Dry Eye Syndrome (Keratoconjunctivitis Sicca)

A Common, Treatable Eye Condition

What is Dry Eye Syndrome?

Dry eye syndrome occurs when your eyes don’t make enough tears, or when the tears you do produce evaporate too quickly. This causes the surface of your eyes to become dry and inflamed. Dry eye is a chronic but manageable condition that can affect daily life if not properly treated.

The Tear Film: A Delicate Balance

Healthy tears contain:

• Aqueous (water) – Keeps eyes moist and nourished
• Oil (lipid) – Prevents evaporation, produced by Meibomian glands in the eyelids
• Mucus – Spreads the tear film evenly across the eye surface

Disruption in any part of this system can lead to dry eye.

Common Causes of Dry Eye

• Aging and hormonal changes, especially after menopause
• Medications: antihistamines, antidepressants, beta-blockers, contraceptives, opioids, and acne drugs (e.g., isotretinoin)
• Laser eye surgery (temporary post-LASIK dryness)
• Blepharitis or Meibomian Gland Dysfunction (MGD)
• Autoimmune diseases: Sjögren’s syndrome, lupus, rheumatoid arthritis
• Environmental exposure: wind, air conditioning, screens
• Neurological conditions: Bell’s palsy, stroke
• Contact lens wear

Symptoms of Dry Eye

• Gritty, sandy, or burning feeling
• Redness or eye fatigue
• Blurred vision
• Stringy mucus
• Light sensitivity
• Watery eyes (a reflex to dryness!)
• Less tearing when crying

Symptoms may worsen in:

• Windy or dry environments
• Central heating or air-conditioned rooms
• During prolonged screen use

Diagnosis

Dry eye is diagnosed using:

• Slit-lamp exam – A magnified look at your eye
• Tear Break-Up Time (TBUT) – Measures tear stability using fluorescein dye
• Schirmer test – Measures tear production with paper strips
• Staining tests – Detect surface damage using special dyes
• Meibography – Visualises oil glands in eyelids (in more advanced clinics)

Modern Treatment Approaches

1. Tear Film Replacement

• Artificial tear drops – Regular use is essential. Preservative-free options are best if used more than 4x/day (e.g., Thealoz Duo, Hycosan Extra, Systane Hydration)
• Eye gels & ointments – Thicker and longer-lasting (e.g., Viscotears®, Lacrilube®), ideal for night use
• Mucolytic drops – Break up stringy mucus (e.g., acetylcysteine/Ilube®)
• Lipid-based sprays – Support the oily tear layer (e.g., Optrex Actimist)

Note: Always discard single-dose vials after use and replace opened bottles after 28 days.

2. Preserving Existing Tears

• Environmental changes:
  • Use humidifiers
  • Reduce screen time or follow the 20-20-20 rule
  • Avoid drafts, fans, or smoke
• Lifestyle adjustments:
  • Hydrate well (6–8 glasses/day)
  • Ensure 7–8 hours of sleep
  • Reduce caffeine and alcohol
  • Include omega-3 rich foods (e.g., flaxseed, oily fish) or supplements
• Manage blepharitis with lid hygiene (see Blepharitis leaflet)
• Treat systemic inflammation (autoimmune conditions)
• Immunosuppressive drops: Cyclosporine A (e.g., Ikervis®, Cequa®) may be prescribed to reduce surface inflammation

3. Reducing Tear Drainage

• Punctal plugs – Inserted into tear ducts to keep moisture on the eye
  • Temporary (collagen) or semi-permanent (silicone)
  • Easily done in clinic
• Thermal cauterisation – Permanent option for severe dry eye, done only if plugs are successful

Emerging Therapies and Devices

• IPL (Intense Pulsed Light) – Reduces inflammation in Meibomian gland dysfunction
• LipiFlow® Thermal Pulsation – Clears blocked oil glands
• Autologous serum drops – For severe or refractory dry eye (made from your own blood)
• Manuka honey eye drops – Shown to reduce inflammation and microbial growth

Self-Care & Prevention Tips

• ✅ Use warm compresses (e.g., Optase, MGDRx EyeBag, EyeSoothe)
• ✅ Maintain regular lid hygiene with Blephaclean® wipes or tea tree cleansers
• ✅ Take omega-3 and vitamin D supplements if deficient
• ✅ Use sunglasses outdoors to reduce evaporation
• ✅ Follow screen hygiene: frequent blinking, breaks, and proper lighting

When to Seek Help

• Symptoms persist despite regular self-care
• Eye pain or vision changes
• Redness, discharge, or light sensitivity worsens