Dry eye disease is a condition in which the tear film — the thin layer of fluid that covers the surface of the eye — is either insufficient in quantity, poor in quality, or both.

A healthy tear film is essential for comfortable vision. It lubricates and protects the ocular surface, provides nutrients to the cornea, clears debris with each blink, and creates the smooth optical surface needed for clear sight.

When the tear film fails — whether because not enough tears are produced, or because the tears that are produced evaporate too quickly — the result is an exposed, irritated ocular surface. That's dry eye disease.

It affects an estimated one in four people in the UK to some degree. Many have never had it properly diagnosed or treated.

The tear film — what it is and why it matters

The tear film has three main components, each produced by different structures:

The mucin layer sits closest to the eye surface and is produced by goblet cells in the conjunctiva. It allows the watery layer above it to spread evenly and adhere to the ocular surface.

The aqueous layer forms the bulk of the tear film and is produced by the lacrimal gland. It contains water, electrolytes, proteins, and growth factors that nourish and protect the cornea.

The lipid layer sits on the outermost surface and is produced by the meibomian glands in the eyelids. It acts as a seal — slowing evaporation and keeping the aqueous layer intact between blinks.

A problem with any one of these components can destabilise the whole tear film. Most dry eye disease involves a problem with the lipid layer — which is why meibomian gland health is so central to dry eye treatment.

Types of dry eye disease

Dry eye disease is broadly divided into two main types, though most patients have a degree of both:

Evaporative dry eye The most common type. Tears are produced in adequate quantity but evaporate too quickly because the lipid layer is deficient. The most common cause is meibomian gland dysfunction — when the oil-producing glands in the eyelids become blocked or dysfunctional, the protective lipid layer breaks down.

Other contributors to evaporative dry eye include blepharitis, Demodex infestation, incomplete blinking, low blink rate from screen use, and environmental factors such as air conditioning and low humidity.

Aqueous deficient dry eye The lacrimal gland produces insufficient watery tears. This can occur as a natural consequence of ageing, as a side effect of certain medications, in autoimmune conditions such as Sjögren's syndrome, or following damage to the lacrimal gland or its nerve supply — including post-surgical dry eye following LASIK.

Mixed dry eye Many patients have elements of both types. Evaporative dry eye left untreated can lead to secondary aqueous deficiency over time, as chronic ocular surface inflammation damages the lacrimal gland and goblet cells. This is one reason early, effective treatment matters.

What causes dry eye disease?

Dry eye has many contributing causes — which is one reason it's often underdiagnosed and undertreated. Common drivers include:

Meibomian gland dysfunction The leading cause of dry eye worldwide. When the oil-producing glands in the eyelids stop working properly, the lipid layer of the tear film breaks down. MGD is present to some degree in a very large proportion of the adult population — often without awareness.

Age Tear production and meibomian gland function both decline with age. Dry eye is more common and more severe in older adults, though it affects people of all ages.

Hormonal changes Oestrogen and androgen levels influence tear film production. Dry eye is significantly more common in women, particularly around menopause. HRT, the contraceptive pill, and other hormonal medications can also affect tear film stability.

Screen use Prolonged screen use significantly reduces blink rate and blink completeness — the eye simply doesn't blink fully or often enough to maintain a healthy tear film. Digital eye strain and dry eye are closely related.

Contact lens wear Lenses disrupt the tear film, increase bacterial load on the lid margin, and gradually reduce corneal sensitivity over time — all of which contribute to dry eye.

Medications A wide range of commonly prescribed medications reduce tear production or alter tear film composition, including antihistamines, antidepressants, beta-blockers, diuretics, and HRT.

Systemic conditions Autoimmune conditions including Sjögren's syndrome, rheumatoid arthritis, and lupus are associated with significant dry eye. Rosacea, thyroid disease, and diabetes also affect the ocular surface.

Environmental factors Low humidity, air conditioning, heating, wind, and high altitude all accelerate tear evaporation and worsen dry eye symptoms.

Previous eye surgery LASIK and other forms of refractive surgery disrupt corneal nerves and can cause significant post-operative dry eye — see our dedicated Post-LASIK Dry Eye page for more detail.

Why drops alone often aren't enough

Eye drops are the most commonly recommended treatment for dry eye — and for mild cases, they can be sufficient. But for many patients, drops address the symptom rather than the cause.

If the meibomian glands aren't producing adequate oil, drops can temporarily lubricate the eye but they don't restore gland function. If the lid margins are inflamed and colonised with bacteria or Demodex mites, drops won't clear the infection. If the tear film is unstable because of underlying MGD, blinking away drops simply restores the same unstable situation a few minutes later.

Effective treatment of dry eye disease means identifying what's actually driving it — and addressing that directly. That requires a proper assessment, not just a prescription for lubricating drops.

The dry eye cycle

Dry eye is often self-perpetuating. A disrupted tear film exposes the ocular surface, triggering inflammation. That inflammation damages the surface cells and the glands that produce the tear film components — making the tear film worse. A worse tear film increases inflammation further.

Breaking this cycle requires treatment that targets the underlying drivers — gland dysfunction, lid margin disease, inflammation — rather than just supplementing the tears that are missing.

Explore the conditions driving your dry eye

Dry eye disease rarely exists in isolation. Most patients have one or more underlying conditions contributing to their symptoms. Use the links below to learn more about each:

• Meibomian Gland Dysfunction
• Blepharitis
• DemodexBlepharitis
• OcularRosacea
• Post-LASIK Dry Eye
• ContactLens Dry Eye
• Dupilumab Ocular Surface Disease

Explore our treatments

We offer a range of specialist treatments targeting the underlying causes of dry eye disease:

• IPL Therapy
• LLLT — Red & Blue Light Therapy
• ZEST Eyelid Treatment
• NuLids

Frequently asked questions

Is dry eye disease serious? For most people dry eye is a chronic but manageable condition rather than a sight-threatening one. However, significant untreated dry eye can cause corneal damage over time, and the impact on quality of life — affecting work, sleep, screen use, and driving — should not be underestimated.

Can dry eye be cured? For some patients — particularly where there is a single identifiable and reversible cause — symptoms can resolve completely. For most, dry eye is a condition to be managed long term. With the right treatment approach, symptoms can be very significantly reduced and quality of life restored.

How do I know what type of dry eye I have? A proper assessment is the only way to know. Symptoms alone don't reliably distinguish between evaporative and aqueous deficient dry eye, or identify the underlying drivers. That's what a specialist dry eye assessment is for.

Are there things I can do at home to help? Yes — warm compresses, omega-3 supplementation, appropriate lid hygiene, staying well hydrated, reducing screen time, and managing environmental factors all contribute. We'll advise on a home care routine as part of any treatment plan.

When should I see a specialist? If you've been using drops regularly for more than a few weeks without lasting relief, if your symptoms are affecting your daily life, or if you've never had a proper dry eye assessment — now is a good time.

Start with a proper assessment

Understanding what's driving your dry eye is the foundation of effective treatment. A dry eye assessment at our clinic will examine your tear film, your meibomian glands, your eyelid margins, and your ocular surface — and give you a clear, honest picture of what's going on and what will help.

📍 Openshaw Opticians, Unit 4, 16 Cheapside, Cleckheaton, BD19 5AF 

📞 01274 878214