Learning More About Dry Eye Disease

Every day, an unseen battle happens behind your eyelids as your eyes struggle to stay comfortable. That is the reality for millions of people worldwide who live with dry eyes. This condition is far more than a minor annoyance. It affects productivity, visual clarity, and overall wellbeing. In this article, we explore dry eye disease and the steps you can take to prevent and treat it.

DRY EYE DISEASE: PREVALENCE AND SYMPTOMS

Your tear glands produce tears constantly. These tears form a protective layer on the eye surface and keep it well moisturised. Dry eye develops when the tears do not provide enough lubrication.

Epidemiological studies report a wide prevalence range — from 5% to 50%. A 2015 study in Singapore found symptomatic dry eye disease in 12.3% of adults, with women affected more often than men.

When the eye surface lacks proper lubrication, you may experience:

Gritty or foreign body sensation
Redness
Intermittent blurring
Light sensitivity
Tearing or discharge
Eye fatigue, especially after reading or screen use

Some people experience increased tearing despite having dry eye disease. This happens because dry eye can result from reduced tear production or increased tear evaporation. To understand this better, we look at the tear film’s structure.

THE THREE LAYERS OF THE TEAR FILM

Lipid Layer

Produced by the meibomian glands along the eyelid margins. This outer layer slows down tear evaporation.

Aqueous Layer

Made by the lacrimal glands. It forms most of the tear film and contains water and nutrients that support the eye surface while flushing away debris.

Mucin Layer

Produced by goblet cells in the conjunctiva. This innermost layer helps the aqueous layer spread evenly and stabilises the tear film.

In conditions such as meibomian gland dysfunction, the lipid layer becomes insufficient, causing faster tear evaporation. The lacrimal glands try to compensate by producing more tears, which explains why some patients tear excessively despite having dry eye disease.

Dry eye disease should not be ignored. Although lubricant drops help, identifying and treating the underlying cause is essential. A comprehensive eye examination by an ophthalmologist allows for accurate diagnosis and management.

CAUSES OF DRY EYE DISEASE

Dry eye disease affects quality of life and, in some cases, may even become disabling. It can also lead to complications such as recurrent corneal erosions, ulcers, infections, and vision loss.

The causes fall into three broad categories:

Aqueous-deficient dry eyes (reduced tear production)
Evaporative dry eyes (increased tear evaporation)
Mixed dry eyes (a combination)

AQUEOUS-DEFICIENT DRY EYES

This occurs when the lacrimal glands fail to produce enough tears. Common reasons include:

Age-related decline in tear production
Autoimmune conditions such as Sjögren’s syndrome
Corneal desensitisation from LASIK, contact lenses, or other causes
Hormonal changes such as menopause
Medication effects (antihistamines, decongestants, some antihypertensives, antidepressants)

EVAPORATIVE DRY EYE

Dry eyes can also result from faster-than-normal tear evaporation. Causes include:

Meibomian gland dysfunction
Prolonged reading or screen use that reduces blinking (digital eye strain)
Eyelid closure problems (e.g., Bell’s palsy)
Environmental factors such as air-conditioning or direct fan exposure

PREVENTION

You can take several steps to reduce the risk of dry eyes.

Modify Your Environment

Redirect air-conditioning or fans, or avoid windy areas, to reduce evaporation.

Adopt Good Eye Habits

Use adequate lighting and take regular breaks. The 20-20-20 rule helps: every 20 minutes, look at something 20 feet away for 20 seconds.

Consider Nutritional Supplements

Omega-3 supplements may help reduce eyelid inflammation and support the meibomian glands.

TREATMENT OPTIONS

Several treatments can help manage dry eyes.

Artificial Tears, Gels and Ointments

Artificial tears lubricate the eyes during the day. Gels and ointments last longer but may blur vision temporarily, making them more suitable before bedtime.

Types of Lubricant Eye Drops

Eye Drops with Preservatives

Affordable, but preservatives may irritate the eyes. Best for mild dry eyes and limited use (up to four times daily).

Preservative-Free Drops

Available in single-dose vials or special bottles. Suitable for frequent use and safe for all severities.

Lubricant Eye Gels

Thicker and longer-lasting. Ideal for severe dry eyes, especially symptoms worse at night.

Warm Compress and Lid Hygiene

Use a warm towel for two to four minutes, followed by gentle massage. This liquefies clogged oil, which can then be cleaned off. The routine helps improve lipid layer quality and tear film stability.

Prescription Eye Drops

Cyclosporine reduces inflammation and improves tear production. Steroid drops work similarly but are not suitable for long-term use due to risks such as glaucoma and cataract.

Punctal Plugs

Tiny devices inserted into the tear duct openings to slow tear drainage. This helps keep the eye surface moist for longer. PRIME

Author

Dr. Jason Lee Kian Seng

Senior Consultant, Medical Director
The Straits Eye Centre

Dr Jason Lee is Senior Consultant and Medical Director at The Straits Eye Centre based in Camden Medical Centre. Dr Lee’s proficiency in the management of General Ophthalmology conditions, such as myopia and refractive error, cataracts and diabetic retinopathy, is complemented by an added focus in the field of Oculoplastics.

After completing his residency training at Tan Tock Seng Hospital, he went on to pursue fellowships at the National Taiwan University Hospital, Taiwan and the Wenzhou Medical University Eye Hospital, China to further hone his surgical skills in the management of conditions pertaining to the eyelids, orbit and tear system.

Prior to setting up The Straits Eye Centre, Dr Lee was Senior Consultant at Khoo Teck Puat Hospital as well as Visiting Consultant at Tan Tock Seng Hospital.

View all posts