Dry eyes aren’t just an annoyance — they’re a chronic medical condition that can slowly worsen if left untreated. Most people chalk up burning, watering, or gritty eyes to “just allergies” or “being tired,” but dry eye disease is one of the most common (and most underestimated) conditions we see. And the good news? With the right diagnosis and the right mix of treatments, patients can get dramatic relief.
Let’s break it all down.
Dry eye disease happens when your tears are either poor quality or produced in too little quantity. The tear film has three layers — oil, water, and mucin — and when one part breaks down, the whole system cracks.
Common causes include:
Meibomian gland dysfunction (MGD): The oil glands in the eyelids get clogged or inflamed, leading to evaporative dry eye.
Age: Tear production naturally decreases over time.
Hormonal changes: Especially peri-menopause and menopause in women.
Screen time: Blinking slows down when you stare at screens, causing evaporation.
Contact lenses: They draw water right off the eye.
Autoimmune diseases: Such as Sjögren’s syndrome, rheumatoid arthritis, lupus.
Medications: Antihistamines, antidepressants, beta-blockers, diuretics, etc.
Environmental factors: Wind, AC, smoke, low humidity, CPAP airflow.
Prior eye surgery: Including LASIK and cataract surgery, which can temporarily worsen dryness.
Dry eye can feel completely different from patient to patient. Some don’t even feel “dryness” at all.
Common symptoms include:
Burning
Stinging
Tearing or watering
Grittiness or “sand in the eye”
Blurred vision that fluctuates
Eye fatigue
Light sensitivity
Redness
Contact lens intolerance
One tricky thing about dry eye: eyes can water because they’re dry. Reflex tearing kicks in like a fire alarm, but that watery layer doesn’t fix the underlying oil deficiency.
Untreated dry eye isn’t harmless — it’s inflammatory.
Low-grade, chronic inflammation damages the surface of the eye and slowly destroys the meibomian glands, the tiny oil-producing glands that keep tears from evaporating. Once these glands atrophy, they don’t come back.
Over time, this leads to:
Worse symptoms
More rapid tear evaporation
Increased redness and irritation
Scarring of the eyelid margin
Chronic blepharitis
Dry eye also becomes a vicious cycle: dryness → inflammation → gland blockage → worse dryness.
This is a big one.
Dry eyes can cause:
Unstable measurements (biometry): The tear film is the first refractive surface of the eye—if it’s irregular, calculations for lens power become less accurate.
Post-operative blurred vision: Even if the surgery went perfectly, a rough tear film can make vision seem inconsistent or hazy.
Reduced satisfaction with premium lenses (multifocal, toric, or LAL), since these lenses depend on a pristine tear film to perform well.
For cataract patients, treating dryness before surgery isn’t optional — it’s critical for hitting the refractive target.
There is no single “best” treatment. Dry eye is nearly always multifactorial, which means the best results come from layering therapies.
Here’s the full spectrum of modern options:
The first line for quick symptom relief.
Types include:
Low-viscosity drops for daytime use
High-viscosity gels for more severe dryness
Preservative-free tears, which are essential for frequent use or sensitive eyes
Lipid-based tears (e.g., Retaine MGD, Systane Balance) for oil deficiency
They help—but they’re temporary. Think “moisturizer,” not “cure.”
High-quality omega-3s (particularly triglyceride-based EPA/DHA) can:
Reduce inflammation
Improve the quality of the oil layer
Help stabilize the tear film
Studies are mixed, but clinically many patients improve with consistent use.
These suppress the inflammatory root of dry eye , not just the symptoms.
Restasis (cyclosporine) – increases natural tear production over time
Xiidra (lifitegrast) – reduces inflammatory molecules causing symptoms
Cequa (cyclosporine 0.09%) – a higher-strength nanomicellar formulation
Vevye (cyclosporine 0.1%) – preservative-free and well-tolerated
These are long-term therapies: usually taking 1–3 months to work, but they target the disease itself. However, they do not eliminate the inflammation. If you stop using them, the inflammation will return.
Short courses of low-dose steroids (e.g., Lotemax, fluorometholone) can calm inflammation quickly, often used:
During dry eye flare-ups
When starting Restasis/Xiidra to ease the transition
Before cataract surgery to stabilize the tear film
A regenerative option made from the patient’s own blood.
PRP contains:
Growth factors
Anti-inflammatory components
Healing proteins
PRP can dramatically improve corneal health in moderate to severe dry eye and neurotrophic corneas.
Tiny plugs inserted in the tear drainage ducts that carry tears away from your eyes to keep natural tears on the eye longer.
Good for:
Aqueous deficiency
Patients with chronic dryness who don’t respond to drops alone
Options include temporary collagen plugs or long-lasting silicone plugs.
These actively treat gland blockage—the real cause of evaporative dry eye.
A 12-minute thermal pulsation treatment that warms the glands internally and gently expresses them.
Similar concept, handheld device providing heat and compression.
Uses warming patches on the lids followed by manual gland expression.
A breakthrough treatment for MGD and ocular rosacea.
IPL reduces:
Eyelid inflammation
Abnormal blood vessels
Bacterial load
It improves oil flow and can provide long-lasting relief when performed as a series of treatments. This actually addresses the underlying root cause of dry eyes in a significant and enduring way.
An in-office exfoliation of the eyelid margins that removes:
Biofilm
Bacteria
Debris and mites (Demodex)
A clean lid margin allows the glands to function normally again.
Daily maintenance includes:
Warm compresses
Lid scrubs or foams
Hypochlorous acid sprays
Proper makeup removal
These small steps help keep glands clear and inflammation under control.
Helpful for severe cases or night symptoms, especially for CPAP users.
Dry eye disease is real, progressive, and treatable — but it needs attention early. With chronic inflammation, meibomian glands can deteriorate and permanently reduce oil production. That’s why early diagnosis and a customized treatment plan matter so much.
And if you're a cataract surgery patient, treating dryness is one of the most important steps you can take to ensure sharp, stable vision after surgery.
Every month you wait, your meibomian glands lose function they can’t get back. Take control now — call to schedule your dry eye evaluation today.
