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DRY EYE SYNDROME
Diagnosis and treatment
PATIENTS - FACT SHEET
What is it?
How is it treated?
Dry eye syndrome is a disorder of the tear film due to tear
Lifestyle and environment
deficiency or excessive evaporation, which causes the eyes
Following a diagnosis of dry eye syndrome, your doctor or
to become dry, inflamed and uncomfortable and damages
optometrist will initially focus on identifying and addressing
the ocular surface. There are two main causes of dry eye:
lifestyle/environmental factors that may cause or worsen your
firstly a condition in which the eyes can’t make enough
symptoms. These include:
tears, sometimes called keratoconjunctivitis sicca, and
• Smoky or dusty environments
secondly where the tears evaporate too quickly. The most
• Air conditioning/heaters in the home or car
common cause of excessive tear evaporation is blockage and
• Prolonged viewing of computer screens
dysfunction of the Meibomian oil glands in the eyelids causing
• Contact lens wear
inflammation of the rims of the eyelids, which is also known
• Use of redness-relieving eyedrops such as witch hazel
as blepharitis.
How is it diagnosed?
A good level of daily water intake will also be encouraged
to aid hydration. As omega-3 fatty acids may reduce tear
Your GP may make a diagnosis of dry eye syndrome by
evaporation and inflammation, oral supplements or dietary
reviewing your symptoms and examining your eyelids,
intake via oily fish (salmon, sardines) or flax seed oil is also
considering your medical history and looking at any medicines
often recommended.
that you may be taking. An examination may also be carried
out to check for other conditions and complications.
Treatment of excessive tear evaporation:
Following your initial consultation, your GP may refer you to
Meibomian gland dysfunction (blepharitis) treatment
an optometrist for a complete eye check-up. An optometrist
will use specialist equipment to confirm whether you have
Hot eyelid compresses and massage
dry eye syndrome, blocked Meibomian glands (blepharitis)
Blockage and dysfunction of the Meibomian oil glands in the
or other conditions.
eyelids (posterior blepharitis) is treated by using heat to warm
Will I need to see a hospital doctor?
up the oil glands and massage to encourage Meibomian oil to
be expressed normally from the eyelids. Heat can be applied
If the diagnosis of dry eye syndrome is uncertain or specialist
to the eyelids with a folded up small flannel or face towel
tests and treatment are required, your GP may refer you to an
soaked in moderately hot water (not so hot as to burn the
ophthalmologist. These are hospital doctors who specialise
skin, but quite hot) and applied approximately 6 times given
in eye disorders and surgery. The vast majority of cases,
that the towel loses its heat every 30 seconds, to give a total
however, do not need referral.
of 3 minutes of heat on the eyelids. Alternatively a hot eye
mask can be used for 3 – 5 minutes, for example the EyeBag
http://www.eyebag.org/. Unblocking the Meibomian oil glands
restores natural Meibomian “oily tears” to the tear film and
ocular surface, which is important because this water-proof
oily barrier stops evaporation of aqueous (watery) tears.
Restoring this source of natural “oily tears” to the surface of
Lifestyle modifications
the eye can reduce the frequency of needing water-based
A skin condition called rosacea is often associated with
artificial tears and lubricants in the eyes.
Meibomian oil gland blockage. Factors which exacerbate
rosacea include factors associated with facial flushing,
Eyelash cleaning
such as eating hot chilli and curries, and alcohol. Avoiding
If there is any stickiness of the eyelashes (usually noticed first
these factors or minimising them for a few months can help
thing in the morning on awakening), crusting or debris on the
during an exacerbation of Meibomian oil gland blockage.
eyelashes then this is called anterior blepharitis. The sticky
Eating oily fish rich in omega-3 fatty acids and flax seed oil
debris is due to thickened toothpaste-like material being
supplementation have also been reported to improve function
expressed from the Meibomian oil glands, rather than smooth
of the Meibomian oil glands.
clear oil. Stickiness of the eyelashes is treated by cleaning
the eyelashes using a cotton bud and cooled boiled water,
Treatment of keratoconjunctivitis sicca (lack of aqueous
dilute bicarbonate of soda, dilute baby shampoo or proprietary
tear production):
preparations such as LidCare or Blephagel.
Artificial tears and lubricants
Oral antibiotics
The term ‘artificial tears’ is commonly used to describe drops,
A 3 month course of oral tetracyclines such as doxycycline
solutions and liquid gels applied directly into the eye. Artificial
helps to restore Meibomian oil gland function, reduce
tears don’t have all the components of real tears - they mainly
inflammation of the ocular surface and eyelids and promote
just act as a lubricant. The term ‘ocular lubricants’ generally
production of better quality tears. Antibiotics are used
refers to more viscous products such as ointments. Your
here in a similar fashion to treatment of acne oil glands by
doctor or optometrist may recommend or prescribe artificial
dermatologists, rather than solely for their anti-bacterial effect.
tears or an ocular lubricant in addition to addressing the above
Topical azithromycin antibiotic eye drops have recently been
lifestyle and environmental factors. If frequent use of artificial
shown to have a similar effect on Meibomian oil gland function
tears or ocular lubricants does not control dry eye symptoms,
as oral tetracyclines do.
hydroxypropyl methylcellulose inserts (lacriserts) may be
considered. These are small pellets that contain artificial tears.
Artificial tears and lubricants
They must be inserted under the eyelid once-daily, to help
Replenishment of tears and lubrication to the ocular
keep the surface of the eye moist..
surface is important in the setting of rapid tear evaporation.
This is discussed further below, in treatment of
keratoconjunctivitis sicca.
Anti-inflammatory eye drops and ointments
A limited course of steroid eye drops and ointments may
be necessary if there is a lot of inflammation on the ocular
surface associated with the blepharitis (blepharoconjunctivitis).
Blepharoconjunctivitis is not an infection which can
be transmitted to others. It is a term used to describe
inflammation of the mucosal lining covering the white of the
eyeball and the undersurfaces of the eyelids (conjunctivitis)
which is associated with blepharitis. Topical cyclosporine is
a steroid-sparing anti-inflammatory treatment which
promotes improved Meibomian oil gland function and
increased tear production, but has a slow onset of effect,
usually several months.
Punctual occlusion
Salivary gland autotransplantation
If frequent use of artificial tears or ocular lubricants does not
In this procedure, some of the glands that produce
control dry eye symptoms, providing blepharitis has been
saliva are removed from the lower lip and grafted into
treated, insertion of small plugs to seal the tear drainage
the side of the eyes. The saliva produced by the glands
passages near the nose, helps tears to pool and thus protect
acts as a tear-substitute. This procedure is not frequently
the eyes. Temporary plugs made of silicone are normally used
performed now because the quality of salivary tears does not
first to see if there is a positive effect. If so, the tear drainage
replicate that of natural tears.
passages can be permanently sealed shut, using a laser
or cautery.
Consult your doctor or optometrist if you think you may
need treatment for dry eye syndrome.
Medicines
Further information can be found in our fact sheet
Anti-inflammatory medicines including topical steroids
‘Dry Eye Syndrome – Causes and Symptoms’
and topical cyclosporine can be used to help reduce the
inflammation associated with more severe cases of dry
eye syndrome. Anti-mucus eye drops can help in severe
dry eye, to improve the quality of the tear film and reduce
eye discomfort. Specialist oral medication in the form
of tear secretagogues may be necessary in advanced
keratoconjunctivitis sicca. Your doctor will provide more
information on these if they are needed.
Specialised spectacles
Some cases of dry eye syndrome can be treated using
specially made glasses, known as moisture chamber
spectacles. These wrap around the eyes like goggles,
helping to retain moisture and protecting the eyes
from irritants. Their popularity is increasing as modern
designs look like sports sunglasses, unlike the more
cumbersome appearance of earlier versions.
Specialist contact lenses
If regular contact lenses are causing dry eye syndrome,
specially designed ones are available to help overcome
the problem. Your optometrist or ophthalmologist
will be able to give you more information on contact
lens options.
Surgery
Surgical procedures including reducing the eyelid aperture
may be an option if dry eye syndrome doesn’t respond to
other forms of treatment.