Guide · dry eye
Why do my eyes water when they’re dry?
It sounds like a contradiction and it’s the commonest dry eye story we hear: eyes that stream in the wind and feel like sand the rest of the time. Both are the same problem.
The tear film has layers
Water in the middle, made by the tear gland above the eye. A thin film of oil on top, made by glands inside the eyelids, which stops the water evaporating. When the oil glands block, the water evaporates in seconds, the surface of the eye dries and stings — and the eye responds the only way it can: by pumping out more water. Thin, oil-less tears that run straight off. Wind, cold and air conditioning speed the evaporation, so the streaming is worst then.
Why drops don’t stop it
Drops add water. The problem is the missing oil. So the drops evaporate too, and the eye keeps watering.
What does
Clearing the oil glands so they make oil again. The £15 gland scan photographs them; if they’re blocked, EyeClean clears them over three visits. For most people the streaming stops when the oil comes back.
When watering is something else
A blocked tear duct (constant watering, no dryness, often one eye) · an in-turned lash · allergy (itchy, both eyes, seasonal). We tell the difference in the chair.
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
- Watering and dryness are the same problem: no oil layer, so the water evaporates
- The eye over-produces thin tears that run straight off
- Drops add water; the glands need oil
- The assessment shows the cause; clearing the glands stops the streaming