Dry eye syndrome: UK causes, symptoms and treatment

Dry eye syndrome affects an estimated 1 in 4 UK adults and is now the commonest reason for an ophthalmology outpatient appointment. Screen use, contact lenses, air conditioning and an ageing population all push the numbers up. This guide explains the two main types, the treatment ladder, and when a specialist assessment is worth the money.

The two main types

Dry eye is not a single disease. Around 85% of cases are **evaporative dry eye** — the oily layer of the tear film is deficient, so tears evaporate too quickly. The remaining 15% are **aqueous-deficient dry eye** — the lacrimal gland does not produce enough tears. Many patients have elements of both.

Evaporative dry eye is almost always driven by meibomian gland dysfunction (blepharitis). Aqueous-deficient dry eye is more often linked to autoimmune conditions (Sjögren's syndrome, rheumatoid arthritis), age, hormonal change and certain medications.

Symptoms

Classic symptoms are:

- Gritty, sandy or burning sensation

- Fluctuating blurred vision that clears with a blink

- Fatigue after 30 minutes of screen work

- Contact lens intolerance

- Paradoxically, **watery eyes** (reflex tearing — see our epiphora guide)

- Worsening at the end of the day, in air conditioning or on aeroplanes

Risk factors

You are more likely to develop dry eye if you:

- Are female and over 40

- Spend more than 4 hours a day at a screen

- Wear contact lenses

- Take antihistamines, antidepressants, diuretics or hormone-replacement therapy

- Have had refractive surgery (usually short-lived — see laser eye surgery recovery)

- Have rosacea or an autoimmune condition

How dry eye is properly diagnosed

Dry eye is over-diagnosed in the community and under-diagnosed by cause. A structured consultation includes:

- OSDI or SPEED symptom questionnaire

- Tear break-up time (TBUT)

- Ocular surface staining with fluorescein and lissamine green

- Meibomian gland expression and infrared meibography

- Schirmer's test if aqueous-deficiency is suspected

- Osmolarity or MMP-9 point-of-care testing where available

This identifies the subtype and drives targeted treatment rather than generic drops.

The treatment ladder

**Step 1 — self-care.** Preservative-free lubricants 4×/day, screen breaks (20/20/20 rule), room humidifier, warm compresses and lid hygiene twice a day.

**Step 2 — added interventions.** Omega-3 supplementation, gel drops at night, punctal plugs to preserve natural tears, and a course of oral doxycycline for rosacea-related MGD.

**Step 3 — prescription drops.** Ciclosporin (Ikervis) or lifitegrast for chronic inflammation; short courses of steroid drops for flares.

**Step 4 — advanced treatments.** LipiFlow thermal pulsation, intense pulsed light (IPL) for MGD with rosacea, autologous serum drops for severe surface disease, and scleral contact lenses.

Most patients are well controlled at steps 1–2. It is worth investing time in getting these right before spending on advanced treatments.

Dry eye and surgery

Dry eye must be settled before cataract or refractive surgery. Poor tear film distorts corneal measurements and gives inaccurate intraocular lens calculations, so a treated dry-eye patient sees far better after surgery than an untreated one.

Next steps

If your dry eye is not settling with over-the-counter drops, you would benefit from a structured assessment. Book a private consultation or call **020 3137 3237** — we complete diagnostic testing, meibography and a personalised treatment plan in a single visit.