Dry Eye: Why Your Eyes Might Be Watery, Gritty, and Tired All at Once

Dry eye is probably the most misunderstood condition I see in practice - on a daily basis.

People come in not expecting to be told that their watery, irritated, constantly fluctuating vision is actually dry eye too. Or that the gritty feeling they have been putting up with for years is not normal. Or that the drops they have been using every day are barely scratching the surface of what is actually going on.

Dry eye disease is genuinely common, genuinely uncomfortable, and genuinely underdiagnosed. It is also very treatable when you understand what is actually causing it.

Let me explain what dry eye actually is, what drives it, and what we can do about it.

What is dry eye disease?

Dry eye disease is a condition of the tear film. Not just a lack of tears, but a breakdown in the quality, stability, or composition of the tear film that sits on the surface of the eye.

A healthy tear film is not just water. It has three layers working together: an oily outer layer that prevents evaporation, a watery middle layer, and a mucus inner layer that helps everything spread evenly across the eye surface. When any part of this system is not working properly, the tear film breaks down too quickly, the surface of the eye is exposed, and the result is irritation, inflammation, and all the symptoms that come with it.

The most common cause of dry eye disease in Australia is meibomian gland dysfunction (MGD). The meibomian glands are tiny glands in the eyelids that produce the oily outer layer of the tear film. When these glands become blocked or inflamed, the oil they produce changes in quality, the tear film becomes unstable, and the eye surface becomes irritated and inflamed. Over time, untreated MGD can actually lead to permanent gland loss, which is why early treatment matters.

Dry eye is not just a lack of tears. It is a breakdown in the quality and stability of the tear film, and it has many causes.

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What does dry eye actually feel like?

This is where dry eye surprises people, because the symptoms are more varied than most expect. Dry eye does not always feel dry.

• Grittiness or a foreign body sensation, as though something is in the eye.
• Burning or stinging.
• Redness and irritation.
• Watery eyes. This is the one that confuses people most. When the tear film is unstable, the eye produces reflex tears in response to irritation. Paradoxically, watery eyes can be a sign of dry eye disease.
• Fluctuating vision that clears temporarily when you blink.
• Sensitivity to light, wind, or air conditioning.
• Tired eyes, particularly by the afternoon or after screen use.
• Difficulty wearing contact lenses comfortably.
• Eyes that feel worse in certain environments, such as air-conditioned offices, aeroplanes, or windy conditions.

If several of these sound familiar and you have been putting up with them, please do not. Dry eye is not something you just have to live with, and the longer it goes unmanaged, the more of a problem it can become.

Who gets dry eye?

Dry eye disease is extremely common, and it becomes more common with age. But there are a number of factors that can contribute at any age.

• Screen use. When we concentrate on screens, we blink significantly less than normal. Reduced blinking means reduced tear film renewal and faster evaporation. This is one of the reasons dry eye has become so prevalent.
• Age. Tear production naturally declines with age, and meibomian gland function tends to worsen over time.
• Hormonal changes. Dry eye is significantly more common in women, particularly around menopause. Hormonal fluctuations affect both tear production and meibomian gland function.
• Contact lens wear. Contact lenses disrupt the tear film and can accelerate evaporation.
• Certain medications. Antihistamines, antidepressants, blood pressure medications, and some other systemic medications can reduce tear production.
• Environmental factors. Air conditioning, low humidity, wind, and dust all increase tear evaporation.
• Eyelid conditions. Blepharitis (inflammation of the eyelid margins) and demodex are both closely linked to MGD and dry eye.
• Skin conditions. Ocular rosacea is a common but under recognised cause of MGD and dry eye, even in people who do not have obvious skin rosacea.

When we look at screens, we blink up to 60 percent less than normal. Less blinking means less tear film renewal. It adds up.

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How we assess dry eye at Outlook Eye Centre

A proper dry eye assessment goes well beyond asking whether your eyes feel dry. At Outlook Eye Centre, we take a thorough approach that looks at the tear film, the meibomian glands, the eyelid margins, and the ocular surface together.

We assess the quality and stability of the tear film, look for signs of meibomian gland dysfunction, evaluate the health of the lid margins and lashes, and examine the ocular surface for signs of inflammation or damage. We also take a careful history of your symptoms, your environment, your screen habits, and any medications that might be contributing.

Understanding the cause is what allows us to put together a treatment plan that actually works, rather than just recommending drops and hoping for the best.

What are the treatment options?

Treatment depends on what is driving the dry eye. For many patients, it is a combination of approaches rather than a single fix.

• Lubricating eye drops. The right drops for the right type of dry eye. Not all drops are the same, and using the wrong type can actually make things worse. We will recommend what is appropriate for your tear film.
• Warm compresses and lid hygiene. For MGD, regular warming of the eyelids softens the blocked meibomian gland secretions and helps restore normal oil flow. Lid hygiene removes debris and reduces bacterial load on the lid margins.
• Omega-3 supplementation. Good quality omega-3 fatty acids have good evidence behind them for improving meibomian gland function and tear film stability.
• In-clinic treatments. For patients with moderate to severe MGD, we offer more intensive in-clinic options including meibomian gland expression and, where appropriate, referral for Intense Pulsed Light (IPL) therapy. IPL targets the inflammation that drives MGD and has excellent results for suitable patients.
• Addressing contributing factors. Screen breaks, humidifiers, reviewing medications with your GP, adjusting contact lens wear. Sometimes small changes make a significant difference.

For most patients, dry eye is not a condition you cure once and never think about again. It is something you manage, and the goal is to get it well enough controlled that it stops interfering with your daily life. Most patients, with the right treatment plan, get there.

A note from Shannon

Dry eye is a condition I have a particular interest in, partly because I understand from personal experience how uncomfortable and disruptive it can be.

What I find most rewarding about managing dry eye is seeing patients who have been quietly putting up with symptoms for years finally get real relief. Often they did not realise how much it was affecting them until it improved.

If your eyes are bothering you on a regular basis, please come in. Even if you are not sure whether it is dry eye or something else entirely. That is what we are here for.

Book a dry eye assessment at Outlook Eye Centre. Call 07 4635 8844 or email andrew@outlookeyecentre.com.au. We are open Monday to Friday, 8:30am to 5:00pm, at 65 High Street, Rangeville, Toowoomba.

Shannon Smith | Optometrist | Outlook Eye Centre | 65 High Street, Rangeville, Toowoomba QLD 4350