Dry Eye Syndrome: Causes, Symptoms and Treatment Options

Dry eye syndrome — also known as dry eye disease or keratoconjunctivitis sicca — is the most common reason patients visit an ophthalmologist in the UK. The condition occurs when the tear film fails to adequately lubricate the surface of the eye, either because the eyes produce insufficient tears or because the tears evaporate too quickly. Research published in the British Journal of Ophthalmology estimates that dry eye affects between 14% and 33% of the adult population worldwide.

The tear film is a complex three-layered structure consisting of an outer lipid (oil) layer produced by the meibomian glands, a middle aqueous (water) layer produced by the lacrimal glands, and an inner mucin layer produced by goblet cells in the conjunctiva. Disruption to any of these layers can trigger dry eye symptoms.

Evaporative dry eye — caused by meibomian gland dysfunction (MGD) — accounts for approximately 86% of all dry eye cases according to the TFOS DEWS II report. When the meibomian glands become blocked or produce poor-quality oil, the lipid layer thins and tears evaporate rapidly from the eye surface. Aqueous-deficient dry eye, where the lacrimal glands produce insufficient watery tears, accounts for the remaining cases.

Common symptoms of dry eye include a persistent gritty or sandy sensation, burning or stinging, excessive watering (paradoxically, the eye overproduces reflex tears in response to dryness), redness, blurred vision that fluctuates with blinking, and eye fatigue — particularly after prolonged screen use or reading.

Several risk factors increase susceptibility to dry eye. Age is the strongest predictor, with prevalence rising significantly after 50. Hormonal changes — particularly during menopause — make women approximately twice as likely to develop dry eye as men. Prolonged digital screen use reduces blink rate by up to 66%, accelerating tear evaporation. Contact lens wear, certain medications (antihistamines, antidepressants, beta-blockers, oral contraceptives), autoimmune conditions (Sjögren's syndrome, rheumatoid arthritis), and previous eye surgery including LASIK can all contribute.

Treatment for dry eye follows a stepwise approach. Mild cases often respond well to preservative-free artificial tears, warm compresses applied to the eyelids for 10 minutes twice daily, and lid hygiene with dedicated cleansing wipes. Environmental modifications — such as using a humidifier, positioning computer screens below eye level, and taking regular screen breaks using the 20-20-20 rule — can also provide meaningful relief.

Moderate to severe dry eye may require prescription anti-inflammatory eye drops (such as ciclosporin), punctal plugs to retain tears on the eye surface, or in-clinic meibomian gland expression to unblock the oil glands. Intense pulsed light (IPL) therapy is an emerging treatment showing promising results for MGD-related dry eye.

At K Vision Centre, Miss Tina Khanam conducts a thorough dry eye assessment that includes tear break-up time measurement, Schirmer's test for tear production, meibomian gland imaging, and corneal staining to identify surface damage. This comprehensive evaluation ensures an accurate diagnosis and a targeted treatment plan.

Importantly, dry eye must be adequately managed before undergoing any refractive or cataract surgery. Untreated dry eye can compromise the accuracy of pre-operative measurements and affect surgical outcomes. If you are considering laser eye surgery or cataract surgery, addressing dry eye first is a critical step in achieving the best possible results.