Dry Eye Relief: Causes, Treatments and What Actually Works

What Is Dry Eye Syndrome?

Dry eye syndrome (DES), also known as keratoconjunctivitis sicca, is one of the most prevalent ocular conditions in the UK, affecting an estimated 1 in 3 people at some point in their lives. It occurs when the tear film — the thin, multilayered coating that protects and lubricates the ocular surface — is either insufficient in quantity or poor in quality.

The tear film has three layers: an outer lipid layer (produced by the meibomian glands) that prevents evaporation, a middle aqueous layer (produced by the lacrimal glands) that provides hydration and nutrients, and an inner mucin layer that anchors the tear film to the corneal surface. Disruption to any of these layers can result in dry eye symptoms.

Types of Dry Eye: Aqueous-Deficient vs Evaporative

Understanding the type of dry eye is essential for selecting the right treatment:

• Aqueous-deficient dry eye (ADDE) — the lacrimal glands produce insufficient tears. Less common, accounting for roughly 10–15% of cases. Associated with Sjögren's syndrome and other autoimmune conditions.
• Evaporative dry eye (EDE) — the most common form, responsible for up to 85% of cases. Caused primarily by meibomian gland dysfunction (MGD), where the lipid layer is compromised and tears evaporate too quickly.
• Mixed dry eye — a combination of both, which is increasingly recognised as the most prevalent presentation in clinical practice.

Common Causes and Risk Factors

Dry eye is multifactorial. Key contributing factors include:

• Screen use — reduced blink rate during prolonged screen time (from ~15 blinks/min to ~5) significantly increases tear evaporation
• Age — tear production naturally declines with age; post-menopausal women are particularly susceptible due to hormonal changes affecting meibomian gland function
• Contact lens wear — lenses disrupt the tear film and increase evaporation
• Environmental factors — air conditioning, central heating, low humidity, and wind all accelerate tear evaporation
• Medications — antihistamines, antidepressants, beta-blockers, and oral contraceptives can reduce tear production
• Refractive surgery — LASIK and PRK can temporarily or permanently reduce corneal nerve density, impairing the blink reflex
• Systemic conditions — rheumatoid arthritis, lupus, thyroid disease, and diabetes are all associated with dry eye

Recognising the Symptoms

Dry eye symptoms are often paradoxical — many patients with dry eye experience watery eyes, as the ocular surface triggers reflex tearing in response to irritation. Other common symptoms include:

• A persistent gritty, sandy, or foreign body sensation
• Burning or stinging, particularly in the afternoon or evening
• Redness and light sensitivity
• Blurred vision that fluctuates with blinking
• Discomfort when reading, driving, or using screens
• Difficulty wearing contact lenses

Evidence-Based Treatments

1. Lubricating Eye Drops (Artificial Tears)

The first-line treatment for most dry eye presentations. Drops vary significantly in their composition and mechanism:

• Hyaluronic acid (sodium hyaluronate) — a viscoelastic polymer with excellent water-retention properties. Widely supported by clinical evidence as an effective lubricant. Found in products such as Thealoz Duo and Hycosan.
• Trehalose — a disaccharide that protects corneal epithelial cells from desiccation stress. Thealoz Duo combines trehalose with hyaluronic acid for dual-action protection.
• Manuka honey — has demonstrated antimicrobial and anti-inflammatory properties in ocular surface research. Optimel Manuka Dry Eye Drops are specifically formulated for this application and are particularly useful where blepharitis or MGD is a contributing factor.

2. Eye Sprays and Mists

For patients who find instilling drops difficult, or who wear contact lenses, lid sprays offer a convenient alternative. The Optase Comfort Dry Eye Spray and Blink Refreshing Eye Mist are applied to closed eyelids and work by stabilising the lipid layer of the tear film.

3. Warm Compresses and Lid Hygiene

For evaporative dry eye driven by MGD, warming the eyelids to approximately 40–45°C for 10 minutes softens the meibum (the waxy secretion of the meibomian glands), improving lipid layer quality. This should be followed by gentle lid massage and, where blepharitis is present, lid hygiene with a dedicated cleanser. Clinical guidelines from the Tear Film & Ocular Surface Society (TFOS) DEWS II report support this as a core component of MGD management.

4. Omega-3 Supplementation

Omega-3 fatty acids (EPA and DHA) have anti-inflammatory properties and have been shown in several randomised controlled trials to improve meibomian gland function and reduce dry eye symptoms. The TFOS DEWS II report includes omega-3 supplementation as a recommended intervention for evaporative dry eye.

5. Prescription Treatments

For moderate-to-severe dry eye unresponsive to OTC treatments, clinicians may consider:

• Cyclosporine A (Ikervis) — an immunomodulatory drop that reduces ocular surface inflammation
• Lifitegrast (Xiidra) — a lymphocyte function-associated antigen-1 antagonist approved for dry eye disease
• Autologous serum eye drops — derived from the patient's own blood, used in severe cases

Building a Dry Eye Routine

Consistency is key. A structured approach yields better outcomes than sporadic treatment:

• Morning — warm compress (10 min) + lid massage + lubricating drops
• During the day — preservative-free drops as needed; take regular screen breaks using the 20-20-20 rule (every 20 minutes, look 20 feet away for 20 seconds)
• Evening — lid hygiene if blepharitis is present; nighttime gel or ointment for severe cases

Ocular Express Dry Eye Solutions

We've curated a range of clinically supported dry eye products to suit different presentations and severities. Our bundles are designed to provide a complete, cost-effective solution:

• Ocular Express Essentials Dry Eye Relief Bundle — ideal for mild-to-moderate dry eye
• Ocular Express Comprehensive Dry Eye Solution — a complete protocol for moderate dry eye
• Ocular Express Ultimate Dry Eye Restoration System — our most complete offering for persistent or severe dry eye
• Eye Doctor Dry Eye Intensive Bundle — a trusted clinical-grade option

When to See a Specialist

Consult an optometrist or ophthalmologist if:

• Symptoms persist despite monthly consistent OTC treatment for dry eye
• You experience significant pain, sudden vision changes, or photophobia
• You suspect an underlying systemic condition may be contributing
• You are considering or have had refractive surgery

A slit-lamp examination and tear film assessment (including meibography to evaluate meibomian gland structure) can identify the specific subtype of dry eye and guide targeted treatment.

This article is intended for informational purposes only and does not constitute medical advice. Always consult a qualified eye care professional for a diagnosis and personalised treatment plan.