Dry Eye - It's More Common Than You Think!

Sarah Bersey BSc (Hons) Pg Dip

If you are suffering from blurred vision, particularly temporary blurredness that clears after blinking, and/or light sensitivity/photophobia (where bright lights can feel harsh or uncomfortable) or eye discomfort in general, it could be worth finding out about Dry Eye Disease (DED).

Background On The Eye:

https://www.nei.nih.gov/eye-health-information/healthy-vision/how-eyes-work/how-tears-work

How Do Tears Work?

When you blink, tears spread over the eye. This keeps the eye’s surface smooth and clear. Tears are important for good vision.

Tears are made of three layers:

• An oily layer

• A watery layer

• A mucus layer

  
  

Each layer of your tears serves a purpose.

The oily layer is the outside of the tears. It makes the tear surface smooth and keeps tears from drying up too quickly. This layer comes from the meibomian glands in the eyelids.

The watery layer is the middle of the tears. It makes up most of what we see as tears. This layer cleans the eye, washing away particles that do not belong in the eye. This layer comes from the lacrimal glands in the eyelids.

The mucus layer is the inner layer of the tears. This helps spread the watery layer over the eye’s surface, keeping it moist. Without mucus, tears would not stick to the eye. Mucus is made in the conjunctiva. This is the clear tissue that covers the white of your eye and inside your eyelids.

Normally, our eyes constantly make tears to stay moist. If our eyes are irritated, or we cry, our eyes make a lot more tears. But sometimes the eyes don’t make enough tears or something affects one or more layers of the tears. In this situation, someone can end up with Dry Eye Disease (DED)

(Puente et al 2025)

Dry Eye Disease

DED or Dry Eye Syndrome may have its root in a number of eye conditions. These have underlying causes (see later), but all result in the same broad symptoms. It has been termed “a multifaceted disorder with diverse underlying causes” by ocular professionals and poses a complex challenge for both patients and healthcare professionals around the world” (W00 2021).

Symptoms: Dry eye symptoms often include a gritty, sore, itchy, or burning feeling, redness, and light sensitivity.

https://www.woou.org/woou-blog/differential-diagnoses-for-dry-eye

Paradoxically, they can also cause watery eyes (reflex tearing), sticky eyelids, stringy mucous (especially in the morning), and temporary blurred vision, often worsening with screen time, wind, or dry conditions.  (The College Of Optometrists 2024, Woo 2021).

Contact lens wearers may have difficulty tolerating them for long and night-time driving may be affected in dry eye sufferers (Mayo Clinic 2025).

Symptoms may worsen when reading, watching TV, or using computers (less blinking), when in windy, smoky, or dry environments and at the end of the day. (The College Of Optometrists 2024).

Dry Eye Disease Treatments:

Dry Eye is usually chronic and managed rather than cured.

Management Strategies

(i)             Lifestyle & Environmental Adjustments

·      Blink consciously during screen use; follow the 20‑20‑20 rule (every 20 min, look 20 ft away for 20 s).

·      Humidify indoor air and avoid direct drafts or air‑condition vents.

·      Protect eyes with wrap‑around glasses outdoors or when exposed to wind/smoke.

·      Stay hydrated and limit caffeine/alcohol that can dehydrate the body.

(Cherian 2022, Cleveland Clinic 2025, Mayo Clinic 2025, Puente, M. et al 2025, UF Health 2025)

(ii)            Over‑the‑Counter (OTC) Lubricants

·      Artificial tears (preservative‑free for frequent use) – first‑line for mild‑moderate DED.

·      Ointments/gels at night to coat the eye and reduce evaporation.

·      Lipid‑containing drops (e.g., Systane® Balance) help restore the oily layer lost in MGD.

(Cherian 2022, Cleveland Clinic 2025, Mayo Clinic 2025, Puente, M. et al 2025, UF Health 2025)

(iii)           Prescription Medications

Drug class	Mechanism Of Action	Typical use
Cyclosporine A (Restasis®, Cequa®)	Reduces ocular surface inflammation, boosts natural tear production	Moderate‑to‑severe DED, especially with inflammatory component
Lifitegrast (Xiidra®)	Blocks lymphocyte function‑associated antigen‑1 (LFA‑1) to lessen inflammation	Similar indications as cyclosporine, faster onset reported
Topical corticosteroids (short‑term)	Potent anti‑inflammatory effect	Acute flare‑ups; limited duration due to side‑effects
Oral tetracyclines (doxycycline)	Anti‑inflammatory, improves meibum quality	MGD‑related DED
Autologous serum eye drops	Contain growth factors and vitamins from patient’s own blood	Severe refractory DED, especially post‑LASIK or graft‑versus‑host disease

(Cherian 2022, Cleveland Clinic 2025, Mayo Clinic 2025, Puente, M. et al 2025, UF Health 2025)

(iv)           Eyelid & Meibomian Gland Therapies

·      Warm compresses (10–15 min) followed by gentle lid massage to melt clogged meibum.

·      Clean with diluted baby shampoo or commercial lid scrubs.

·      In‑office procedures:

• Meibomian gland expression (manual or device‑assisted).

• Thermal pulsation (e.g., LipiFlow®) – applies heat and pressure to clear glands.

• Intense pulsed light (IPL) – reduces inflammation and improves gland function.

(Cherian 2022, Cleveland Clinic 2025, Mayo Clinic 2025, Puente, M. et al 2025, UF Health 2025)

(v)             Punctal Occlusion/Plugging

·      Temporary plugs (silicone or collagen) inserted into tear ducts to retain existing tears.

·      Permanent silicone plugs for chronic cases.

(Cherian 2022, Cleveland Clinic 2025, Mayo Clinic 2025, Puente, M. et al 2025, UF Health 2025)

(vi)          Emerging & Adjunctive Options

·      Nanotechnology‑based drops delivering anti‑inflammatory agents more efficiently.

·      Omega‑3 fatty acid supplementation(dietary fish oil or prescription‑grade EPA/DHA) – modest benefit in reducing inflammation.

·      Biologic agents (e.g., topical IL‑1 antagonists) under clinical investigation.

(Cherian 2022, Cleveland Clinic 2025, Mayo Clinic 2025, Puente, M. et al 2025, UF Health 2025)

Putting It All Together – A Practical Roadmap For Treatment:

1.    Identify & modify contributors (meds, environment, screen habits)

2.    Start with over-the-counter lubricants such as Carbomer gel – choose preservative‑free if using more than 4 times/day

3.    Add warm compresses if MGD signs are present

4.    If symptoms persist, see an eye‑care professional for:

·      Tear‑film assessment (osmolarity, staining).

·      Prescription anti‑inflammatory drops (cyclosporine or lifitegrast).

·      Possible punctal plugs or in‑office gland therapy.

·      For severe or refractory cases, discuss autologous serum drops or referral to a specialty dry‑eye clinic.

(Cherian 2022, Cleveland Clinic 2025, Mayo Clinic 2025, Puente, M. et al 2025, UF Health 2025)

Summarizing DED causes and treatments:

https://ufhealth.org/conditions-and-treatments/dry-eye-syndrome#:~:text=Definition,or%20permanently%20disrupt%20tear%20production

Key Takeaways From This Article:

Dry‑eye disease is multifactorial; successful treatment often combines lifestyle tweaks, lubricants, and targeted medical therapy.

Addressing underlying contributing conditions (autoimmune disease, medication side‑effects, eyelid dysfunction) is essential for lasting relief.

Modern options—from prescription anti‑inflammatories to thermal pulsation—provide options for most severity levels.

(Cherian 2022, Cleveland Clinic 2025, Mayo Clinic 2025, Puente, M. et al 2025, UF Health 2025)

Related Opthalmic Conditions:

Each of these conditions can act as an independent or synergistic driver of dry‑eye disease by affecting tear production, tear‑film stability, lid function, or by provoking chronic eye surface inflammation.

Keratoconjunctivitis Sicca– Also called keratitis sicca, this is a multifactorial disorder in which the eye surface loses tear‑film homeostasis, leading to inflammation of the cornea and conjunctiva, ocular discomfort, visual fluctuation and potential epithelial damage (Kloosterboer et al 2023). The principal causes are water-deficient tear production (lacrimal hyposecretion) and/or evaporative loss from meibomian‑gland dysfunction; systemic autoimmune diseases (e.g., Sjögren’s syndrome, rheumatoid arthritis), hormonal changes (post‑menopause), certain medications, and environmental stressors further impair tear volume or quality, driving the dry‑eye cascade (Juber 2025).

Keratitis sicca – Often used interchangeably with keratoconjunctivitis sicca, keratitis sicca denotes inflammation of the cornea that arises primarily from severe tear deficiency. When the tear film is insufficient, the corneal epithelium becomes exposed to high salt concentration stress, triggering inflammatory mediators that damage the surface and perpetuate a vicious cycle of dryness and keratitis (Kloosterboer et al 2023).  Contributing factors mirror those of dry‑eye disease: lacrimal gland hypofunction, meibomian‑gland obstruction, systemic autoimmune disorders, aging, and ocular surface toxicity from preservatives or contact‑lens wearing (Juber 2025).

Xerophthalmia – Xerophthalmia is a spectrum of eye damage caused by vitamin A deficiency; the lack of retinoic acid impairs mucin production and goblet‑cell function, leading to conjunctival and corneal xerosis, Bitot’s spots, keratomalacia and eventual dry‑eye syndrome (Feldman et al 2025). Inadequate dietary vitamin A (or malabsorption, chronic alcoholism, or severe liver disease) reduces tear‑film lipid and aqueous components, producing a dry, fragile ocular surface that can progress to ulceration and blindness if untreated (Juber 2025).

Blepharitis – A chronic inflammation of the eyelid margins (often bacterial or seborrheic) that disrupts the meibomian glands and destabilises the lipid layer of the tear film, leading to evaporative dry‑eye symptoms.

Trichinosis – A parasitic infection (Trichinella spp.) that can cause periorbital edema and conjunctival inflammation; the resulting ocular surface irritation and tear‑film disruption act as precipitating factors for dry‑eye disease (Cleveland Clinic 2025).

Vernal keratoconjunctivitis (VKC) – An allergic eye disease, most common in young males, characterised by giant papillae, photophobia and chronic inflammation; the persistent inflammatory milieu and mucus over‑production compromise tear stability and promote dry‑eye symptoms (Cleveland Clinic 2025).

Allergic eye disease – Allergic conjunctivitis and related hypersensitivity reactions generate ocular surface inflammation and excessive tearing that quickly evaporates, leaving the eye dry; epidemiological data show a strong overlap between allergic eye disease and dry‑eye syndrome.

Advancing wavelike epitheliopathy (AWE) – A rare corneal epithelial disorder with wavelike plaques that reflect limbal stem‑cell dysfunction; the abnormal epithelial surface interferes with tear spreading and promotes ocular surface dryness.

Mucus‑fishing syndrome – A behavioural condition in which patients repeatedly “fish” out mucus strands; the mechanical trauma induces chronic inflammation, increases mucus production and disrupts the tear‑film, thereby aggravating dry‑eye disease.

Kearns‑Sayre syndrome – A mitochondrial disorder featuring progressive external ophthalmoplegia and ptosis; impaired eyelid closure and reduced blink efficiency limit tear distribution and increase exposure‑related evaporation, contributing to dry‑eye symptoms.

Thyroid eye disease (TED) – Autoimmune inflammation of the orbital tissues (often in Graves’ disease) that widens the palpebral fissure and exposes the ocular surface to wind and dust; this exposure, together with altered lid dynamics, leads to significant dry‑eye complaints (Cleveland Clinic 2025).

Floppy eyelid syndrome – A condition of lax, easily everted upper eyelids, frequently associated with obstructive sleep apnoea; the laxity hampers proper lid apposition and tear‑film maintenance, producing chronic dry‑eye irritation.

Epithelial basement membrane dystrophy (EBMD) – A corneal epithelial disorder with irregular basement‑membrane folds (“map‑dot‑fingerprint” changes) that destabilises the tear film and is strongly associated with aqueous‑deficient dry eye (Lazarus 2023).

It’s easy to see that if you experience persistent dry eye symptoms, seeing an eye care professional to determine the cause and appropriate treatment is extremely important.  Although the condition may not be curable, it is manageable. 

Useful References

Cherian, B. (2022) How To Better Manage Dry Eye Disease [online] https://www.aoa.org/news/clinical-eye-care/diseases-and-conditions/how-to-better-manage-dry-eye-disease

Cleveland Clinic (2025) Dry Eye: What Is Dry Eye? [online] https://my.clevelandclinic.org/health/diseases/24479-dry-eye

College Of Optometrists, The. (2024) Clinical Management Guidelines: Dry eye (keratoconjunctivitis sicca, KCS)  [online] https://www.college-optometrists.org/clinical-guidance/clinical-management-guidelines/dryeye_keratoconjunctivitissicca_kcs#:~:text=What%20is%20dry%20eye%20disease,side%2Deffect%20of%20drug%20treatment

Feldman, B., Chong, K., Sundar,G., Yen, M., Alsuhaibani, A., Burkat, C.N., Sebastian, J.U. (2025) EyeWiki:Floppy Eyelid Syndrome [online] https://eyewiki.org/Floppy_Eyelid_Syndrome

Juber, M. (2025) What is Xeropthalmia [online] https://www.webmd.com/eye-health/what-is-xerophthalmia

Kloosterboer, A., Negron,C. Stokkermans, T. (2023)  Floppy Eyelid Syndrome [online] https://www.ncbi.nlm.nih.gov/books/NBK592408/#:~:text=Floppy%20Eyelid%20Syndrome%3A%20Marked%20laxity,%2C%20(more...)

Lazarus, R. (2023) Do I Have Floppy Eyelids? [online] https://www.optometrists.org/general-practice-optometry/guide-to-eye-conditions/dry-eye/eyelid-conditions/do-i-have-floppy-eyelids/

Mayo Clinic (2025) Dry Eyes [online] https://www.mayoclinic.org/diseases-conditions/dry-eyes/symptoms-causes/syc-20371863#

Puente, M. et al (2025) Dry Eye: Symptoms, Causes and Treatment [online] https://www.aao.org/eye-health/diseases/what-is-dry-eye

UF Health (2025) Dry Eye Syndrome [online] https://ufhealth.org/conditions-and-treatments/dry-eye-syndrome#:~:text=Definition,or%20permanently%20disrupt%20tear%20production.

Woo, S. (2021) Differential Diagnosis For Dry Eye [online] https://www.woou.org/woou-blog/differential-diagnoses-for-dry-eye

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