Guide · dry eye drops
Which eye drops for dry eyes? An optometrist’s honest guide
There is no single best drop. There is a best drop for your kind of dry eye, and most people are using the wrong kind. Here is how to choose, and when drops are not the answer.
First: which kind of dry eye?
Most dry eye, around eight in ten, is evaporative: there is enough water, but the oil layer that should hold it in place is missing because the glands in the lids are blocked. The rest is aqueous deficient: not enough watery tear is made. Many people have a little of both. The drop that helps one does little for the other.
The four types of drop
Watery lubricating drops. Top up the water layer. Good for mild, occasional dryness and for aqueous deficient dry eye. They help for a short while because they evaporate like the tears they replace.
Gels and ointments. Thicker, last longer, blur the vision for a few minutes. Best at night.
Oil-based drops and lid sprays. Put back the oil layer. These are the ones that help evaporative dry eye, which is most of it, and they are the type most people have never been told about.
Anti-inflammatory and prescription drops. For lids and eyes that stay inflamed. These need an assessment first.
Preservative-free, always if you use them often
If you use drops more than four times a day, use preservative-free. Preservatives irritate the surface of the eye over time, which is the opposite of what you want.
Why even the right drop only lasts so long
Drops sit on top of the eye. If the cause is blocked oil glands, the drop is doing the glands’ job for half an hour, then evaporating. That is why so many people end up using drops eight or ten times a day and still feel gritty. Clearing the glands is what changes that. How we treat the cause.
The short way to know which suits you
At the Dry Eye Assessment we measure your tears and photograph your glands, then write down the specific drops that match what we found, as part of your home routine. Not the generic bottle from the pharmacy shelf: the one that suits your eyes.
The three types of dry eye, and what we do for each
Most people are told “you’ve got dry eyes” and handed drops. But there are three different causes, and each needs something different. Most people have a mix.
Blocked oil glands: meibomian gland dysfunction (MGD)
About 8 in 10 people with dry eye have this. Along the edge of each eyelid are about 30 tiny glands that put a thin layer of oil on your tears. When they block, your tears dry up in seconds, however much water your eyes make. It feels gritty, burning and tired, often worse on screens or by evening. Drops help for an hour, because they don’t unblock the glands.
What we do: photograph your glands so you can see them, warm and clear them in clinic, clean the lid edge, and use IPL or light therapy where it helps. Then we give you a simple routine for home.
Not enough tears
Your eyes don’t make enough of the watery part of tears. This is more common with age, some medicines, the menopause, and conditions like Sjögren’s.
What we do: measure your tear level, choose the right drops for you, and use tiny plugs to keep your own tears in where they help. We’ll write to your GP if something needs checking.
Inflamed eyelids: blepharitis, often with tiny mites called Demodex
Crusty, itchy, red lid edges, often worse in the morning.
What we do: deep-clean the lid edge in clinic, treat the mites, and show you how to keep the lids clean at home.
Not sure which one you have? That’s what the assessment is for. We look at your glands, tears and lids, and tell you which type, or which mix.
The short version
- Most dry eye is evaporative and needs an oil-based drop, not a watery one
- Gels at night, preservative-free if you use drops often
- Even the right drop only lasts so long if the glands are blocked
- Your assessment names the drops that suit your type