Dry, tired eyes. A gritty, sandy feeling by the end of the workday. Many of us put it down to a late night and expect it to pass.
But when these feelings keep coming back, it may be dry eye.
Dry eye is very common, and there's no need to worry. Once you understand what's behind it, most cases can be gently improved over time. In this guide, we walk through the symptoms, causes, assessment and treatment options from an optometrist's perspective, so you can understand your eyes a little better.
In this guide
What is dry eye?
Dry eye isn't simply a lack of tears. It happens when the tear film on the surface of your eye loses its balance.
The tear film is very thin, but it has three layers, each with its own role:
Oil layer
Produced by the meibomian glands along your eyelid edges. Locks in moisture and slows evaporation.
Water layer
Produced by the tear glands. Hydrates and cleans the surface of the eye.
Mucus layer
Helps tears spread evenly and stay on the cornea.
When any layer is disrupted, the tear film becomes unstable and the eye surface dries out and irritates more easily. The international TFOS DEWS II consensus report describes dry eye as a multifactorial condition of the ocular surface, where tear film imbalance and inflammation affect each other.
Common symptoms of dry eye
Dry eye feels different for everyone. Common signs include:
- Dry, gritty eyes, as if there's sand or something in them
- Eye fatigue, especially after using a computer or phone
- Redness, stinging or a burning sensation
- Vision that blurs on and off, then clears when you blink
- Contact lenses that feel less comfortable, or can't be worn for as long
- Sensitivity to light, wind or air conditioning
Can watery eyes be a sign of dry eye?
Yes, and it's very common. When the tear film is unstable, the irritated eye surface triggers a rush of reflex tears. These tears lack the protective oil layer, so they evaporate quickly. That's why eyes can feel dry and watery at the same time. Watery eyes don't mean your eyes aren't dry.
What causes dry eye?
Dry eye generally falls into two types, and many people have a little of both:
- Evaporative dry eye: there are enough tears, but not enough oil, so tears evaporate too quickly. The most common cause is meibomian gland dysfunction (MGD)
- Aqueous-deficient dry eye: the tear glands produce less water to begin with
Clinical studies show that most dry eye cases involve excess evaporation, which is why checking the meibomian glands is a key part of any dry eye assessment. Read more about the types of dry eye.
Meibomian gland dysfunction (MGD)
The meibomian glands sit along the edges of the upper and lower eyelids and release oil to protect the tear film every day. When that oil thickens and the gland openings become blocked, it can't flow out, and tears evaporate faster. Over time, blocked glands may shrink, so the earlier it's addressed, the better.
Lifestyle and environmental factors
- Long screen time: we blink much less when focusing on a screen, and often don't close our eyes fully
- Contact lenses: they affect how the tear film spreads, and long wear or poor lens care can make things worse
- Eye makeup and lash extensions: eyeliner on the inner lash line and incomplete makeup removal can block the glands
- Air conditioning and dry air: Hong Kong's indoor air conditioning speeds up tear evaporation
- Age and hormonal changes: meibomian gland function naturally declines with age
- Lack of sleep: your eyes don't get enough time to rest and recover
- Certain medications: some allergy or acne medications, for example, can affect tear production
Self-check: when should you get a dry eye assessment?
If two or more of these sound familiar, it may be worth booking a full dry eye assessment:
- ✓You feel dry, tired or gritty eyes several days a week
- ✓You use a computer or phone for more than 6 hours a day
- ✓Your contact lenses feel less comfortable than they used to
- ✓Your eyes feel dry again soon after using artificial tears
- ✓Your eyes often water, yet still feel dry
- ✓You regularly wear eyeliner or lash extensions
- ✓Your eyelid edges feel sticky or crusty when you wake up
There's no need to wait until dry eye becomes severe. The earlier you understand your meibomian glands, the easier it is to improve.
What does a full dry eye assessment involve?
Dry eye has different causes for different people, so the first step is understanding your eyes clearly. A comprehensive dry eye assessment usually includes:
-
1Symptom questionnaire and lifestyle review
Screen time, contact lenses, makeup and sleep habits. -
2Non-invasive tear breakup time (NITBUT)
Measures how long your tear film stays stable before it starts to break up, with no drops needed. -
3Tear meniscus height
Assesses how much tear fluid you produce. -
4Meibography
Infrared imaging that shows whether your meibomian glands have shortened or shrunk. -
5Ocular surface evaluation
A slit lamp examination of the eyelid margins, gland openings and cornea, with fluorescein staining when needed to check for surface damage.
Afterwards, your optometrist will go through the results with you, explain what's behind your symptoms, and recommend a care plan that suits you.
Dry eye treatment and care options
Dry eye is usually managed step by step, starting with daily care and adding in-clinic treatment when needed.
Daily care
- Warm compresses: help soften thickened oil in the meibomian glands so it flows more easily
- Eyelid hygiene: gently cleaning the lash line with an eyelid cleanser reduces oil and bacteria build-up
- Artificial tears: preservative-free formulas are recommended; for evaporative dry eye, lipid-based drops are often a better fit
In-clinic treatments
When daily care isn't enough, these in-clinic treatments may help. Each targets a different part of the problem, and they can be combined depending on your needs:
| Treatment | How it works | Best suited for |
|---|---|---|
|
IPL Intense Pulsed Light |
Light energy applied to the skin around the eyes helps improve meibomian gland function and eyelid inflammation | MGD, red or inflamed eyelid margins |
|
RF Radiofrequency |
Gentle heat warms the eyelids deeply to help melt thickened oil | Thick oil, blocked gland openings |
|
MGX Meibomian gland expression |
Professional technique to clear the gland openings and release trapped oil | Clearly blocked glands |
The latest research shows IPL can help improve meibomian gland function and tear film stability. Treatment usually takes several sessions, and results vary from person to person. Your optometrist will recommend a plan based on your assessment results.
What to expect from IPL treatment →
Small daily habits for calmer eyes
- The 20-20-20 rule: every 20 minutes, look at something 20 feet (about 6 metres) away for 20 seconds
- Blink fully: when working on a screen, slowly close your eyes all the way, then open them
- Avoid direct air conditioning: sit away from vents where you can
- Keep screens slightly below eye level: your eyes open less widely, so tears evaporate more slowly
- Remove makeup thoroughly: pay extra attention to the lash line and eyeliner area
- Replace contact lenses on schedule: avoid sleeping in them or wearing them beyond their recommended time
- Rest and hydrate: give your eyes enough time to recover
When to see an ophthalmologist
Most dry eye can be assessed and managed by an optometrist. But if you notice any of the following, please see an ophthalmologist as soon as possible:
- A sudden, significant drop in vision
- Severe eye pain, or extreme sensitivity to light
- Persistent redness with heavy discharge
- Dry eyes together with a dry mouth, joint pain or other whole-body symptoms
If your assessment shows anything that needs further attention, we'll arrange a referral so you receive the most appropriate care.
Frequently asked questions
Does dry eye go away on its own?
Mild, short-term dryness may ease with lifestyle changes. But when it's caused by blocked meibomian glands, it usually needs ongoing care, and can slowly worsen if left alone.
Can I use artificial tears long-term?
Preservative-free artificial tears are generally fine for daily use. If you find you need them very often to feel comfortable, a dry eye assessment can help uncover why.
Does IPL treatment hurt?
Most people describe a gentle warmth, or a feeling like a light rubber band snap. Each session usually takes around 15 minutes.
How long does a dry eye assessment take?
A full dry eye assessment, including going through your results, usually takes about 45 to 60 minutes.
Can young people get dry eye?
Yes. With long screen time, contact lens wear and makeup habits, dry eye is becoming more common in younger people, including students and office workers.
Can I use the Elderly Health Care Voucher?
Yes. Réspa accepts the Hong Kong Elderly Health Care Voucher, which eligible seniors can use for eye examinations and related services.
Keep reading
Curious about your own eyes?
Everyone's dry eye has its own story. Finding the cause is the first step to the right care.
If your eyes often feel dry or tired, you're welcome to book a detailed assessment. Our optometrists will look at your tear film and meibomian glands with you, and talk you through what we find 🤍
Book an assessmentRéspa — Optometry & Dry Eye Wellness Centre
Room 1303, Hang Shing Building, 363–373 Nathan Road, Yau Ma Tei
11:00 AM – 7:00 PM · Closed Wednesday and Friday
About the author
Written by a registered optometrist at Réspa. Réspa was founded by three optometrists and focuses on comprehensive dry eye assessment and care, bringing evidence-based optometry together with a calm, wellness-focused experience.
References
- Craig JP, et al. TFOS DEWS II Definition and Classification Report. The Ocular Surface, 2017.
- Lemp MA, et al. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort. Cornea, 2012.
- Wolffsohn JS, et al. TFOS DEWS II Diagnostic Methodology Report. The Ocular Surface, 2017.
This article is for general health information only and does not replace a professional eye examination. If you have any eye discomfort, please consult a registered optometrist or ophthalmologist.
