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Dry Eye Treatment Sydney
Specialist Assessment and Management of Dry Eye Disease in Green Square
Dry eye disease (DED) is a common chronic condition affecting the surface of the eye and the stability of the tear film. Symptoms may include irritation, fluctuating vision, burning, watering, redness and visual fatigue, and in some patients the condition can significantly affect reading, computer use, driving and day-to-day comfort.
At Eye and Retina Specialists in Waterloo, we provide comprehensive ophthalmic assessment and evidence-based management of dry eye disease and related ocular surface disorders.
Dry eye disease is not simply a problem of “not producing enough tears”.
Modern understanding recognises that it is a multifactorial disorder involving loss of tear film homeostasis, with tear instability, excessive evaporation, inflammation of the ocular surface and eyelids, blepharitis /Meibomian gland dysfunction (MGD), and in some patients reduced tear production.
Dry eye disease is a multifactorial condition and symptoms may arise from several different underlying mechanisms. Careful assessment of the tear film, eyelids and ocular surface is important in determining the most appropriate management approach for each patient.
What Is Dry Eye Disease?
The front surface of the eye is protected by a thin layer of tears known as the tear film. The tear film plays a critical role in:
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maintaining ocular comfort
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supporting clear vision
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protecting the corneal surface
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stabilising the optical surface of the eye.
The tear film consists of an oily outer layer, a watery middle layer and a mucin layer that helps tears spread evenly across the eye.
Dry eye disease occurs when this tear film becomes unstable and loses normal homeostasis. This instability may occur because of reduced tear production, excessive tear evaporation, Meibomian gland dysfunction, eyelid inflammation, abnormal blinking patterns, ocular surface inflammation or environmental stressors.
When the tear film becomes unstable, the ocular surface becomes more exposed and inflamed, leading to irritation, fluctuating vision and chronic discomfort.
The Tear Film and Ocular Surface society (TFOS) DEWS II classifies dry eye disease broadly into evaporative dry eye disease, aqueous deficient dry eye disease, or a mixed pattern involving both mechanisms.
Common Symptoms of Dry Eye Disease
The tear film is a thin, structured layer that helps keep the eye surface smooth, comfortable and optically clear
Symptoms vary considerably between individuals and may fluctuate throughout the day. Patients commonly describe burning, grittiness, redness, watering, fluctuating vision, eye fatigue, light sensitivity and discomfort during prolonged reading or screen use. Some patients experience heavy or tired eyes, while others notice intermittent blurred vision or a foreign body sensation.
Symptoms often worsen later in the day, during prolonged computer use, in windy or air-conditioned environments, or during periods of visual concentration.
Many patients are surprised that excessive watering can actually be a symptom of dry eye disease. Irritation of the ocular surface may trigger reflex tear production, although these tears are often poor quality and evaporate rapidly.
Dry Eye Disease Can Affect Vision
Dry eye disease affects not only comfort but also visual quality. The tear film forms part of the optical surface of the eye. When the tear film becomes unstable, vision may fluctuate from moment to moment. Patients often notice temporary improvement after blinking, intermittent blur, inconsistent focus or worsening visual quality later in the day.
This is particularly important in patients considering cataract surgery or laser vision correction, as untreated ocular surface disease may affect both visual quality and the accuracy of pre-operative measurements.
Evaporative Dry Eye and Meibomian Gland Dysfunction
One of the most important causes of modern dry eye disease is Meibomian gland dysfunction (MGD). The Meibomian glands are specialised oil-producing glands located within the eyelids. These glands produce oils that form the outer layer of the tear film and help reduce tear evaporation.
When the glands become blocked or dysfunctional, tears evaporate too quickly and the tear film becomes unstable. This contributes to inflammation of the ocular surface and worsening symptoms. Over time, a self-perpetuating inflammatory cycle may develop.
MGD is extremely common and is frequently associated with ageing, prolonged screen use, contact lens wear, rosacea, blepharitis and chronic eyelid inflammation. If left untreated, longstanding gland dysfunction may contribute to progressive gland loss and chronic ocular surface disease.
Blepharitis and Eyelid Inflammation
Many patients with dry eye disease also have associated blepharitis, a chronic inflammatory condition affecting the eyelid margins.
Patients may notice redness of the eyelids, crusting around the eyelashes, debris along the lash line, foamy tears or recurrent styes and chalazia. Blepharitis frequently coexists with Meibomian gland dysfunction and contributes to tear film instability and ocular surface inflammation.
Successful management of dry eye disease often requires treatment of the underlying eyelid disease rather than relying on lubricating drops alone.
Ocular Rosacea and Dry Eye
Rosacea is a common, chronic inflammatory skin condition that causes redness, pimples and broken blood vessels on the face. It frequently affects the eyelids and ocular surface. Ocular rosacea involves dysregulation of the immune and neurovascular systems with activation of inflammatory cascades. Ocular rosacea may contribute to chronic eye redness, burning, irritation and recurrent chalazia.
Some patients have ocular rosacea even without obvious facial rosacea. Symptoms may fluctuate and are often aggravated by heat, alcohol, spicy foods, wind, stress and sun exposure.
Management usually involves a stepwise approach, incorporating ocular and skin hygiene, lifestyle modifications, and pharmacological interventions. Recent advancements have led to the exploration of targeted therapies, including biologics and small-molecule inhibitors.
Screen Use and Modern Dry Eye Disease
Heavy screen use has become a major contributor to dry eye symptoms.
During prolonged computer or device use, blink rate decreases and blinks often become incomplete. This increases tear evaporation and may worsen Meibomian gland dysfunction.
Many patients experience worsening symptoms later in the day after prolonged digital device use, particularly in modern office environments with air conditioning and sustained visual concentration.
How Dry Eye Disease Is Assessed
Dry eye disease is diagnosed based on both symptoms and clinical examination. The Tear Film and Ocular Surface Society (TFOS) released the comprehensive Dry Eye Workshop guidelines (DEWS II ) that emphasises that symptoms alone are insufficient, and clinical signs are important in confirming disease and identifying the dominant subtype of underying disease.
Assessment may include evaluation of the tear film, slit lamp examination of the ocular surface, assessment of tear stability, ocular surface staining, examination of the eyelids and Meibomian glands, and assessment for blepharitis or ocular rosacea. Due to the multifactorial nature of dry eye disease, management plans are individualised according to the patient’s underlying pattern of disease and response to treatment.
Schirmer Testing and Tear Production Assessment
In some patients, symptoms are related not only to tear evaporation but also to reduced tear production.Schirmer testing is a clinical test used to assess aqueous tear production.
Small calibrated paper strips are placed beneath the lower eyelids to measure tear production over a short period of time. This may be useful in patients with suspected aqueous deficient dry eye, autoimmune-related dry eye or more severe ocular surface disease.
Treatment Options for Dry Eye Disease
Treatment depends on the underlying cause and severity of disease. TFOS DEWS II and the American Academy of Ophthalmology Preferred Practice Pattern recommend a staged and individualised treatment approach based on disease severity and the dominant underlying mechanism.
Most patients benefit from a combination approach targeting tear film instability, eyelid inflammation, Meibomian gland dysfunction and ocular surface inflammation.
1. Artificial Tears and Lubricants
Lubricating eye drops remain an important component of dry eye management. Different formulations may be recommended depending on whether symptoms are primarily related to tear evaporation, aqueous tear deficiency, ocular surface inflammation or overnight dryness.
Preservative-free lubricants are preferred in patients requiring frequent use. Lubricants alone may provide only temporary relief if significant Meibomian gland dysfunction or eyelid inflammation is present.
2. Warm Compresses and Eyelid Hygiene
Warm compress therapy and eyelid hygiene are particularly important in patients with Meibomian gland dysfunction and blepharitis.
These treatments aim to soften thickened oils within the glands, improve gland secretion, reduce eyelid inflammation and improve tear film stability. Consistency is important, and ongoing maintenance is required at least 1-2 times daily.
3. Lacritec and Oral Dry Eye Supplements
Lacritec is an oral dry eye supplement used to support tear film quality and improve ocular surface health. These supplements aim to support the lipid layer of the tear film, improve Meibomian gland function and reduce tear evaporation.
Lacritex contains a proprietary combination of omega fatty acids derived from fish oil, flaxseed oil and borage oil. The Australian product information lists concentrated omega-3 triglycerides from fish oil, providing EPA (Eicosapentaenoic Acid) and DHA (Docosahexaenoic Acid), together with flaxseed oil and borage oil, including gamma-linolenic acid.
The rationale for oral fatty acid supplementation in dry eye disease relates to the role of essential fatty acids in inflammation, tear film quality and Meibomian gland function. In clinical practice, oral supplements such as Lacritec may be can be useful adjunctive treated patients with chronic evaporative dry eye, Meibomian gland dysfunction or ocular surface inflammation.
4. Punctal Plugs
Punctal plugs are small devices inserted into the lacrimal puncta to reduce tear drainage and increase retention of tears on the ocular surface. They are most commonly considered in patients with aqueous deficient dry eye, particularly where reduced tear production contributes significantly to ocular surface instability and symptoms.
Dissolvable punctal plugs are typically composed of materials such as collagen or absorbable synthetic polymers and gradually dissolve over a period of 3-6 months. Insertion is performed in the clinic and is not painful.
Appropriate patient selection is important. Punctal plugs are generally less suitable as first-line treatment in patients where evaporative dry eye, active blepharitis or significant Meibomian gland dysfunction are the dominant mechanisms, as retention of poor-quality inflammatory tears may worsen ocular surface inflammation. In these patients, optimisation of eyelid disease and tear film quality needs to be addressed before considering punctal occlusion.
Punctal plugs are usually considered after significant eyelid inflammation or Meibomian gland dysfunction has been addressed. Insertion is performed in the clinic.
5. BlephEx® Treatment for Eyelid Hygiene
BlephEx is an in-clinic eyelid hygiene procedure used in selected patients with blepharitis and Meibomian gland dysfunction. The procedure uses a specialised handheld device to gently clean the eyelid margins and remove bacterial biofilm, inflammatory debris and accumulated oils from the lash line and eyelid margins. It has been specifically designed to treat demodex mite infestation of the eyelids.
BlephEx is used as part of a multipronged management strategy combined with ongoing home eyelid care.
6. Ciclosporine Eye Drops
Ciclosporine eye drops (such as Cequa 0.09% and Ikervis 0.1% drops) are a prescription anti-inflammatory treatment used in selected patients with inflammatory dry eye disease. Ciclosporine acts as an immunomodulatory therapy aimed at reducing ocular surface inflammation and improving tear film function over time.
This treatment is most relevant when dry eye disease is associated with persistent ocular surface inflammation, reduced tear production, keratoconjunctivitis sicca, autoimmune-associated dry eye or inadequate response to lubricants and eyelid-directed therapy.
The expected response is gradual rather than immediate. Patients often require several weeks to months of treatment before assessing benefit. Stinging or irritation may occur when commencing treatment, particularly in patients with an inflamed ocular surface. Ciclosporine is therefore usually discussed as a longer-term disease-modifying treatment rather than a quick-relief drop.
7. IPL (Intense Pulsed Light) Treatment for Dry Eye
Intense Pulsed Light (IPL) therapy has emerged as an adjunctive treatment for patients with evaporative dry eye disease associated with Meibomian gland dysfunction and ocular rosacea.
The proposed mechanisms are multifactorial and may include reduction of periocular telangiectatic vessels, modulation of inflammatory mediators, improvement in Meibomian gland function and altered bacterial or Demodex load on the eyelid margins. Unlike lubricating drops, IPL is directed primarily at the inflammatory and evaporative components of ocular surface disease.
The evidence base has expanded substantially over recent years. Multiple prospective studies and systematic reviews have reported improvements in tear break-up time, symptom scores and Meibomian gland function in selected patients with evaporative dry eye disease.
IPL is not a universal treatment for all forms of dry eye disease. It is generally most relevant in patients where evaporative dry eye, Meibomian gland dysfunction and ocular rosacea are dominant contributors to symptoms.
Dry Eye Clinical Settings
Prolonged screen use can contribute to dry eye symptoms and visual fatigue
Schirmer testing may help assess tear production in patients with dry eye symptoms
Dry eye disease may present in a wide variety of clinical settings and is often influenced by systemic health, medications, environmental factors, hormonal changes and ocular surgery.
In many patients, symptoms arise from multiple overlapping contributors rather than a single isolated cause.Understanding these broader associations is important when assessing chronic ocular surface dryness
Contact Lens-Associated Dry Eye
Contact lens wear is a common contributor to ocular surface symptoms and tear film instability.
Some patients experience dryness, fluctuating vision, irritation or reduced wearing time due to altered interaction between the tear film, ocular surface and contact lens surface. Underlying Meibomian gland dysfunction, incomplete blinking and environmental factors frequently contribute. In some patients, longstanding contact lens wear may also be associated with chronic inflammatory changes of the ocular surface.
Management may involve optimisation of the tear film, treatment of associated eyelid disease, changes in contact lens material and wearing schedule and consideration of alternative refractive options.
Dry Eye and Autoimmune Disease
Aqueous deficient dry eye disease may occur in association with systemic autoimmune conditions. In these patients, lacrimal gland dysfunction and chronic ocular surface inflammation may contribute to significant tear deficiency and keratoconjunctivitis sicca (dryness of the ocular surface).
Sjögren syndrome is an autoimmune conditions associated with severe dry eye disease. Dry eye may also occur in association with rheumatoid arthritis, systemic lupus erythematosus, thyroid disease, graft-versus-host disease and other connective tissue disorders.
Patients may report persistent dryness, burning, fluctuating vision or foreign body sensation despite frequent lubricant use. Some also experience dry mouth, joint symptoms or systemic inflammatory disease.
Autoimmune-associated dry eye disease often requires a broader management approach involving tear supplementation, anti-inflammatory therapy and optimisation of the ocular surface. Collaboration with rheumatologists and other medical specialists is usually required in the management of autoimmune related dry eye.
Dry Eye and Ageing
The prevalence of dry eye disease increases with age. Age-related changes in tear production, Meibomian gland function, eyelid anatomy and blink dynamics can all contribute to ocular surface instability over time. Older patients are also more likely to have concurrent medical conditions, medication use and previous ocular surgery that further influence tear film function.
Dry Eye Associated with Medications
A wide range of systemic and topical medications may contribute to dry eye symptoms by reducing tear production, altering tear film stability and affecting Meibomian gland function.
Commonly implicated medications include antihistamines, antidepressants, isotretinoin, acne therapies, hormone therapies, beta blockers, diuretics and anticholinergic medications. Eye drops containing preservatives, particularly when used chronically, may contribute to ocular surface irritation and tear film instability.
Careful review of systemic and topical medication forms an important part of dry eye assessment.
Dry Eye and Glaucoma Medications
Patients using long-term glaucoma eye drops may develop ocular surface irritation and dry eye symptoms related to chronic topical medication exposure. Preservatives such as benzalkonium chloride (BAK) have been associated with ocular surface toxicity, tear film instability and chronic conjunctival inflammation, particularly in patients requiring multiple topical medications over extended periods.
Symptoms may include burning, redness, fluctuating vision, foreign body sensation and reduced tolerance of eye drops.
Management may involve optimisation of the ocular surface, consideration of preservative-free formulations where appropriate and alternative glaucoma treatment (such as SLT laser).
Dry Eye and Hormonal Factors
Hormonal influences play an important role in ocular surface health and tear film stability.
Dry eye disease is more common in women, particularly during peri-menopause and post-menopause, where hormonal changes may influence tear production, Meibomian gland function and ocular surface inflammation.
Androgen deficiency has also been associated with Meibomian gland dysfunction and evaporative dry eye disease, reflecting the hormonal sensitivity of the Meibomian glands.
Dry Eye and Occupation
Occupational and environmental factors are increasingly recognised contributors to modern dry eye disease.
Patients working in office environments frequently report worsening symptoms during prolonged screen use, particularly in settings involving air conditioning, heating, low humidity and sustained visual concentration. Reduced blink rate and incomplete blinking during computer use may increase tear evaporation and contribute to Meibomian gland dysfunction.
Other occupational settings associated with dry eye include prolonged driving, aviation, healthcare, operating theatres, manufacturing and exposure to dust, airflow or low humidity environments
Dry Eye After Cataract or Laser Eye Surgery
Dry eye symptoms may be exacerbated following cataract surgery or laser vision correction surgery. This often occurs in patients who have underlying ocular surface disease prior to surgery. Symptoms may become more noticeable during the postoperative period.
Optimisation of the ocular surface before surgery is particularly important because dry eye disease may affect intraocular lens calculation measurements and affect postoperative visual quality and comfort. Newer refractive laser techniques such as SMILE and SMILE Pro have lower rates of postoperative dry eye.
Dry Eye and Demodex Blepharitis
Demodex mites are microscopic organisms that inhabit eyelash follicles and sebaceous glands. Increased Demodex infestation has been associated with chronic blepharitis, eyelid inflammation and ocular surface irritation.
Patients may experience itchiness, crusting, recurrent chalazia, lid margin inflammation or cylindrical dandruff at the lash bases.
Demodex-associated blepharitis frequently coexists with Meibomian gland dysfunction and evaporative dry eye disease. Management may involve targeted eyelid hygiene strategies and treatment of associated inflammatory eyelid disease.
Nocturnal Lagophthalmos and Exposure-Related Dry Eye
Some patients experience ocular surface dryness related to incomplete eyelid closure during sleep or increased ocular surface exposure.
Symptoms may be particularly noticeable on waking and can include burning, irritation, foreign body sensation or fluctuating morning vision.
Contributing factors may include eyelid laxity, facial anatomy, previous eyelid surgery, facial nerve dysfunction or nocturnal lagophthalmos.
Management may involve overnight lubricating ointments, moisture protection strategies and treatment of associated ocular surface inflammation. In more severe cases, surgical intervention to assist eyelid closure may be needed.
Long-Term Management of Dry Eye Disease
Dry eye disease is usually a chronic condition that typically needs ongoing management. Symptoms may fluctuate over time, and many patients require ongoing maintenance treatment. Improvement may occur gradually over weeks to months, particularly when inflammation and Meibomian gland dysfunction are significant contributors.
Treatment frequently involves a combination of strategies directed at tear film stability, eyelid disease, ocular surface inflammation and environmental contributors. Management plans may therefore evolve over time depending on symptoms, clinical findings and response to treatment.
Specialist Dry Eye Assessment in Waterloo
Eye and Retina Specialists is located in Waterloo near Green Square, with free onsite patient parking and convenient access from Sydney CBD and surrounding suburbs.
We provide comprehensive ophthalmic assessment and management of dry eye disease, Meibomian gland dysfunction, blepharitis and ocular surface disorders using evidence-based and individualised treatment strategies tailored to each patient’s underlying pattern of disease.
Call our email our clinic today to organise an appointment.
