Ocular surface

Dry eye: when your eyes feel heavy, burning and tired.

Dry eye syndrome is one of the most common — and most under-diagnosed — eye conditions. It affects one in three people over 50, especially women, and many people who spend long hours at a screen.

Do you have any of these symptoms?

A gritty, burning or itchy feeling in your eyes.
Fluctuating blurred vision that improves when you blink.
Heavy, tired eyes, especially in the afternoon.
Sensitivity to air conditioning, wind or central heating.
Frequent use of artificial tears without lasting relief.
Paradoxically, excessive watering at times (yes, dry eyes water).

If several of these sound familiar, you probably have some degree of tear film dysfunction.

Why dry eye happens

Tears are much more complex than "eye water". They have three layers: an oily layer (which prevents evaporation), a watery layer (most of the volume) and a mucus layer (which anchors the tears to the cornea). Dry eye appears when one of these layers fails:

Evaporative dry eye (most common): the meibomian glands, which produce the oily layer, do not work properly. It is often linked to blepharitis.
Aqueous-deficient dry eye: not enough tears are produced. Common in autoimmune diseases (Sjögren's syndrome, rheumatoid arthritis).
Mixed dry eye: a combination of both.

Aggravating factors: age, menopause, constant screen use, contact lenses, heated rooms, previous refractive surgery and some medicines (antihistamines, antidepressants, hormone treatments).

A personalised diagnosis

The first step is to find out which type of dry eye you have, because treatment varies greatly depending on the cause. In the clinic we carry out:

A validated symptom questionnaire (OSDI).
Slit-lamp examination with dyes (fluorescein, lissamine green).
Schirmer test (tear production).
Tear break-up time (TBUT).
Assessment of the meibomian glands and any associated blepharitis.

Available treatments

Treating dry eye is not just "using drops". It is a stepped, personalised plan:

Eyelid hygiene

Essential when there is blepharitis: a daily routine with specific products, eyelid massage and, in selected cases, in-clinic treatments.

Lubricants

Preservative-free artificial tears matched to your profile. Formulations differ a lot depending on which part of your tear film is failing.

Anti-inflammatory treatment

For chronic inflammation of the eye surface: short courses of steroids, topical ciclosporin, lifitegrast.

Advanced therapies

Autologous serum and platelet-rich plasma eye drops for severe cases. Punctal plugs to keep your own tears on the eye.

Everyday tips

If you work at a screen, follow the 20-20-20 rule: every 20 minutes, look at something 20 feet (6 metres) away for 20 seconds.
Blink consciously, especially at a screen (blinking drops by about 60 % when looking at a monitor).
Use a humidifier in heated rooms.
Avoid air conditioning blowing directly on your face.
Stay well hydrated and look after your diet (omega-3 helps).