Dry Eyes

By Dr. Khang Ta

Published March 16, 2025

Dry eyes, a common condition affecting 18% of Australians, is clinically recognised as Dry Eye Disease (DED).1 While often considered a simple ailment, it is frequently underdiagnosed and inadequately treated, leading to ongoing discomfort and complications for many sufferers.

DEFINITION

Dry eye disease is defined as2:

  • A multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film.
  • It includes symptoms like discomfort, visual disturbance, and tear film instability, with potential damage to the ocular surface.
  • Inflammation and damage to the corneal and conjunctival surfaces are central to the disease.

SYMPTOMS:

Dry eyes can manifest in a variety of ways, including:

  • A stinging, burning, or scratchy sensation in the eyes.
  • A feeling of having something foreign in your eye.
  • Redness of the eyes
  • Sensitivity to light.
  • Blurred vision or difficulty focusing, especially after prolonged screen time.
  • Eye fatigue or discomfort, particularly after reading or using digital devices
  • Watery eyes, which may seem contradictory but can occur as a reflex response to irritation or dryness.

These symptoms can range from mild to severe and may fluctuate depending on environmental factors or activities. If left untreated, dry eyes can lead to more significant discomfort or complications.

AETIOLOGY AND PATHOPHYSIOLOGY

There are two main types of dry eye:

  • Aqueous-deficient dry eye: Caused by insufficient tear production.
  • Evaporative dry eye: Related to rapid evaporation of tears, often linked to meibomian gland dysfunction (MGD).

The loss of tear film homeostasis as the underlying mechanism driving DED. It is common to have a mixed form of both types.

RISK FACTORS

Risk factors include:

  • Aging, female sex, and hormonal changes.
  • Environmental factors like wind, dry climates, and screen use.
  • Poor health, nutrient deficiency and gut microbiome imbalance.
  • Medications (antihistamines, antidepressants).
  • Ocular and systemic diseases (e.g., Sjögren’s syndrome, rheumatoid arthritis).
  • Surgical procedures, such as LASIK.

DIAGNOSIS

Clinical tests for DED include:

  • Tear break-up time (TBUT): Evaluates tear film stability.
  • Osmolarity testing: Measures the concentration of solutes in the tear film.
  • Ocular surface staining: Uses fluorescein and lissamine green to assess surface damage.
  • Schirmer test: Measures aqueous production.
  • Infrared meibography: Analyses meibomian glands to assess dysfunction.

MANAGEMENT AND TREATMENT

Treatment is approached in a stepwise manner, progressing from less invasive to more intensive strategies:

  • Lifestyle modifications and environmental factors: Encouraging patients to optimise screen time, blink more frequently, and adjust the humidity of their environment.
  • Over-the-counter artificial tears: Primarily for mild cases.
  • Anti-inflammatory treatments: Topical corticosteroids for short-term or cyclosporine for moderate to severe cases, reducing ocular surface inflammation.
  • Lid hygiene: Removing debris, make-up, bacterial and parasites from the lid margin reduces inflammation and allows proper flow of oil from the meibomian glands.
  • Warm compresses: Following a prescribed regimen, warm compresses can be a safe and effective way to soften the oils in the meibomian glands, allowing them to flow more freely and improve the quality of the tear film.
  • Advanced therapies: LipiFlow, IPL, punctal plugs, or scleral lenses for severe cases.

  1. Optometry Australia. (2022). 2022 Vision Index Report. Retrieved from https://www.optometry.org.au/wp-content/uploads/GVFL/Vision_Index/2022-Vision-Index-Report.pdf
  2. Wolffsohn, J. S., Craig, J. P., Nichols, K. K., Akpek, E. K., Caffery, B., Dua, H. S., … & Jones, L. (2017). TFOS DEWS II Diagnostic Methodology report. The Ocular Surface, 15(3), 539-574.