Dry Eye Disease
Establishing which type of dry eye you have, and treating that cause.
Overview
Dry eye is the condition most often dismissed and one of the most disruptive to daily life. In Dubai it is close to universal: dry outdoor air, constant air conditioning, dust, and long hours at a screen, which by itself reduces how often we blink by more than half.
Effective treatment depends on knowing which kind you have. In one form the tear gland simply produces too little. In the other — far more common — the tiny oil glands in the eyelids become blocked, so the tears that are made evaporate within seconds. Most people have some of both. Prescribing drops without establishing which is at work is why so many patients conclude that nothing helps.
When to seek assessment
- Grittiness, burning, or a feeling of sand in the eye
- Watering eyes, especially outdoors or in the wind
- Vision that blurs and then clears when you blink
- Red, heavy eyelids by the end of the afternoon
- Contact lenses becoming uncomfortable after a few hours
- Symptoms that worsen with screens, air conditioning or flying
Diagnosis
How the assessment is made
Tear film analysis
Measurement of how long your tears stay stable between blinks (break-up time), how much tear you produce (Schirmer test), and how concentrated the tears have become.
Lipid layer interferometry
A scan that measures the thickness of the oily film covering your tears — the layer that stops them evaporating. It shows in numbers what the eye only hints at on examination.
Imaging of the oil glands
An infrared photograph of the glands inside your eyelids shows whether they are blocked, shortened or already lost. It is the single most useful test in dry eye, and it is painless.
Surface staining
A harmless dye shows exactly where the surface has become irritated, giving an objective baseline to measure treatment against.
Eyelid and blink assessment
Lid inflammation, mites, incomplete blinking and lid position are each looked for, as each needs a different treatment.
Treatment
Options and what each one is for
The right lubricant, on a schedule
Preservative-free drops matched to your type of dry eye, with a clear routine rather than "use as required" — which usually means "use too late".
Thermal pulsation (LipiFlow®)
A twelve-minute in-clinic treatment that warms the inner surface of the eyelids to a controlled temperature while gently massaging them, clearing blocked oil glands in a way warm compresses at home cannot reach.
Intense pulsed light (IPL)
Pulses of light applied to the skin around the eyes, which reduce inflammation and improve oil flow. Particularly effective where rosacea or persistent lid inflammation is part of the problem. Usually a course of three to four sessions.
Warm compression and gland expression
Heat therapy delivered in clinic followed by manual expression of the glands, together with lid hygiene and a home routine that maintains what the treatment achieves.
Calming the inflammation
Where inflammation is driving the cycle, prescription anti-inflammatory drops, a short course of steroid, or oral omega-3 and low-dose antibiotic treatment.
Keeping the tears you have
Tiny plugs placed painlessly in the tear drainage openings, so that natural tears stay on the eye for longer.
Serum drops for severe cases
For surfaces that have not responded to anything else, drops prepared from your own blood serum, which contain natural healing factors that manufactured tears cannot.
Recovery
What to expect afterwards
After an in-clinic treatment
You can return to normal activity immediately. Thermal pulsation is felt as gentle warmth and pressure; after IPL the skin may look slightly pink for a few hours. Benefit usually builds over four to six weeks.
Weeks one to four
Comfort usually improves first. Gland treatment needs consistency before results appear — keeping to the routine matters more than the brand of drop.
Weeks six to twelve
The same measurements are repeated so that improvement is seen rather than assumed, and treatment is stepped up or down accordingly.
Long term
Dry eye is managed rather than cured. The aim is a maintenance routine light enough that you will keep it, with a review twice a year.
Questions
Frequently asked
If your question is not answered here, it is welcome in consultation — or by message before you book.
An unstable tear film irritates the surface, and the eye responds by flooding itself with watery tears. These have no oily layer to hold them in place, so they spill over. Watering is very often a sign of dryness rather than proof against it.