If you are constantly reaching for lubricating eye drops but your eyes still feel dry, gritty, burning, watery or tired, there may be more going on than simply “not having enough tears”.
For many people with dry eye, the problem is actually with the oil glands in the eyelids, called the meibomian glands.
When these glands become blocked or stop producing healthy oil, tears can evaporate too quickly. Eye drops may temporarily make your eyes feel better, but they do not necessarily address the underlying problem.
Not All Dry Eye Is the Same
The tear film covering the surface of your eyes contains several important components.
Two common contributors to dry eye are:
Aqueous-Deficient Dry Eye
This occurs when the eyes do not produce enough of the watery component of the tears.
Artificial tears can be particularly helpful in these cases, although some patients may require additional treatment depending on the cause and severity.
Evaporative Dry Eye
In evaporative dry eye, you may produce a reasonable amount of tears, but they evaporate too quickly.
One of the most common reasons for this is meibomian gland dysfunction (MGD).
What Are the Meibomian Glands?
The meibomian glands are tiny oil-producing glands located vertically inside your upper and lower eyelids.
Every time you blink, they should release a thin layer of oil over the surface of your tears.
This oil helps slow evaporation and keeps the tear film stable between blinks.
When the glands become blocked, their secretions can become thicker and more difficult to express. Less healthy oil reaches the tear film, allowing tears to evaporate more rapidly.
This can contribute to symptoms such as:
- Burning or stinging
- Grittiness
- Watery eyes
- Redness
- Fluctuating or blurry vision
- Tired or heavy eyes
- Difficulty wearing contact lenses
- Needing to use lubricating drops repeatedly
Why Can Eye Drops Help (But Only Temporarily)?
Lubricating eye drops add moisture to the surface of the eye. That can provide useful relief.
However, if your tears are evaporating because the oily layer is inadequate, simply adding more fluid may not correct the underlying problem. It can be a little like continually adding water to a container with a leak.
This does not mean that lubricating drops are useless. They are an important part of dry-eye management for many patients.
The important question is why your eyes are dry in the first place.
Why Do My Eyes Feel Terrible When My Eye Test Looks Normal?
Dry-eye symptoms and clinical findings do not always match perfectly.
Some patients have significant meibomian-gland changes but surprisingly few symptoms. Others experience considerable burning, dryness or discomfort despite relatively subtle findings on examination.
This is one reason why dry-eye assessment involves more than simply asking whether your eyes feel dry.
We look at the tear film, eyelids, ocular surface and meibomian glands together, while also considering your symptoms, medications, health history and environment.
What Is Meibography?
Meibography allows us to image the meibomian glands inside the eyelids.
It can help us assess:
- The number and appearance of the glands
- Areas of gland shortening or loss
- Structural changes
- Whether meibomian gland dysfunction may be contributing to your dry eye
Meibography does not provide the entire diagnosis on its own. It is interpreted together with examination of the eyelid margins, tear stability, ocular surface and the quality of the oil produced by the glands.
Can Blocked Meibomian Glands Be Treated?
Often, yes. But treatment depends on what is found during your assessment.
Management may include a combination of:
- Warm compresses
- Eyelid hygiene
- Appropriate lubricating drops
- Meibomian gland expression
- Treatment of eyelid inflammation or blepharitis
- Prescription treatment where appropriate
- Changes to environmental or lifestyle factors
- In-office treatments for meibomian gland dysfunction
Current dry-eye guidance recognises that treatment should be tailored to the underlying causes rather than using the same approach for every patient.
What About IPL for Dry Eye?
Intense Pulsed Light (IPL) is one treatment that may be considered when meibomian gland dysfunction, thickened gland secretions or eyelid inflammation are contributing to evaporative dry eye.
Clinical studies have shown improvements in dry-eye signs and symptoms in selected patients with meibomian gland dysfunction, particularly when IPL is combined with meibomian gland expression.
However, not everybody with dry eye needs IPL.
Dry eye can have many different causes, including reduced tear production, meibomian gland dysfunction, eyelid disease, medications, incomplete blinking, environmental exposure and ocular-surface inflammation.
The first step should therefore be identifying what is actually causing your symptoms.
At Westmead Eyes, IPL is used as one part of a broader dry-eye management approach when examination findings indicate that it may be appropriate. Our current dry-eye service specifically assesses the tear film, eyelids and meibomian glands before recommending treatment.
Still Using Eye Drops Several Times a Day?
If lubricating drops provide only short-term relief, it may be worth investigating why your eyes continue to feel dry.
A dedicated dry-eye assessment can examine your tear film, ocular surface, eyelids and meibomian glands and help determine whether the problem is predominantly aqueous-deficient, evaporative, inflammatory or a combination of factors.
Learn more about our Dry Eye Clinic in Sydney
Not sure how significant your symptoms are?
Take our 2-minute Dry Eye Symptom Test
If your symptoms are persistent, you can also book a Dry Eye Assessment at Westmead Eyes Optometrists, located within the Westmead Hospital precinct.
This article provides general information and does not replace an individual eye examination, diagnosis or personalised medical advice.