Patient information · Eyes
Dry eye
why a dry eye waters
Dry eye is one of the commonest eye complaints and one of the most persistently under-treated. It is usually not a lack of tears but poor tear quality — the oily layer that stops tears evaporating is missing, so the eye dries, becomes irritated, and reflexively floods with watery tears. Which is why people with dry eyes often complain of watering.
Seek same-day assessment if you have
- eye pain rather than grittiness, or a red painful eye
- reduced or blurred vision that does not clear with blinking
- marked sensitivity to light
- a red painful eye and you wear contact lenses
- dry eyes with a dry mouth and joint pains — this may be Sjögren's syndrome
Persistent severe dry eye can damage the corneal surface. Contact lens wearers with a red painful eye need examining urgently. Moorfields Eye Hospital runs a 24-hour walk-in emergency eye service; the nearest emergency department is the Royal London Hospital, Whitechapel Road, London E1 1FR.
Symptoms
- grittiness, burning, or a sensation of something in the eye
- watering, particularly in wind or cold
- tired, heavy eyes, worse through the day and after screens
- intermittent blurring that clears when you blink
- redness, crusting on the lids in the morning
- difficulty wearing contact lenses for as long as you used to
Why it happens
- Blepharitis and meibomian gland dysfunction — the oil glands in the lid margins block, so the oily tear layer fails. The commonest cause by far.
- Screen use — blink rate falls by more than half when concentrating on a screen.
- Age and hormonal change, particularly around the menopause.
- Medicines — antihistamines, antidepressants, beta-blockers, diuretics, isotretinoin, and the combined pill.
- Environment — air conditioning, central heating, fans, dust, and aircraft cabins.
- Contact lenses, and previous laser eye surgery.
- Autoimmune conditions, particularly Sjögren's, rheumatoid arthritis and thyroid eye disease.
Warm compresses are the treatment most people skip
For blepharitis and meibomian gland dysfunction, the mainstay is heat and lid hygiene, done daily and indefinitely. Apply a warm compress — a microwaveable eye bag holds heat far better than a flannel, which cools within a minute — for five to ten minutes, then gently massage the lids towards the lashes, then clean the lid margins with a lid wipe or dilute baby shampoo on cotton wool. Done properly for six weeks it transforms symptoms. Done for three days and abandoned, it does nothing.
Drops
- Preservative-free if using more than four times a day — preservatives themselves irritate the surface with frequent use.
- Thicker gels or ointments at night, which blur vision temporarily but protect the eye through the hours it dries most.
- Use them regularly rather than when symptomatic. Dry eye is prevented, not rescued.
- It is normal to need several weeks and to try more than one product before finding what suits.
- Drops containing a vasoconstrictor to whiten the eye should be avoided — they worsen the underlying problem.
Screens and environment
Helps
- The 20-20-20 rule — every 20 minutes, look 20 feet away for 20 seconds
- Lowering the screen below eye level, which reduces the exposed eye surface
- Conscious full blinks, and deliberate complete closure
- A humidifier, and directing air vents away from the face
- Omega-3 in the diet, which has modest supporting evidence
Aggravates it
- Long uninterrupted screen sessions
- Fans and air conditioning blowing towards you
- Eye make-up along the lid margin, and old make-up
- Rubbing the eyes
- Smoking, including passive exposure
Why come to us. Dry eye is usually treated with a bottle of drops and no explanation, which is why it persists. We assess the eyes and lid margins properly, identify whether the problem is blepharitis, tear deficiency or something else, and check for the underlying causes — thyroid function, autoimmune screening and medication review, all with bloods taken in-house. We can arrange ophthalmology where the surface needs specialist assessment. Open seven days a week, no referral needed.
The cause identified, not just drops prescribed
Bloods in-house, ophthalmology referral if needed. Seven days a week.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.