Dry Eye Resource Centre
Over the years, I've found that many patients have been told they simply have "dry eyes", without ever being given an explanation for why their eyes are dry.
In reality, dry eye disease is often the result of an underlying condition.I've created this Resource Centre to answer the questions my patients ask every day in the clinic. I hope these articles help you better understand the diseases associated with dry eyes, the treatments available and the latest approaches to managing this common condition.
"Treat the cause, not just the symptoms."
— Dr Cheryl Lee
Diseases That Cause Dry Eyes
Meibomian Gland Dysfunction (MGD)
Blepharitis
Medical Conditions Associated with Dry Eyes
Rheumatoid Arthritis
Lupus
Thyroid Eye Disease
Diabetes
Menopause
Situations That Can Make Dry Eyes Worse
Computer Use
Contact Lenses
LASIK
Cataract Surgery
Air Conditioning
Flying
Ocular Rosacea and Dry Eyes
What is Ocular Rosacea?
Ocular rosacea is a chronic inflammatory condition that affects the eyes and eyelids. It is closely related to rosacea, a common skin condition that causes facial redness, flushing and visible blood vessels. In many people, eye symptoms may develop before skin changes become obvious, making the condition difficult to recognise.
Inflammation associated with ocular rosacea can affect the eyelids and meibomian glands, resulting in poor tear quality and chronic dry eye disease.
Why Does Ocular Rosacea Cause Dry Eyes?
The meibomian glands produce the oily layer of the tear film that helps prevent tears from evaporating too quickly.
In ocular rosacea, chronic inflammation can block or damage these glands, reducing the quality of the oil they produce. As a result, tears evaporate more rapidly, leaving the eyes dry, irritated and uncomfortable.
Many patients with ocular rosacea also develop Meibomian Gland Dysfunction (MGD) and Blepharitis, making dry eye symptoms more persistent.
Common Symptoms
People with ocular rosacea may experience:
Dry, gritty or burning eyes
Red or bloodshot eyes
Watery eyes
Light sensitivity
Blurred vision that improves after blinking
Red, swollen eyelids
Frequent styes or chalazia
Itchy eyelids
Difficulty wearing contact lenses
Some patients also notice:
Facial flushing
Redness across the cheeks and nose
Small visible blood vessels on the face
Sensitive skin
How Is It Diagnosed?
Dr Cheryl Lee will perform a comprehensive examination of your eyelids, meibomian glands and tear film to look for signs of ocular rosacea and associated dry eye disease.
Because ocular rosacea often affects both the skin and the eyes, the diagnosis is based on your symptoms together with the clinical findings during your eye examination. Some patients may also benefit from assessment by a dermatologist if facial rosacea is present.
Treatment
Although ocular rosacea is a long-term condition, the symptoms can usually be managed successfully with appropriate treatment.
Treatment may include:
Eyelid hygiene
Warm compresses
Preservative-free artificial tears
Management of Meibomian Gland Dysfunction
Prescription anti-inflammatory medications when appropriate
Advanced treatments such as Eye-Light®, Tixel® or BlephEx® to reduce eyelid inflammation and improve meibomian gland function
Lifestyle measures, such as avoiding known rosacea triggers and protecting the eyes from wind and excessive sun exposure, may also help reduce flare-ups.
Dr Cheryl Lee's Perspective
Many patients are surprised to learn that rosacea can affect the eyes as well as the skin.
Persistent dry eyes, recurrent styes or eyelid inflammation may be signs of ocular rosacea, even in patients with only mild facial redness. Identifying the condition early allows treatment to focus on controlling inflammation, improving tear quality and reducing the frequency of flare-ups.
Sjögren's Syndrome and Dry Eyes
What is Sjögren's Syndrome?
Sjögren's syndrome is a chronic autoimmune disease in which the body's immune system mistakenly attacks its own moisture-producing glands, particularly the tear and saliva glands. This reduces the production of tears and saliva, leading to persistent dry eyes and a dry mouth. It may occur on its own (primary Sjögren's syndrome) or alongside other autoimmune conditions such as rheumatoid arthritis or lupus.
Women are affected much more commonly than men, particularly after the age of 40.
Why Does Sjögren's Syndrome Cause Dry Eyes?
Healthy tears protect the surface of the eye, keep vision clear and help prevent infection.
In Sjögren's syndrome, inflammation damages the tear glands, reducing tear production. Without enough tears, the eyes become dry, irritated and uncomfortable.
Many patients with Sjögren's syndrome also have Meibomian Gland Dysfunction (MGD), meaning their tears evaporate more quickly because the protective oil layer is also affected. This combination often makes dry eye symptoms more severe.
Common Symptoms
People with Sjögren's syndrome may experience:
Persistent dry eyes
Burning or stinging
A gritty or sandy sensation
Red eyes
Blurred vision that improves after blinking
Sensitivity to light
Watery eyes despite feeling dry
Difficulty wearing contact lenses
Many people also notice a dry mouth, fatigue, joint pain or frequent dental problems.
How Is It Diagnosed?
If Sjögren's syndrome is suspected, Dr Cheryl Lee will perform a comprehensive dry eye assessment to evaluate tear production, tear quality, the health of the ocular surface and the function of the meibomian glands.
Because Sjögren's syndrome is a systemic autoimmune disease, blood tests can confirm the diagnosis.
Treatment
Although Sjögren's syndrome cannot currently be cured, there are many ways to improve comfort and protect the eyes.
Treatment may include:
Preservative-free artificial tears
Eyelid hygiene and warm compresses
Treatment of Meibomian Gland Dysfunction
Prescription anti-inflammatory eye drops when appropriate
Punctal plugs to reduce tear drainage
Advanced treatments such as Eye-Light®, Tixel® or BlephEx® if MGD or eyelid inflammation is also present
Because every patient is different, treatment is tailored to the underlying cause of the dry eyes rather than using the same approach for everyone.
Dr Cheryl Lee's Perspective
Many patients believe they simply have "dry eyes", when in fact an underlying medical condition may be contributing to their symptoms.
Identifying conditions such as Sjögren's syndrome is important because treating the underlying disease, together with appropriate dry eye management, often provides better long-term results than relying on artificial tears alone.
"Treat the cause, not just the symptoms."
Allergic Eye Disease and Dry Eyes
What is Allergic Eye Disease?
Allergic eye disease occurs when the eyes react to allergens such as pollen, dust mites, pet dander or mould. These allergens trigger an immune response that causes inflammation of the conjunctiva (the clear membrane covering the white of the eye), resulting in itchy, red and watery eyes.
Although allergies and dry eye disease are different conditions, they often occur together. Inflammation caused by allergies can disrupt the normal tear film and make dry eye symptoms worse. At the same time, people with dry eyes may become more sensitive to environmental allergens because the tear film is less able to protect the surface of the eye.
Why Does Allergic Eye Disease Cause Dry Eyes?
A healthy tear film helps wash away allergens and protects the surface of the eye.
During an allergic reaction, inflammation can reduce the stability of the tear film and affect the function of the meibomian glands, causing tears to evaporate more quickly. Frequent eye rubbing, a common response to itchy eyes, may further irritate the eyes and contribute to eyelid inflammation.
Some allergy medications, particularly oral antihistamines, may also reduce tear production and worsen dry eye symptoms in susceptible individuals.
Common Symptoms
People with allergic eye disease may experience:
Itchy eyes
Red eyes
Watery eyes
Burning or stinging
Swollen eyelids
Stringy mucus discharge
Light sensitivity
A gritty or dry sensation
Blurred vision that improves after blinking
Symptoms often worsen during certain seasons or after exposure to specific allergens.
How Is It Diagnosed?
Dr Cheryl Lee will examine the surface of your eyes, eyelids and tear film to determine whether your symptoms are caused by allergies, dry eye disease or a combination of both.
Many patients have more than one condition contributing to their symptoms. Identifying all the underlying causes allows treatment to be tailored more effectively.
Treatment
Successful treatment involves controlling both the allergic inflammation and the dry eye disease.
Treatment may include:
Get rid of allergens on the eyelashes by BlephEx® and Eyelight
Anti-allergy eye drops when appropriate
Cold compresses to relieve itching and swelling
Treatment of associated Meibomian Gland Dysfunction or Blepharitis
Advanced dry eye treatments such as Eye-Light®, Tixel® or BlephEx® where appropriate
Because every patient is different, treatment is personalised according to the underlying cause and severity of the symptoms.
Dr Cheryl Lee's Perspective
Many patients assume that red, itchy eyes are caused only by allergies, while others believe all irritation is due to dry eyes. In reality, the two conditions often occur together.
A careful examination helps determine whether allergies, dry eye disease or another eyelid condition is contributing to your symptoms. By treating the underlying causes rather than simply relieving the symptoms, we can often achieve better long-term comfort.
Treat the cause, not just the symptoms.
Demodex and Dry Eyes
What is Demodex?
Demodex are tiny microscopic mites that naturally live on human skin, particularly around the hair follicles and eyelashes. In small numbers they are usually harmless. However, when they multiply excessively, they can cause inflammation of the eyelids, leading to a condition known as Demodex blepharitis.
Demodex infestation is becoming increasingly recognised as an important cause of chronic eyelid irritation, blepharitis and dry eye disease, especially in adults and older individuals.
How Does Demodex Cause Dry Eyes?
Demodex mites live around the base of the eyelashes and within the oil-producing meibomian glands. They can trigger inflammation, block the meibomian glands and disrupt the normal tear film.
As a result, the oily layer of the tears becomes unstable, causing tears to evaporate more quickly. This leads to dry, irritated eyes and symptoms that may persist despite frequent use of artificial tears.
Demodex may also worsen existing Meibomian Gland Dysfunction (MGD) and Blepharitis, making dry eye disease more difficult to control.
Common Symptoms
People with Demodex blepharitis may experience:
Itchy eyelids, especially on waking
Burning or stinging eyes
Dry or gritty eyes
Red eyelid margins
Frequent styes or chalazia
Crusting around the eyelashes
Blurred vision that improves after blinking
Irritated or watery eyes
Loss or misdirected eyelashes
One of the characteristic signs of Demodex is the presence of cylindrical dandruff, a sleeve-like deposit that forms around the base of the eyelashes.
How Is It Diagnosed?
During your examination, Dr Cheryl Lee will carefully examine your eyelids and eyelashes using a slit lamp microscope. The presence of cylindrical dandruff around the eyelashes is a strong indication of Demodex infestation.
Your tear film, meibomian glands and eyelids will also be assessed to determine whether Demodex is contributing to your dry eye symptoms.
Treatment
Successful treatment aims to reduce the number of mites, improve eyelid hygiene and restore the health of the eyelids and tear film.
Treatment may include:
Careful eyelid hygiene
Special eyelid cleansers recommended by your eye specialist
Treatment for associated Meibomian Gland Dysfunction
BlephEx® to remove debris and biofilm from the eyelid margins
Eye-Light® or Tixel® where appropriate to improve eyelid and meibomian gland health
Prescription treatment when clinically indicated
Because Demodex is only one possible cause of dry eye disease, treatment is personalised according to each patient's underlying condition.
Dr Cheryl Lee's Perspective
Many patients with long-standing dry eyes or recurrent blepharitis are surprised to learn that microscopic mites may be contributing to their symptoms.
Fortunately, Demodex can usually be identified during a comprehensive eyelid examination. Once recognised, targeted treatment often improves eyelid health and helps reduce ongoing irritation, allowing the tear film to function more effectively.
Treat the cause, not just the symptoms.
Roaccutane (Isotretinoin) and Dry Eyes
What is Roaccutane?
Roaccutane® (isotretinoin) is a prescription medication commonly used to treat severe acne. It is highly effective because it reduces the size and activity of the oil-producing glands in the skin.
However, the medication can also affect the meibomian glands in the eyelids. These glands produce the oily layer of the tear film that prevents tears from evaporating too quickly. As a result, many people taking Roaccutane develop dry eye symptoms during treatment.
Why Does Roaccutane Cause Dry Eyes?
The meibomian glands are specialised oil glands located along the eyelid margins. Their role is to produce the lipid layer of the tear film, which keeps the eyes lubricated and slows tear evaporation.
Roaccutane reduces oil production throughout the body, including in the meibomian glands. With less oil available, tears evaporate more quickly, causing evaporative dry eye disease.
Some people notice only mild irritation, while others develop significant dry eye symptoms, particularly if they already have Meibomian Gland Dysfunction (MGD) or spend long hours using digital devices.
Common Symptoms
People taking Roaccutane may experience:
Dry or gritty eyes
Burning or stinging
Red eyes
Blurred vision that improves after blinking
Watery eyes despite feeling dry
Increased sensitivity to light
Eye fatigue
Difficulty wearing contact lenses
Symptoms may begin within a few weeks of starting treatment and often improve after the medication is stopped, although some patients may continue to experience dry eyes for longer.
How Is It Diagnosed?
If you develop dry eye symptoms while taking Roaccutane, Dr Cheryl Lee will assess your tear film, meibomian glands and ocular surface to determine the severity of the dryness and identify any underlying conditions that may be contributing to your symptoms.
Understanding whether the dryness is caused solely by the medication or whether there is pre-existing Meibomian Gland Dysfunction helps guide the most appropriate treatment.
Treatment
Most patients can continue taking Roaccutane while managing their dry eye symptoms.
Treatment may include:
Preservative-free artificial tears
Lubricating eye ointment at night if required
Warm compresses when appropriate
Management of Meibomian Gland Dysfunction
Temporary reduction in contact lens wear if discomfort develops
Advanced dry eye treatments such as Eye-Light® or Tixel® if clinically appropriate
Your treatment plan will be personalised according to the severity of your symptoms and the health of your meibomian glands.
Dr Cheryl Lee's Perspective
Roaccutane is an excellent treatment for severe acne, but it can significantly affect the quality of the tear film.
Most patients experience only temporary symptoms, and with early recognition and appropriate management, dry eye discomfort can usually be controlled without stopping the medication. For patients with pre-existing dry eye disease, identifying and treating underlying Meibomian Gland Dysfunction before or during treatment may help reduce symptoms.
Treat the cause, not just the symptoms-Dr Cheryl Lee