Guide · dry eye
Blepharitis or dry eye? How to tell, and why most people have both
Blepharitis is the lids. Dry eye is the tears. They feel different, but in most people we see they are two ends of the same problem, and treating one without the other is why so many people go round in circles.
Blepharitis: the lids
Itchy, sore or red lid edges. Crusting along the lashes, worse in the morning. Lashes that fall out or grow in odd directions. A gritty feeling right at the lid line. It is inflammation where the lashes grow.
Dry eye: the tears
Gritty or burning eyes that get worse through the day. Vision that blurs on a screen and clears when you blink. Watering, which surprises people, because a dry eye over-produces poor-quality tears. Eyes that feel tired by mid-afternoon. Contact lenses you cannot wear for as long as you used to.
Why they travel together
Along the lid edge are the oil glands that keep your tears from evaporating. Inflamed lids block those glands, the oil stops reaching the tears, and the tears dry out in seconds. So blepharitis very often causes dry eye, and blocked glands make the lids more inflamed in turn. That is why drops alone, or lid wipes alone, rarely settle it.
How to tell which you have
The 60-second check gives you a score at home. The Dry Eye Assessment answers it properly: we look at your lid edges and lashes under the microscope, measure how long your tears last, check how many glands still release oil, and show you every result on the screen. You leave knowing which it is, or how much of each, and what would actually clear it.
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
- Blepharitis is the lid edge, dry eye is the tear film
- Inflamed lids block the oil glands, so one causes the other
- Treating only one is why it keeps coming back
- The assessment shows you which you have, on the screen