Health condition · Clinically reviewed
Dry eye disease, a common cause of ocular discomfort — modern stepped management.
Chronic ocular surface disease with symptoms of dryness, grit and burning. Modern care follows TFOS DEWS II stepped protocol from lubricants to punctal plugs to specialty medications.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced, not summarised
Every claim is checked against TFOS DEWS II, RCOphth or a peer-reviewed source you can see at the end.
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Updated for 2026
Reflects current stepped management, punctal-plug practice and prescription-drop choices in the UK.
Key facts
Dry eye disease at a glance.
The essentials, in plain English - what it is, how it splits into two main forms, and how it is managed in the UK today.
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What it is
A multifactorial disease of the ocular surface with loss of tear-film homeostasis, symptoms of dryness and visual disturbance.
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Two main forms
Aqueous-deficient (too few tears) and evaporative (meibomian gland dysfunction) - most people have a mixed picture.
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Common contributors
Prolonged screen time and contact-lens wear reduce blink rate and destabilise the tear film.
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Autoimmune associations
Sjögren’s syndrome, rheumatoid arthritis and lupus can all present with severe dry eye.
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How it is managed
TFOS DEWS II stepped protocol - from lubricants and lid hygiene up to prescription drops and specialist care.
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Refractory options
Punctal plugs and prescription drops (ciclosporin, lifitegrast, autologous serum) for cases that do not settle.
Why this guide matters
Small habits, a much more comfortable surface.
Most dry eye is under-treated because people cycle through supermarket drops. The three points below shape everything else on this page.
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It is a disease, not a nuisance
Chronic ocular surface disease with measurable damage - worth treating properly, not just tolerating.
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Preservative-free drops matter
Frequent preserved drops can worsen the surface. Preservative-free is the sensible default.
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Escalate when first-line stops working
If lubricants and lid hygiene are not enough, the ladder goes on - plugs, prescription drops and specialist care.
How the diagnosis is made
From symptom questionnaire to a clear plan.
The steps an optometrist or ophthalmologist will normally follow, in order - so you know what to expect and why.
Phase 1 · Screening
Symptoms, slit-lamp and tear-film stability
Phase 2 · Assessing
Tear production and lid oil-gland function
Phase 3 · Escalating
Systemic review and specialist referral
- 01
Screening
Symptom questionnaire (OSDI)
A short scored questionnaire that captures how often symptoms occur and how much they interfere with daily life.
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Screening
Slit-lamp examination
A magnified look at the ocular surface, tear film and lid margins - the cornerstone of every dry-eye assessment.
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Screening
Tear break-up time
Timing how long the tear film stays stable after a blink - a low value points to evaporative dry eye.
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Assessing
Schirmer test
A small strip placed under the lower lid measures aqueous tear production over five minutes.
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Assessing
Meibomian gland evaluation
Pressing along the lid margin to assess oil-gland function - the most common driver of dry eye today.
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Escalating
Rule out systemic autoimmune (Sjögren’s)
Blood tests and a symptom review when dry eye is severe, bilateral or paired with a dry mouth.
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Escalating
Ophthalmology / cornea consultation
Referred when symptoms persist despite first-line care, or when the cornea shows signs of damage.
Typical timeline: 1-4 weeks from first assessment to a settled plan.
Symptoms
What dry eye disease actually feels like.
The symptoms most people describe, plus the red flag that needs same-day ophthalmology.
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Gritty sensation
A foreign-body or sandy feeling, often worse by the end of the day or after screen use.
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Burning
A stinging or hot sensation across the ocular surface, sometimes with a reflex tear.
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Redness
Diffuse conjunctival redness from ocular-surface inflammation, worse in dry or windy conditions.
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Blurred vision that clears with blinking
A classic tear-film sign - vision fluctuates because the film breaks up between blinks.
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Light sensitivity
Photophobia from an unstable tear film and mild surface inflammation.
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Meibomian gland dysfunction
Blocked or thickened lid oil glands - the most common driver of evaporative dry eye.
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Contact lens intolerance
Lenses that were comfortable now feel dry, gritty or force earlier removal each day.
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When to seek urgent care
Severe corneal ulceration or sudden severe eye pain - arrange same-day ophthalmology assessment.
Treatment
How dry eye disease is treated in the UK.
Lubricants and lid hygiene first, prescription drops and procedures where needed - the TFOS DEWS II stepped ladder in practice.
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Preservative-free artificial tears
The first step for almost everyone - used as often as needed, without the irritation of preservatives.
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Warm compress + lid hygiene (MGD)
Daily warmth and gentle lid cleansing to unblock meibomian glands and restore the oily tear layer.
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Punctal plugs
Tiny inserts placed in the tear-drainage puncta to keep natural tears on the surface longer.
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Ciclosporin 0.05% (Ikervis)
A prescription anti-inflammatory drop for moderate-to-severe disease; takes weeks to build effect.
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Lifitegrast (specific cases)
An anti-inflammatory drop used in selected patients where ciclosporin is not tolerated or effective.
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Topical steroid short-course
A brief course to settle flare-ups of ocular-surface inflammation, always under specialist supervision.
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Autologous serum drops (specialist)
Drops made from the patient’s own serum, reserved for severe or refractory dry eye.
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Systemic omega-3 supplements
May improve tear-film stability in some patients, particularly with meibomian gland dysfunction.
What this guide is based on
The sources behind every recommendation on this page.
International consensus, UK specialty guidance and society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your optometrist or ophthalmologist knows your eyes and can tell you which parts apply to you. If in doubt, book a review.
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Tear Film & Ocular Surface Society. TFOS DEWS II Report.
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Royal College of Ophthalmologists. Dry eye disease - clinical guidance.
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European Dry Eye Society. Consensus recommendations on diagnosis and management.
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American Academy of Ophthalmology. Preferred Practice Pattern - Dry Eye Syndrome.
Red flags
When dry eye is more than just discomfort.
Situations where dry eye stops being a nuisance and needs specialist care - some urgently.
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Corneal ulcer
A breach in the corneal epithelium - risks scarring and vision loss without urgent treatment.
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Post-LASIK dry eye
Persistent dryness after refractive surgery that has not settled with standard first-line care.
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Autoimmune systemic disease
Sjögren’s, rheumatoid arthritis or lupus - dry eye is a marker, not a stand-alone problem.
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Post-radiotherapy dry eye
Reduced tear production after head-and-neck or orbital radiotherapy - needs specialist care.
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Contact lens keratitis
Pain, redness and blurred vision in a lens wearer - remove the lens and seek same-day review.
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Herpes simplex keratitis
Unilateral pain, redness and reduced vision, sometimes with a dendritic corneal ulcer - urgent.
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Neurotrophic keratitis
A poorly innervated cornea that does not heal normally - requires specialist ocular-surface care.
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Graft-versus-host disease
Severe dry eye following a bone-marrow transplant - benefits from an ocular-surface specialist.
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Ocular pemphigoid
A rare autoimmune scarring disease of the conjunctiva - progressive if not recognised early.
Living with it
A long-term condition, but a very manageable one.
Four things that make the biggest difference day to day - habits, environment, lid care and regular reviews.
A quiet reminder
Consistency beats intensity, every time.
A daily warm compress and a steady drop routine will out-perform a burst of enthusiasm that fades after a week.
- 01 Daily habits
Blink, break and hydrate
The 20-20-20 rule during screen work, conscious full blinks and steady hydration all help the tear film.
- 02 Environment
Air, wind and heating
Humidifiers in dry rooms, glasses in wind and side-shields on planes reduce evaporation from the surface.
- 03 Lid care
Daily warm compress + lid hygiene
Five minutes of warmth, then gentle lid cleansing - the single most useful habit in evaporative dry eye.
- 04 Reviews
Regular optometry review
An annual review keeps drop regimens, contact-lens fit and any red flags under a watchful eye.
Frequently asked
Everything we get asked about dry eye disease.
Quick answers on diagnosis, stepped management, punctal plugs, prescription drops and when to see a specialist.
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What causes dry eye disease?
A loss of tear-film homeostasis - most commonly evaporative disease driven by meibomian gland dysfunction, sometimes combined with reduced tear production. Screen time, contact-lens wear, age, hormones and autoimmune disease all contribute.
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How is dry eye diagnosed?
A symptom questionnaire (OSDI), a slit-lamp examination and simple tear-film tests - break-up time, Schirmer and meibomian gland evaluation - as set out by TFOS DEWS II.
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What is the TFOS DEWS II stepped approach?
A four-step ladder that starts with lubricants, lid hygiene and lifestyle change, and escalates to prescription drops, punctal plugs, short-course steroids and specialty options such as autologous serum for severe disease.
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When are punctal plugs used?
When symptoms persist despite regular lubricants and lid care, and tear production is reduced. Plugs sit in the tear-drainage puncta and keep natural tears on the surface longer.
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Do prescription drops such as ciclosporin work?
Yes - ciclosporin 0.05% (Ikervis) reduces ocular-surface inflammation in moderate-to-severe dry eye. It typically takes several weeks of daily use to see the benefit.
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When should I see an ophthalmologist?
If symptoms persist despite first-line care, if there is any corneal damage on examination, or if there are red flags such as severe pain, sudden vision loss or possible corneal ulceration.
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