Dry eye disease is one of the most common conditions seen in eye clinics, yet it's also one of the most misunderstood. There is a difference between the occasional dry eyes and chronic dry eye disease – the first will go away after a break from screens and a good night's sleep, the latter can severely impact your quality of life.

What is Dry Eye Disease?

A stable tear film is essential for both comfort and clear vision, as it provides a smooth optical surface and protects the eye. But tears evaporate. To limit the evaporation, tears contain lipids (oils) which work to create a film over the eye.

With dry eye disease, the glands in your eyes either don't produce enough tears (aqueous deficient dry eye) or produce tears that don’t contain enough lipids and which evaporate too quickly to keep the surface of your eye properly lubricated (evaporative dry eye).

In both cases, the eye quickly becomes dry and cannot keep up with the lubrication requirements, leading to dry, sore eyes.

Symptoms you might not expect

Watery eyes are perhaps the most counterintuitive. Just like in healthy eyes, the lack of moisture triggers the release of more tears. Unfortunately, these emergency tears don't solve the underlying problem but simply overflow your eyes and cause them to stream.

Fluctuating or blurred vision is another symptom that can be ambiguous. People will usually assume they need new glasses, but sometimes blurred vision can be a problem with tear film quality. Since a uniform layer of tear film is essential for clear vision, any instability or lack of uniformity can cause vision to shift in and out of focus.

Likewise, light sensitivity can be a result of the tear film. An irregular film surface over the eye ends up scattering incoming light rather than focusing it cleanly, causing glare. For some patients, this reaction to light can be intense and even painful.

Ultimately, almost all dry eye symptoms overlap with other eye issues. Rather than hoping for the best while treating the symptoms, the most effective course of action is always to get a proper consultation with an eye specialist.

Why does Dry Eye develop?

The most common causes of dry eye disease are ageing and prolonged screen use. Looking at screens for long periods of time reduces our blink rate which means tears evaporate before they're replenished. Ageing, meanwhile, reduces tear production and changes the composition of the tear film.

But there are several causes that patients frequently haven't considered. Some medications, such as antidepressants, antihistamines, blood pressure medications, and some hormonal contraceptives, can reduce tear production as a side effect. Unfortunately, patients often aren’t warned that their eyes might be affected by these medications.

Some environmental factors, such as air conditioning, central heating, wind, and smoke, can also cause eyes to dry out over time and negatively impact tear film quality and production. Contact lenses are another common cause, disrupting the tear film over time.

One of the most significant and most overlooked drivers of dry eye is Meibomian Gland Dysfunction, or MGD. The Meibomian glands, located in the eyelids, produce the oily layer of the tear film that prevents evaporation. When these glands become blocked or inflamed, they are unable to produce the right mix of oil for the tear film. As a result, the protective film breaks down, and tears evaporate far too quickly. MGD is frequently associated with rosacea and is thought to be responsible for the majority of evaporative dry eye cases.

Blepharitis is a common, chronic inflammation of the eyelid margins. It can involve the front of the eyelid around the eyelashes or the inner edge where the oil glands (meibomian glands) are located. Typical symptoms include red, swollen eyelids, crusting or flakes at the base of the lashes, itching, burning, and a gritty feeling in the eyes. It often develops due to bacteria, blocked oil glands, or skin conditions like dandruff or rosacea. It is closely linked to Dry Eye Syndrome as blepharitis can disrupt the oily layer of the tear film leading to increased tear evaporation making dry eye symptoms worse. As a result, both conditions frequently occur together and are commonly managed with eyelid hygiene and lubricating eye drops.

Hormonal changes—particularly around menopause—have been found to play a far more significant role than was previously recognised. Research suggests that between 50 and 70 per cent of post-menopausal women experience dry eye symptoms. It is thought that declining hormone levels can lead to reduced Meibomian gland activity and, as a result, evaporative dry eye disease. Often, women in this group attribute their dry eyes to general symptoms of ageing and don't realise that there are specific treatments for dry eye disease.

It's also worth knowing that dry eye can occasionally be an early sign of an underlying systemic condition. Autoimmune conditions such as Sjögren's syndrome, rheumatoid arthritis, and lupus can all present with dry eye symptoms, as can thyroid disease. This is one of the reasons it’s so important to get an informed professional assessment as soon as possible.

Getting a proper diagnosis matters

A professional dry eye assessment is much more involved and in-depth than most patients expect. It begins with a detailed history and symptom review, followed by an external examination of the eye and eyelids using a slit lamp.

Professional clinicians will then assess the Meibomian glands and evaluate the tear film using ocular surface staining – a technique that reveals areas of damage or instability on the eye's surface that would otherwise be invisible.

Advanced clinics can take testing even further. Meibography, for instance, uses imaging to assess the structure of the Meibomian glands directly, while tear osmolarity testing and inflammatory marker analysis provide additional layers of diagnostic precision.

Since dry eye disease is not a single condition with a single cause and a single treatment, it requires careful analysis to establish what's actually going on.

Treatment options for Dry Eye Disease

The good news is that there are now far more treatment options for dry eye disease than in the past. Treatment is also now highly personalised and is shaped by whether a patient has aqueous deficient, evaporative, or mixed dry eye.



Some simple adjustments are almost always recommended in the treatment of dry eye disease, including:
Environmental changes, such as avoiding air conditioning directed at the face, wearing wraparound sunglasses outdoors, reducing exposure to heating vents.
The 20-20-20 rule: every 20 minutes of screen time, look at something 20 feet away for 20 seconds to help with issues associated with screen use.
Eyelid hygiene, consisting of a daily routine of warm compresses followed by a gentle eyelid scrub to ensure that the eyes stay clean and healthy. This is particularly important for patients with MGD, as it helps to keep the Meibomian glands clear and functioning.
Dietary supplements, particularly omega-3 fatty acids and vitamin D, can also support tear film health.
Over-the-counter lubricating drops – look for preservative-free artificial tears for general use and lipid-containing drops if you suffer from evaporative dry eyes.

Dry eye disease is, for most patients, a manageable condition but it does require the right plan, so it’s always important to get a professional diagnosis and personalised treatment.

Dina Sonpal, Optometrist, Midland Ey

Dina Sonpal is an Optometrist at Midland Eye. Midland Eye was founded by four ophthalmic surgeons who wanted to provide patients with a comprehensive, specialist service for the diagnosis and treatment of all eye conditions. The team are leaders in their field and offer a consultant-only service to all patients requiring eye care or surgery. Every consultant is qualified to treat common eye conditions such as cataracts but each one also has a particular area of specialisation, ensuring that patients get the best possible outcome, no matter what the diagnosis. Private patients can benefit from access to collaborative care and facilities with the latest and best technology. The clinic’s approach is designed to be convenient for people who lead busy lives and have limited time to seek medical advice and treatment.

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