluctuating vision
- > Sensitivity to light
- > Eye fatigue or discomfort after reading or screen time
- > Watery eyes, which can actually be a reflex response to dryness
Symptoms can be mild or severe and may come and go.
How dry eye is diagnosed
Eye care professionals use several tools and techniques to diagnose dry eye and understand what type you have.
These may include:
- > A questionnaire to assess symptoms and how they affect daily life
- > A slit-lamp examination to look at your eye surface and eyelids
- > Fluorescein dye to check for dryness or damage on the eye
- > Tear break-up time (how quickly tears evaporate)
- > Meibography, which images the oil glands in your eyelids
- > A Schirmer test, which measures tear production using paper strips
- > Checking the quality of oil from the glands by gentle pressure on the lids
These tests help guide treatment and are often done during a comprehensive eye exam.
Treatment options and how well they work
There is no one-size-fits-all approach to treating dry eyes. Your treatment will depend on the cause, how severe your symptoms are, and your response to different options. Below is an overview of the main treatments, from at-home remedies to in-practice procedures.
Everyday treatments
> Artificial tears
Lubricating eye drops are often the first treatment. They add moisture to the eyes and provide temporary relief. Some contain added oils or ingredients for longer effect. Preservative-free drops are generally preferred for regular use.
> Warm compresses
Applying a warm compress to closed eyelids helps loosen oil in the glands, especially in evaporative dry eye. Microwaveable eye masks or warm towels can be used.
> Eyelid hygiene
Cleaning the eyelid margins with special wipes or foams removes bacteria and debris that can block the glands or cause inflammation.
Prescription and medical treatments
> Anti-inflammatory eye drops
Drops such as cyclosporine or short-term steroid drops may be prescribed to reduce inflammation. These are especially useful when dry eye is linked to autoimmune conditions or long-standing inflammation.
> Omega-3 supplements
Omega-3 fatty acids may help reduce inflammation and support oil gland function, particularly in cases of meibomian gland dysfunction. The evidence is mixed, but some people find them beneficial.
> Punctal plugs
Tiny silicone or gel plugs can be inserted into the tear ducts to slow drainage and keep tears on the eye longer. Results vary depending on the cause of dryness.
In-practice treatments
> Meibomian gland expression
This involves applying controlled pressure to the eyelids to release blocked oil. It is often combined with warm compresses or other therapies.
> BlephEx
This in-practice procedure uses a small rotating brush to clean the lid margins and remove biofilm, which may reduce inflammation and improve comfort.
> Intense pulsed light (IPL) therapy
IPL is a newer treatment that uses light pulses around the eyes to reduce inflammation and improve gland function. Research shows promising results, especially in people with rosacea-related dry eye. It is typically offered as a course of treatments.
> LipiFlow and thermal pulsation
This combines heat with gentle massage to unclog oil glands. Clinical studies show improvement in symptoms for many people with evaporative dry eye.
What are the stages or severity levels of dry eye?
Dry eye is typically classified as mild, moderate, or severe. Each level comes with different signs, symptoms, and treatment strategies.
- > Mild: Occasional discomfort, often related to screen use or environment. Treated with artificial tears and lifestyle adjustments.
- > Moderate: More frequent symptoms that affect daily tasks. May require lid hygiene, warm compresses, or prescription drops.
- > Severe: Constant discomfort, potential damage to the eye surface, and significant impact on vision and quality of life. Often needs advanced therapies.
Understanding where you fall on this spectrum helps tailor the best management plan.
Can dry eye affect vision long term?
Yes, untreated or severe dry eye can affect vision. When the tear film is unstable, the surface of the eye becomes irregular, causing blurred or fluctuating vision. In rare cases, dry eye can lead to:
- > Damage to the cornea (the clear front part of the eye)
- > Infections
- > Recurrent corneal erosions
The good news is that with proper treatment, most people can avoid these outcomes.
What is the link between dry eyes and menopause or hormonal changes?
Hormones play a key role in tear production. As oestrogen and androgen levels shift during menopause, the function of tear glands and oil glands can decline.
Several studies show that women, particularly post-menopausal women, are more likely to experience dry eye. Hormone replacement therapy (HRT) has mixed results and may improve or worsen symptoms depending on the formulation.
Men can also experience hormone-related changes, especially with age or certain medical conditions.
What role does diet play in dry eye?
Nutrition can influence tear production and inflammation. While diet alone will not cure dry eye, it can support eye health.
- > Omega-3 fatty acids (from oily fish or flaxseed) may improve meibomian gland function.
- > Vitamin A helps maintain healthy epithelial tissue on the eye surface.
- > Hydration is important for maintaining tear production.
Some people also find benefit from reducing inflammatory foods like refined sugars or increasing antioxidants from fruits and vegetables.
Dry eye and systemic health: what’s the connection?
Dry eyes are sometimes a sign of a wider health issue. Conditions linked to dry eye include:
- > Sjögren’s syndrome: An autoimmune disease that attacks moisture-producing glands
- > Rheumatoid arthritis and lupus: These can affect the lacrimal glands or cause general inflammation
- > Thyroid dysfunction: Can change eyelid position and affect tear evaporation
- > Diabetes: May reduce corneal sensitivity and tear production
If dry eyes occur alongside dry mouth, joint pain, or fatigue, it is important to speak to a healthcare provider.
Workplace and lifestyle tips for managing dry eye
You can often improve comfort by making small adjustments to your environment:
- > Keep screens at arm’s length and slightly below eye level
- > Take breaks every 20 minutes during screen use
- > Use a humidifier to prevent air from drying out
- > Avoid air blowing directly on your face (fans, heaters)
- > Wear sunglasses or wraparound eyewear outdoors
- > Stay well hydrated throughout the day
Many of these tips are especially useful for people who work in offices or spend long periods indoors.
Frequently asked questions about dry eye
Can dry eye go away on its own?
Sometimes mild cases resolve with lifestyle changes. However, most types of dry eye are chronic and benefit from ongoing care.
Are preservative-free drops better?
Yes, especially if you use drops frequently. Preservatives can irritate the eye over time.
How long does it take for IPL or other treatments to work?
Most in-practice treatments require a course of sessions. Improvements may be noticed after a few weeks.
Can I wear contact lenses with dry eye?
It depends on severity. Some people switch to daily disposable lenses or take breaks. Your optometrist can recommend the best option.
Final thoughts
Dry eye disease is common and can affect your quality of life, but it’s also highly manageable. Causes vary from simple dryness due to screens or environment to more complex issues like hormone changes or autoimmune conditions.
Understanding the underlying cause is key to choosing the right treatment. Most people benefit from a combination of at-home care and professional treatments.
If you’re struggling with dry eyes, book an appointment with us and we’ll guide you through the options to find a plan that works for you.
