Guide · dry eye treatment
The best treatment for dry eyes depends on which kind you have. Here is each one, compared
There is no single best treatment for dry eyes. There is a best treatment for your kind of dry eye, and most people have been given the wrong one. Here is every option, what it actually does, and how to find out which you need.
First: which kind of dry eye do you have?
Most dry eye, around eight in ten, is evaporative. You make enough tears, but the oil layer that should stop them drying out is missing, because the tiny oil glands along your lids have blocked. The rest is aqueous deficient: not enough of the watery part of the tear is made, which is more common with age, some medicines and conditions like Sjögren’s. Many people have some of both, and blepharitis (inflamed lid edges) often sits on top. Dry eye is often driven by an inflammation of the lid edge you may never notice.
The treatment that helps one kind does very little for the other. That is why so many people try drop after drop and still feel gritty.
Every treatment, compared
| Treatment | What it does | Best for | In the UK |
|---|---|---|---|
| Lubricating drops | Top up the tears for a while | Mild, occasional dryness | Pharmacy, from a few pounds |
| Oil-based drops and sprays | Put back the oil layer for a while | Evaporative dry eye, between treatments | Pharmacy |
| Warm mask at home | Softens oil near the surface of the glands | Keeping glands moving | Pharmacy, or our home kit |
| Gland clearing in clinic (our EyeClean) | Heat, lid clean and the glands cleared by hand | Blocked glands, blepharitis, mild symptoms | EyeClean £480 for the course |
| IPL, intense pulsed light (our EyeRelief) | Melts the thick oil at the base of the glands and calms the inflammation that blocks them | Evaporative dry eye and inflamed lids, the most common kind | EyeRelief £900 for the course |
| Punctal plugs | Keep your own tears on the eye for longer | Too few tears (aqueous deficient) | From £320 |
| Prescription anti-inflammatory drops | Calm long-standing inflammation of the eye surface | Severe dry eye that has not settled | On prescription |
Drops: helpful, but they mask the symptoms
Drops sit on top of the eye. If the cause is blocked glands, the drop does the glands’ job for half an hour and then evaporates, which is why people end up using them eight or ten times a day. Drops mask the symptoms and don’t solve the root cause. Use preservative-free ones if you use them often, and see which drop suits which kind of dry eye.
Clearing the glands: EyeClean
In the chair we warm the glands with our own heat masks and Blephasteam, clean the lid edges (BlephEx), and the optometrist clears the glands by hand under high magnification. It gets good results for many people, especially with blepharitis or milder symptoms. It is not the gold standard, because heat from the outside cannot melt the oil right at the base of the glands. EyeClean, £480 for the course.
IPL: treating the cause
IPL light reaches the base of each gland and warms the whole gland in one go, so it can be cleared fully. It also calms the inflammation that keeps re-blocking the glands, which is why the results last. IPL also reduces the bacteria and Demodex mites on the lids. Each EyeRelief visit is IPL, then a red-light mask, then the glands cleared. EyeRelief, £900: four IPL sessions and one EyeClean session, a home kit and an end of treatment follow-up, done within about three months. For lids where blepharitis keeps coming back, EyeRelief Max, £1,495. IPL is available at all our practices. More about IPL.
Plugs and prescription drops: for too few tears
If your tears are low in volume, tiny plugs in the tear ducts keep your own tears on the eye for longer. Punctal plugs, explained. Where the surface of the eye stays inflamed, prescription drops such as ciclosporin can help over months. Prescription drops in the UK.
Will dry eye go away for good?
For most people, dry eye is managed, not cured. The good news is that once the glands are cleared and the inflammation calmed, most people need far fewer drops, and a short home routine keeps it that way. Does dry eye go away?
How to find out which you need
The Dry Eye Assessment, £145, measures how long your tears last, how much tear you make, how healthy the surface of your eye is, and looks at your lids and lashes under the microscope. You see every result on the screen, and leave knowing which kind of dry eye you have and which treatment would actually help. £50 of it comes off any treatment you choose. Not sure yet? Start with the 60-second dry eye check.
The short version
- The best treatment depends on which kind of dry eye you have
- Most dry eye is blocked oil glands, so drops only mask it
- IPL (EyeRelief £900) treats the cause; EyeClean £480 clears the glands by hand
- Plugs and prescription drops are for too few tears
- The £145 assessment tells you which you need, £50 off treatment