Symptoms
Dry eye does not only feel “dry”
It can cause stinging, burning, itching, a gritty sensation, eye strain, redness, contact lens intolerance, discomfort in wind or bright light, and fluctuating vision that improves after blinking.
A dry eye can also water. This reflex tearing is often triggered by irritation, but the tears produced do not always restore lasting tear-film quality.
Understand
Why does the tear film become unstable?
Tears form an optical and protective surface. Their stability depends on their volume, composition, blinking, the eyelids and particularly the meibomian glands, which produce the lipid layer that limits evaporation.
Several factors may occur together:
- meibomian gland dysfunction or eyelid inflammation;
- screens and less frequent or incomplete blinking;
- dry air, heating, air conditioning, wind or pollution;
- age, hormonal changes, systemic or autoimmune disease;
- certain medicines, eye surgery or contact lens wear;
- hypersensitivity of the ocular surface nerves in some situations.
The TFOS DEWS III recommendations favour management based on identified mechanisms over the same step-by-step sequence of treatments for everyone.
Examine
What does an ocular surface assessment look for?
- Your symptoms and their context.Time of day, screens, environment, lenses, treatments, general health and impact on activities.
- Tear stability.Observation of the tear film and the time for which it remains even between blinks.
- The ocular surface.Suitable dyes are used to identify vulnerable areas, and tear quantity is observed.
- The eyelids and glands.Blink quality, eyelid margins and the appearance of meibomian secretions.
- Associated factors.Prescription, binocular vision, contact lenses, environment and signs requiring medical referral.
No single test can fully describe dry eye. Diagnosis is based on bringing together the patient history, symptoms and several clinical observations.
Personalise
What management options are available?
The plan depends on the mechanisms and their severity. It is explained, reassessed and adjusted over time.
Habits and environment
Visual breaks, complete blinking, screen position, protection from wind, environmental humidification and reviewing the products used can reduce certain aggravating factors.
Restore and retain tears
Tear substitutes selected for the individual profile, gels or other ways of retaining tears can be useful. “Drops for dry eyes” are not a single category: composition, viscosity and preservatives matter.
Treat the eyelids
When the meibomian glands are involved, eyelid hygiene, correctly applied warm compresses or targeted professional treatments may be discussed.
Treat inflammation or an associated condition
Anti-inflammatory medicines, antibiotics, immunomodulators, punctal plugs or device-based procedures have specific indications. They require assessment and, depending on their nature, a prescription or ophthalmological follow-up.
For some severe ocular surface conditions, a scleral lens may be considered as part of coordinated care, but it is not a first-line treatment for every case of dry eye.
Safety
When should I seek advice promptly?
in the event of severe pain, marked sensitivity to light, sudden reduction in vision, pronounced redness in one eye, discharge, trauma, chemical exposure or symptoms occurring with a contact lens.
Until proven otherwise, these signs should not be considered simple dry eye. In the event of chemical exposure, rinse immediately and thoroughly, then contact the emergency services.
