Dry eye syndrome: symptoms, causes and treatment

The NHS says you may have dry eyes if your eyes are itchy, sore, gritty, red, blurry, sensitive to light, or more watery than normal.

The College of Optometrists describes the same picture from the clinic side: irritation of the eyes, a feeling that there is something in the eye, a discharge, and sometimes blurred vision. People notice that symptoms are worse in windy or dry conditions or when irritants such as smoke are in the air.

• Itchy, sore or gritty eyes.

• Red eyes, or eyes that are sensitive to light.

• Blurry vision or the feeling that something is in the eye.

• Eyes that are more watery than normal, even though they are dry.

• Symptoms that are worse in wind, dry air, smoke or air-conditioned rooms.

The NHS says you can get dry eyes if you do not make enough tears or your tears dry up quickly. The College of Optometrists describes dry eye disease as a common condition where the eyes do not make enough tears, or the tears do not work properly, and notes that it affects many people in the later decades of life.

The College adds that most cases have no apparent cause, but some are related to inflammatory conditions, surgical treatment or the side effects of medicines. Some are caused by abnormalities of the eyelids or blinking, or by disorders of the meibomian (oil) glands of the eyelid margin. On examination there may be reduced tear production or increased tear evaporation, sometimes due to a lack of normal oil gland secretion, with possible damage to the surface of the eye from the increased saltiness of the tears.

There is rarely one cause. The NHS says you may be more likely to get dry eyes if you are over 50, wear contact lenses, look at computer screens for long periods without a break, spend time in air-conditioned or heated environments, are in windy, dry or dusty places, smoke or are around smoke, or drink alcohol. Certain medicines are on its list, with some antidepressants and blood pressure medicines given as examples.

Underlying conditions matter too. The NHS names blepharitis, Sjögren's syndrome and lupus. The College of Optometrists says cases can relate to systemic inflammatory conditions, drug side effects, eyelid abnormalities or disorders of the meibomian (oil) glands, and that it is more common in post-menopausal women and in people of East Asian ethnicity. In many people no single cause is found.

Screens deserve a specific mention because they are an easy factor to change. The College of Optometrists suggests blinking more often and taking regular breaks, which fits with the NHS advice to rest the eyes when watching TV or using a computer and to place the screen just below eye level.

NHS self-care starts with cleaning the eyelids daily. The advice is to soak a flannel in warm (not hot) water and press it gently on the area around the eyes, which makes the oil in the glands runnier, then to massage the lids gently and wipe away excess oil, crusts or grime with damp cotton wool. It also advises breaks from screens, a humidifier if the air is dry, and resting contact lenses by wearing glasses.

Lubricating products are the next step. The NHS says a pharmacist may be able to advise on eyedrops, gels and ointments, and on whether you need to see an optician or GP. Which product suits depends on how severe the symptoms are and on whether preserved or preservative-free drops are better tolerated; a pharmacist or optometrist can explain the options. Medicines should be used as directed on the pack or by the prescriber.

For persistent problems the College of Optometrists describes further options. Natural tears can be conserved by blocking the tear drainage openings, either temporarily with tiny plugs or permanently with a surgical procedure, and where the oil glands are the problem, treatment is directed at the eyelids. The suitable choice is a decision for an eye professional after examination.

Most people are first seen by a high-street optician (optometrist), a pharmacist or a GP. The NHS advises seeing an optician or GP if dry eyes persist after a few weeks of home treatment or if there is any change in the shape of the eyelids. They can look for a cause and recommend treatment, and if no cause is found they may refer you to an eye specialist (ophthalmologist) for tests.

The College of Optometrists describes the clinical picture as reduced tear production or increased tear evaporation, sometimes because the oil glands are not working normally, with possible damage to the surface of the eye from the salty tears. An optometrist will typically ask about symptoms, medicines, screen use and contact lens habits, and examine the eyelids and the surface of the eye with a magnifying microscope. Specific test choices vary between practices.

Most dry eye is a nuisance rather than an emergency, but a few symptoms point to something different. The NHS says to ask for an urgent GP appointment or call NHS 111 if the eye is painful and red, or if you wear contact lenses and have a red eye, because this may be an infection.

The NHS says to call 999 or go to A&E for any change in sight such as wavy lines, flashing or loss of vision, if it hurts to look at light, if a red eye comes with a severe headache and feeling sick, if the eye or eyes are very dark red, after an injury or piercing of the eye, or if something such as glass or grit is stuck in the eye. Do not drive yourself.

For many people dry eye is a long-running condition that is managed rather than cured. Symptoms tend to come and go with the environment and with how much time is spent concentrating on screens, so a few routines usually make the biggest difference: lid care, breaks, and a lubricant that you reach for early rather than late.

It is worth reviewing the list of medicines you take with a prescriber or pharmacist if dry eyes started after a change. The NHS is clear that you should not stop a prescribed medicine without medical advice. If an underlying condition such as blepharitis or Sjögren's syndrome is involved, treating that condition is part of improving the eyes.

On the NHS, dry eye is normally handled in the community: a pharmacist for first advice and products, an optometrist for assessment, and a GP if there is a possible underlying condition. Referral to a hospital ophthalmology clinic is usually reserved for cases that do not settle, where the cause is unclear, or where there are signs of damage to the eye surface. Whether an optometrist visit is NHS-funded depends on your circumstances and where you live, so it is worth asking when you make the appointment.

Some people choose to see a private ophthalmologist or an optometrist with a special interest in dry eye. The practical differences tend to be around appointment length, the range of tests and in-clinic eyelid procedures on offer, and how soon you are seen, rather than a different diagnosis. Whichever route you take, it helps to bring a list of your medicines, your contact lens details and notes on what makes symptoms better or worse.