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Dry Eye doesn't go away

Dry eye doesn't go away - Ophthalmologist checking for dry eye on patient

Dry Eye doesn't go away, and is a progressive disease which needs to be continually managed to stop it getting worse.

The Dry Eye Zone team are always surprised at how often people are not aware that dry eye is a chronic and progressive disease. This means that if you do suffer from dry eye it is likely that you will experience symptoms frequently and that if nothing is done to control these symptoms, they will get worse.

Dry Eye is increasingly being taken seriously as a threat to our overall well-being, with numbers on the increase globally. In fact, dry eye was included in the recent World Health Organisation (WHO) Vision Report with a clear call-out for dry eye not be overlooked when considering your overall ocular health.

Dry Eye Zone is on a mission to raise awareness for the need to manage dry eye symptoms right from the start: through accurate diagnosis, best-in-class products and the expert input of your eye care professional.

This journey definitely starts with the knowledge that those annoying symptoms will not just go away – action is required!

What exactly is going on?

It all starts with moisture evaporating from your eye at a rate faster than it can be replenished. This could be caused by physical changes, such as those which occur naturally as we age, and/or behavioural changes such as spending more time looking at screens or in airconditioned environments. Either way the root causes are often unavoidable.

This accelerated loss of moisture results in the finely balanced ocular environment being disrupted. Tears become too salty, which could cause damage to the cells at the surface of the eye, it also results in an inflammatory response which starts what is known as a ‘vicious circle’ The inflammatory response makes the tears even saltier, leading to more potential damage to the surface of the eye, then more inflammation and so on ………..

If left unchecked permanent cell damage can occur leading to ocular pain, loss of essential cells from the cornea and loss of vision quality.

How dry eye progresses

If the symptoms of dry eye are left unmanaged the condition will have impacts on the integrity of the surface of the eye, your quality of life and visual functioning.

There is generally considered to be four stages or levels to dry eye disease. Your eye care professional will assess the severity of your dry eye – the level of progression might not always link to the levels of symptom you experience. It is possible to have signs of dry eye without actually experiencing symptoms. That is why regular eye examinations are essential.

The global dry expert forum DEWS II has 4 levels of treatment which link to the severity of the condition. But, like a lot of things dry eye related, this is not always straight forward.

Level 1 – mild.

At this early stage your eye care professional should take the time to explain why early intervention is important and what you can do. This might require changes to your environment such as turning down the air-conditioning, giving your eyes a rest from the computer.

Level 2 – mild to moderate

If the level 1 advice is not having the affect needed then more intervention is required. A dry eye drop will most likely be recommended, and if MGD is suspected greater eyelid hygiene and heat therapy.

More involved treatment in the practice rather than at home, such as intense eyelid cleaning to unblock glands might be offered. Additionally, more regular heat treatment, lid massage and more specialist cleaners might be suggested. Consideration will be given to adding more omega-3 to your diet or where possible modifying medications known to result in dry eye.

Level 3 – moderate to severe

A lack of relief with level 2 treatment will then result in adding addition therapies such as; more viscous eye drops, and over-night treatments such as ointments or moisture chamber goggles. There may be a suggestion that your tears might need to be plugged. There are also some prescription medicines that could help such as antibiotics or topical corticosteroids, some opticians are able to prescribe these to help bring relief to symptoms.

Level 4 – severe

At this point your eye care professional might consider referring you as you may require more prescription medicines or more invasive interventions.

This is an illustration of some of the therapies available and an indication of how seriously dry eye is taken and NOT designed to replace the professional advice from a qualified expert.

How to stop the progression

Dry eye will not just go away, but the good news is that if you catch it early enough you can stop it progressing to the point where there is damage to the surface of the eye.

The first thing to be done is to break that ‘vicious circle’ by rebalancing the ocular environment through the use of hypotonic (formulated with a lower salt level) hydrating eye drops to bring the salt level of your tears back into the normal range. This is important because it stops the inflammatory response.

Your eye care professional then needs to consider what type of dry eye you have and what approach is needed to keep your dry eye stable.

The impact of dry eye on your life can be surprising large so taking the initiative in the early stages makes sense. The first step towards taking control is to book a dry eye appointment with your eye care professional who offers both diagnosis and management for a better future outcome.

If you are experiencing dry eye symptoms then you should ask the advice of your eye care professional. Why not book your next eye examination with an independent optician today.


Bron AJ, de Paiva CS, Chauhan SK, Bonini S, Gabison EE, Jain S, Knop E, Markoulli M, Ogawa Y, Perez V, Uchino Y, Yokoi N, Zoukhri D, Sullivan DA. TFOS DEWS II pathophysiology report. Ocul Surf. 2017 Jul;15(3):438-510. doi: 10.1016/j.jtos.2017.05.011. Epub 2017 Jul 20. Erratum in: Ocul Surf. 2019 Oct;17(4):842. PMID: 28736340..

McDonnell PJ, Pflugfelder SC, Stern ME, Hardten DR, Conway T, Villanueva L, Hollander DA. Study design and baseline findings from the progression of ocular findings (PROOF) natural history study of dry eye. BMC Ophthalmol. 2017 Dec 28;17(1):265. doi: 10.1186/s12886-017-0646-5. PMID: 29284427; PMCID: PMC5746001.

Rodriguez-Garcia A, Babayan-Sosa A, Ramirez-Miranda A, Santa Cruz-Valdes C, Hernandez-Quintela E, Hernandez-Camarena JC, Ramos-Betancourt N, Velasco-Ramos R, Ruiz-Lozano RE. A Practical Approach to Severity Classification and Treatment of Dry Eye Disease: A Proposal from the Mexican Dry Eye Disease Expert Panel. Clin Ophthalmol. 2022;16:1331-1355

Jones L, Downie LE, Korb D, Benitez-Del-Castillo JM, Dana R, Deng SX, Dong PN, Geerling G, Hida RY, Liu Y, Seo KY, Tauber J, Wakamatsu TH, Xu J, Wolffsohn JS, Craig JP. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017 Jul;15(3):575-628. doi: 10.1016/j.jtos.2017.05.006. Epub 2017 Jul 20. PMID: 28736343.

Dr Luigi Marino. The Psychology of Dry Eye Disease - The emotional impact of this disease can be just as burdensome as the physical. CRST GLOBAL (Europe Edition). September 2016

WHO Vision Report


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