Dry eye: causes, risks, and effective treatments

Dry eye disease is one of the most common eye conditions seen in clinical practice. It can affect anyone, though it becomes increasingly prevalent with age. While often considered a mild irritation, persistent dry eye can cause significant discomfort and, in severe cases, lead to complications that affect both vision and overall eye health. In this article, Mr Dilesh Makwana, consultant optometrist and specialist in advanced eye care based in Coventry and Warwickshire, explains what dry eye is, why it occurs, and the most effective ways to manage and treat it.

What is dry eye?

Dry eye occurs when the eyes either do not produce enough tears or when the tears evaporate too quickly. Tears are essential for maintaining a healthy and comfortable ocular surface — they provide lubrication, protect against infection, and keep vision clear.

The tear film has three key layers:

• Oily layer: Produced by the meibomian glands in the eyelids to prevent evaporation.
• Watery layer: Produced by the lacrimal glands to provide hydration and nutrients.
• Mucous layer: Produced by goblet cells in the conjunctiva to help tears spread evenly.

When any part of this system is disrupted, the tear film becomes unstable, leading to inflammation, irritation, and the sensation of dryness or grittiness.

What causes dry eye and who is at risk?

Dry eye can develop for many reasons, and it is often multifactorial. Common causes and risk factors include:

• Ageing: Tear production tends to decrease with age, especially after the age of 50.
• Hormonal changes: More common in post-menopausal women.
• Contact lens wear: Can reduce oxygen flow and increase tear evaporation.
• Environmental factors: Exposure to dry, windy, or air-conditioned environments.
• Screen use: Exposure to dry, windy, or air-conditioned environments.
• Medical conditions: Such as blepharitis, rosacea, rheumatoid arthritis, Sjögren’s syndrome, and diabetes.
• Certain medications: Including antihistamines, antidepressants, beta-blockers, and some diuretics.
• Eye surgery: Procedures such as LASIK or cataract surgery may affect tear production temporarily or permanently.

Because dry eye is influenced by multiple factors, treatment typically requires addressing several causes at once for long-term relief.

What are the symptoms and risks of dry eye?

Dry eye symptoms vary from mild to severe and may include:

• Grittiness or a foreign body sensation
• Burning, stinging, or soreness
• Redness or tired eyes
• Blurred or fluctuating vision
• Excessive watering (reflex tearing due to poor tear quality)

If left untreated, chronic dry eye can lead to:

• Damage to the cornea and ocular surface
• Increased risk of infection due to reduced tear protection
• Visual disturbances that impact reading, driving, or screen work
• Persistent discomfort that affects quality of life
• In rare cases, corneal ulcers or scarring requiring specialist intervention

How are dry eyes treated?

Treatment depends on the underlying cause and severity of the condition. In most cases, dry eye is manageable and responds well to personalised care. The goals are to relieve discomfort, improve tear quality, and protect the ocular surface.

First-line and conservative treatments

• Lubricating eye drops (artificial tears): Help replenish moisture and relieve irritation.
• Lipid-based sprays or gels: Improve the oily layer of the tear film.
• Warm compresses and lid hygiene: Especially beneficial for meibomian gland dysfunction or blepharitis.
• Anti-inflammatory drops: Such as ciclosporin or mild corticosteroids are prescribed when inflammation is present.
• Lifestyle changes: Regular screen breaks, using a humidifier, wearing wraparound glasses, and staying hydrated.

Advanced and specialist treatments

For patients whose symptoms persist despite standard care, advanced in-clinic therapies may include:

• Punctal plugs: Tiny silicone plugs inserted into the tear ducts to slow tear drainage.
• Thermal cautery: A permanent solution for severe tear loss.
• Autologous blood treatment: Using a drop of the patient’s own blood to promote healing and rejuvenate the tear film.
• Scleral or bandage lenses: Special contact lenses that protect the eye’s surface and retain moisture.
• Intense Pulsed Light (IPL) therapy: A quick, non-invasive light treatment that unblocks the meibomian glands and restores healthy tear production. (Not suitable for all patients — your specialist will advise.)

For those with underlying medical conditions, collaborative management with a hospital specialist may also be beneficial.+

If you experience persistent dryness, irritation, or blurred vision despite using lubricating drops, it’s important to see an eye specialist. Early assessment can prevent long-term damage and significantly improve comfort and visual quality. 

To discuss your symptoms and explore treatment options, you can book a consultation with Mr Dilesh Makwana BSc MCOptom DipTp (IP) Prof Cert Glau, specialist optometrist at Eyesite Eyecare Centres in Coventry and Warwickshire.