DRY EYE DISEASE: UNDERSTANDING A COMMON BUT COMPLEX CONDITION

This blog on Dry eyes has been contributed by Dr. Alia Issa, Aesthetic Oculoplastic Surgeon at Moorfields Eye Hospital Dubai 

Dry eye disease is one of the most common reasons people seek advice from an ophthalmologist. While it is often a minor irritation, dry eye can significantly affect comfort, vision, productivity, and overall quality of life. In a city like Dubai, where air conditioning, screen use, and environmental factors are part of everyday life, dry eye symptoms are particularly prevalent.

It is therefore essential to understand its causes, symptoms, and treatment options to effectively manage it.

 

What is Dry Eye Disease?

Dry eye disease occurs when the surface of the eye does not receive adequate lubrication. This may be due to reduced tear production, increased tear evaporation, or an imbalance in the quality of the tear film. Tears play an important role in maintaining eye comfort, clear vision, and protection against infection. When the tear film is unstable, the surface becomes irritated and inflamed, and, over time, this irritation can create a cycle in which dryness leads to inflammation, and inflammation further worsens tear quality.

Why is Dry Eye Disease common in Dubai and the UAE?

Environmental and lifestyle factors play a major role in the development and worsening of dry eye symptoms. Studies in the United Arab Emirates have shown that dry eye disease affects a large proportion of people, with one cross-sectional study in Dubai estimating that about 62.6% of adults report dry eye symptoms.

Common causes of Dry eye disease include:

• Air conditioning, which reduces humidity and increases tear evaporation
• Hot, dusty, and polluted environments, which irritate the ocular surface
• Prolonged digital screen use, leading to reduced blinking
• Contact lens wear, especially for extended hours
• Exposure to cigarette smoke

What are the common symptoms of Dry Eye Disease?

Dry eye symptoms can vary in severity and may fluctuate throughout the day. In the UAE, symptoms may also fluctuate throughout the year, often worsening during the hotter months when air conditioning use increases and outdoor conditions are more challenging for the eyes.

Common symptoms include:

• A gritty or foreign body sensation
• Burning, stinging, or soreness
• Redness of the eyes
• Excessive tearing (a reflex response to dryness)
• Blurred or fluctuating vision
• Eye fatigue, especially after screen use

Because symptoms can be subtle or inconsistent, dry eye is sometimes overlooked or self-treated for long periods before a proper diagnosis is made. Some people experience significant discomfort despite minimal visible signs, while others may have advanced disease with surprisingly mild symptoms.

Who is at risk of Dry Eye Disease?

Dry eye disease can affect people of all ages, but certain factors increase the likelihood of developing symptoms. You may be at higher risk if you:

• Spend long hours using digital screens, such as computers, tablets, or smartphones
• Work or live in air-conditioned environments for much of the day
• Are over the age of 40, as tear production and tear quality tend to reduce with age
• Are a woman, as hormonal changes can contribute to a higher risk of dry eye
• Wear contact lenses, particularly for extended periods
• Live in hot, dry, dusty, or polluted environments, such as those common in the UAE
• Have underlying medical conditions, including autoimmune or thyroid disorders
• Take certain medications, such as antihistamines, antidepressants, or blood pressure treatments
• Have had previous eye surgery, which can temporarily or permanently affect tear stability

What are the Different types of Dry Eye Disease?

Not all dry eyes are the same, and when diagnosing dry eye disease, ophthalmologists differentiate between two main types, although many people experience a combination of both.

• Evaporative Dry Eye: The most common form of dry eye. It occurs when tears evaporate too quickly from the eye’s surface, often due to dysfunction of the meibomian glands in the eyelids. These glands produce the oily layer of the tear film, which slows evaporation.
• Aqueous-Deficient Dry Eye: This type occurs when the lacrimal glands do not produce enough tears. It is more commonly associated with autoimmune conditions, ageing, or certain medications.

Because these types have different underlying causes, they require different treatment strategies. This is why a detailed assessment is essential before recommending treatment.

How is Dry Eye Disease diagnosed?

Dry eye disease cannot be accurately diagnosed based solely on symptoms. A comprehensive evaluation typically includes:

• A detailed medical and lifestyle history
• Slit lamp examination of the eyelids and ocular surface
• Assessment of tear quantity and quality
• Evaluation of the meibomian glands
• Specialised tests to assess tear film stability

A specialist dry eye assessment allows all contributing factors to be identified, which is essential because dry eye disease is rarely caused by a single issue and often involves several overlapping factors.

How is Dry Eye Disease treated?

Dry eye disease is a chronic condition, and successful management usually involves addressing both symptoms and underlying causes. Chronic does not mean constant and many individuals experience significant improvement and long periods of comfort once the right treatment combination is found.

Treatment plans vary depending on the type and severity of dry eye and may include:

Lifestyle and Environmental Adjustments

• Improving blinking habits and following the 20-20-20 rule
• Reducing direct exposure to air conditioning or fans
• Using humidifiers where appropriate

Artificial Tears and Lubricants

Different formulations are used depending on whether lubrication, oil replacement, or inflammation control is needed. Not all eye drops are the same, and choosing the right type is important for effective relief.

Eyelid Hygiene and Warm Compresses

These help improve meibomian gland function and tear film stability.

Specialised treatment

For some individuals, dry eye symptoms persist despite lifestyle adjustments and regular use of eye drops. In these cases, more specialised treatments may be recommended following a detailed assessment by a dry eye specialist.

At Moorfields Eye Hospital Dubai, a range of specialised dry eye treatments are available, depending on the underlying cause and severity of the condition. These may include:

• Prescription medications, used in selected cases to help reduce inflammation or support tear quality
• Tear duct (punctal) plugs, which help retain natural tears on the eye surface by reducing tear drainage
• Intense Pulsed Light (IPL), an advanced in-office treatment that may be recommended for certain forms of evaporative dry eye, particularly when related to meibomian gland dysfunction
• Lipiflow, an in-office treatment for dry eyes that gently warms and massages the eyelids to unblock the meibomian glands, restoring the natural oil layer of the tear film and improving eye comfort.
• Treatment plans are customised to each patient, recognising that dry eye disease often involves multiple contributing factors and that management is rarely a one-size-fits-all approach.

Why is it important to manage Dry Eye Disease early?

If left untreated, dry eye disease can lead to chronic discomfort, inflammation, and damage to the ocular surface. It can also affect visual clarity, reading comfort, and work performance, particularly for individuals who spend long hours on digital devices. In more severe or prolonged cases, ongoing inflammation can compromise the eye surface and increase the risk of complications. Early assessment helps prevent this progression and reduces the need for more intensive treatments later.

With appropriate diagnoses and tailored treatment, most people experience significant improvement in comfort and quality of life.

Conclusion

Dry eye disease is common, complex, and often underestimated. Understanding that dry eye has many contributing factors, whether environmental, systemic, and lifestyle-related, is the first step towards effective management. With a thorough assessment and an individualised treatment plan, symptoms can be controlled, and long-term eye health protected.

FREQUENTLY ASKED QUESTIONS (FAQs)

Is dry eye a permanent condition?

Dry eye disease is often a long-term (chronic) condition, particularly when linked to age, hormonal changes, environmental factors, or underlying health issues. However, this does not mean symptoms must be constant or severe. With the right diagnosis and a personalised treatment plan, most people can achieve good symptom control and enjoy long periods of comfort. Ongoing care and regular reviews help adapt treatment as needs change over time.

Why do my eyes water if they are dry?

Watery eyes may seem contradictory, but excessive tearing is actually a common sign of dryness. When the eye surface becomes irritated, the tear glands produce a surge of reflex tears. These tears are mostly watery and lack the oils and proteins needed for proper lubrication. As a result, they do not remain on the eye long enough to relieve dryness and may instead overflow onto the cheeks.

Can screen use really make dry eye worse?

Yes. When using computers, tablets, or smartphones, people tend to blink less often and less completely. Blinking is essential for evenly distributing tears across the eye surface. Reduced blinking increases tear evaporation, leading to dryness, irritation, and blurred vision. This is particularly relevant for individuals who spend long hours on screens in air-conditioned environments, such as offices in Dubai.

Are artificial tears safe to use every day?

Most artificial tears, especially preservative-free formulations, are safe for regular and long-term use. Different products are designed to address different aspects of dry eye, such as lubrication, oil replacement, or inflammation control. Using the most appropriate formulation is important, which is why an ophthalmologist may recommend specific drops based on your type of dry eye and symptom pattern.

Does dry eye affect vision permanently?

Dry eye most commonly causes fluctuating or blurred vision that improves with blinking or lubrication. In most cases, vision changes are temporary. However, if severe dry eye is left untreated, chronic inflammation can damage the eye surface and, in rare cases, permanently affect vision. Early diagnosis and appropriate management greatly reduce this risk.

Can diet affect dry eye?

Diet can play a supportive role in managing dry eye symptoms. Omega-3 fatty acids, found in foods such as oily fish and flaxseed, may help improve tear film quality in some individuals. Adequate hydration is also important, as dehydration can worsen dryness. While dietary changes alone may not resolve dry eye, they can complement medical treatments.

When should I see a specialist for dry eye?

If symptoms persist despite using over-the-counter eye drops, interfere with daily activities, or worsen over time, it is advisable to seek professional assessment. A specialist can identify the underlying causes of your dry eye and recommend targeted treatment rather than relying on trial-and-error solutions.