Dry eye is one of the most common things we treat, and one of the most under-treated. Most people assume burning, watering, or gritty eyes are just something to live with, or they cycle through drops from the pharmacy for years without much relief. It doesn't have to be that way, but it does require figuring out why your eyes are dry before treating them.
It doesn't always feel dry
The name is misleading. Dry eye shows up as:
Burning, stinging, or a gritty feeling, like there's sand in your eye
Watery eyes — yes, watery. Reflex tearing is a classic response to a dry, irritated surface.
Vision that blurs and then clears when you blink
Redness, especially late in the day
Eyes that feel tired or heavy after reading or screen work
Contact lenses that used to be comfortable and now aren't
Crusting or irritation along the lash line in the morning
Why it happens
Your tear film is composed of three layers: an oily outer layer, a watery middle, and a mucous layer that helps it stick. Dry eye means something is off in that system, and the fix depends entirely on which part.
Evaporative dry eye is the most common form. The meibomian glands in your eyelids are responsible for producing the oil layer. They can get blocked or thickened, so your tears evaporate too fast. You can be making plenty of tears, but they’re evaporating too quickly to provide you with relief.
Aqueous-deficient dry eye means you aren't producing enough tear volume. This is more common with age, with certain medications, and with some autoimmune conditions.
Inflammation is usually part of the picture either way, and it's self-perpetuating: a dry surface gets inflamed, and an inflamed surface makes worse tears.
Screen time, contact lens wear, Santa Ana winds and low humidity, air conditioning, LASIK allergies, and a long list of common medications all make it worse.
We can show you your meibomian glands
Most dry eye care is guesswork about structures nobody has actually looked at. We use a MYAH imaging system to take an infrared photograph of the inside of your eyelids, which makes your meibomian glands visible — all of them, in a single image.
Healthy glands look like long, evenly spaced vertical lines running the length of the lid. When glands are blocked, shortened, twisted, or missing altogether, you can see it immediately. And so can you — we'll turn the screen around and walk you through your own images.
It explains your symptoms. If two-thirds of your glands are gone, that's why the drops aren't working. No amount of artificial tears replaces oil your body isn't producing.
Gland loss doesn't come back. Meibomian glands that have atrophied are gone for good. What treatment does is protect the ones you still have and get them working properly.
It lets us track you honestly. We keep your images on file, so at your next visit we're comparing pictures rather than comparing memories of how your eyes felt.
Your dry eye evaluation
A dry eye workup is different from a routine exam. We're looking at the surface of your eye and the structures that keep it healthy:
A detailed history of your range and duration of symptoms, medications, and environment
Evaluation of your tear film: how much you're producing and how quickly it breaks down
Assessment of the corneal and conjunctival surface with staining, to see where the damage is
Evaluation of your eyelids and lash line
That's what tells us whether you need better oil, more volume, less inflammation, or some combination — and that's the difference between treatment that works and years of artificial tears that don't.
How we treat it
Treatment is layered. Most people start with the simpler options and add from there.
At home. Warm compresses and lid hygiene, done consistently, do real work for evaporative dry eye — but most people do them for a week and stop, or don't get the lids warm enough for long enough. We'll show you how to do it so it actually helps. We'll also go over which artificial tears to use and which to avoid; preserved drops used many times a day can make things worse.
Nutrition and environment. Omega-3 supplementation, a humidifier, adjusting your screen setup, and reviewing medications with your primary doctor all contribute more than people expect.
Prescription treatment. When inflammation is driving the cycle, prescription drops like Restasis, Xiidra, or Cequa can break it. They may take weeks to months to show their full effect, and knowing that up front is half the battle of sticking with them. Miebo is another prescription drop that focuses on treating the evaporative component, keeping your tears on your eyes for longer. Short courses of steroid drops are sometimes used to get symptoms under control while a long-term treatment takes hold. However, steroid drops may increase your risk of glaucoma and cataracts, which is why you should only use them at the discretion of your doctor.
Specialty contact lenses. For more severe surface disease, scleral lenses hold a reservoir of fluid against the cornea all day. They're both a vision correction and a treatment.
A word about expectations
Dry eye is usually managed rather than cured. The goal is getting you comfortable and keeping your eye surface healthy, and that generally means a few visits to find the right combination and periodic check-ins to keep it working. Anyone who promises a one-visit fix isn't being straight with you.
When dry eye is a sign of something else
Dry eye is sometimes the first sign of an autoimmune condition like Sjögren's disease, rheumatoid arthritis, or thyroid disease. If your history suggests it, we'll tell you and coordinate with your primary care doctor rather than just treating the surface.
Related: Read more about the MYAH and the rest of our diagnostic equipment on our Technology page. If your symptoms are worse during screen work, our Digital Eye Strain page covers that overlap. Dry eye also affects contact lens comfort and is often what's behind lenses that stopped feeling good
Tired of eyes that never feel right?
Book a dry eye evaluation and bring a list of every drop you've tried and every medication you take.
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