Specialty Eye Care
Dry Eye Evaluation and Treatment
Dry eye happens when the eye cannot maintain a stable tear film, either because it produces too few tears or because the tears evaporate too quickly. Treatment depends entirely on which of those is happening, which is why evaluation comes first.
In short
Two different causes need two different treatments. Evaluation decides which.
Dry eye is the most under diagnosed common condition in eye care, partly because the symptoms are so misleading. Many people with dry eye have watering eyes, not dry ones, because a compromised surface triggers reflex tearing. Others describe grittiness, burning, fluctuating vision that clears when they blink, or contact lenses that used to be comfortable and no longer are.
There are two broad mechanisms and they need opposite treatments. Aqueous deficiency means not enough tear volume is being produced. Evaporative dry eye, which is far more common, means enough tears are made but the oily layer that stops them evaporating is not working, usually because the meibomian glands in the eyelids are blocked. Dropping artificial tears into an evaporative problem is why so many people conclude that drops do not work for them.
Arizona makes all of this worse. Ambient humidity here is low enough that the tear film is under constant evaporative pressure, and air conditioning removes what little is left. A tear film that would be borderline elsewhere becomes symptomatic here.
What to expect
- A proper history
- Medications, screen hours, environment, autoimmune conditions and previous surgery all bear on the cause, and the pattern of symptoms through the day is genuinely diagnostic.
- Ocular surface examination
- The tear film, the corneal surface, the eyelid margins and the meibomian gland openings are all assessed at the slit lamp.
- Tear film assessment
- How quickly the tear film breaks up after a blink distinguishes evaporative from aqueous deficient dry eye, which determines the treatment.
- A staged plan
- Treatment starts with what is likely to work and escalates if it does not, rather than starting with the most aggressive option.
Our process
Evaluation45 to 60 minutes
History, ocular surface examination, tear film assessment and identification of the underlying mechanism.
Initial treatment plansame visit
Targeted at the cause found, whether that is gland dysfunction, tear deficiency, environment, medication or a combination.
Review4 to 8 weeks
Response is assessed and the plan adjusted. Dry eye rarely resolves on a first attempt and that is expected.
Ongoing managementas needed
Chronic dry eye is managed rather than cured, and the management is adjusted as circumstances change.
What is included
- Full ocular surface and tear film evaluation
- Identification of the underlying mechanism
- A targeted, staged treatment plan
- Eyelid hygiene technique instruction
- Contact lens compatibility assessment
- Scheduled review and plan adjustment
What this does not do
- Chronic dry eye is managed, not cured. The goal is comfortable, stable vision rather than permanent resolution.
- Improvement usually takes weeks rather than days, particularly for gland dysfunction.
- Some causes are systemic. Autoimmune disease and certain medications need addressing with your physician.
Questions and answers
Why do my eyes water if they are dry?
Reflex tearing. A compromised ocular surface signals distress and the gland floods the eye with watery tears that lack the oily layer needed to stay put. They run down your face instead of coating the eye, so the surface stays dry. Watering is one of the most common presentations of dry eye.
I have tried artificial tears and they did not help.
That is a very common experience and it usually points to evaporative dry eye. If the problem is that your tears are evaporating too fast, adding more watery tears without addressing the oily layer gives a few minutes of relief and no more. The treatment for gland dysfunction is different.
Can I still wear contact lenses?
Often yes, once the underlying problem is addressed. Lens material, replacement schedule and wearing time all make a difference, and scleral lenses with their permanent fluid reservoir are sometimes the answer for severe cases.
Does the Arizona climate cause this?
It does not cause dry eye but it reliably exposes and worsens it. Low ambient humidity accelerates tear evaporation, and air conditioning compounds it. A tear film that would cope elsewhere becomes symptomatic here.
How long before I feel better?
It depends on the cause. Environmental and medication related dryness can improve within days. Meibomian gland dysfunction typically takes six to eight weeks of consistent treatment before a clear difference is felt.
Talk to someone about dry eye evaluation and treatment
Appointments are scheduled two per hour, so there is time to answer questions properly. Call (480) 706-3937 or request a time online.