Dry Eye Disease
Also known as: DED, Keratoconjunctivitis sicca, Ocular surface disease
Overview
Dry eye disease is a multifactorial disease of the ocular surface characterized by loss of tear film homeostasis, accompanied by ocular symptoms, in which tear film instability, hyperosmolarity, inflammation, and neurosensory abnormalities play etiological roles. It is among the most common reasons patients present to eyecare providers. Management is staged and targets the underlying subtype—aqueous-deficient, evaporative, or mixed.
- Nature
- Multifactorial ocular surface disease
- Core mechanism
- Tear film instability + hyperosmolarity
- Main subtypes
- Evaporative, aqueous-deficient, mixed
- Framework
- TFOS DEWS II
Key clinical points
- Evaporative dry eye from meibomian gland dysfunction is the most common subtype.
- Symptoms and signs frequently do not correlate, so evaluation combines questionnaires with objective testing.
- Tear osmolarity and matrix metalloproteinase-9 testing support diagnosis and characterize inflammation.
- Management is staged from lubricants and lid hygiene up to anti-inflammatories, secretagogues, and procedures.
- Identifying and treating meibomian gland dysfunction is central to most evaporative disease.
Pathophysiology
The TFOS DEWS II report frames dry eye around a self-perpetuating vicious cycle: tear film instability and hyperosmolarity trigger ocular surface inflammation and damage, which further destabilizes the tear film. Neurosensory abnormalities can amplify symptoms and, in some patients, produce a mismatch between reported discomfort and visible signs.
Classifying disease along the evaporative–aqueous-deficient spectrum guides therapy. Most patients have a significant evaporative component driven by meibomian gland dysfunction.
Diagnosis
A validated symptom questionnaire (such as OSDI or DEQ-5) begins the workup. Objective tests include tear breakup time, ocular surface staining with fluorescein and lissamine green, meibomian gland expression and meibography, and Schirmer testing for aqueous production.
Point-of-care tear osmolarity and MMP-9 testing add objective measures of instability and inflammation. Because signs and symptoms often diverge, an integrated picture is more reliable than any single test.
Management
Treatment is staged. Foundational measures include artificial tears, lid hygiene, warm compresses, environmental modification, and addressing contributing medications and systemic disease. Meibomian gland dysfunction is treated with lid-warming therapies and, when needed, in-office thermal pulsation or intense pulsed light.
Persistent disease warrants anti-inflammatory therapy such as topical cyclosporine or lifitegrast, short pulses of topical corticosteroid, and secretagogues. Punctal occlusion conserves tears in aqueous-deficient disease, and autologous serum or scleral lenses are reserved for severe or refractory cases.
Dry Eye Disease videos
Ocular Surface Disease: Do patients really take all their drops?
iDSocial is proud to serve as the Official Meeting Organizer for the 2027 Ocular Surface Summit.
Dry Eye Travel Tips
Contact Lens and the Ocular Surface
IPL for Dry Eye
TFOS: Cosmetics and the Ocular Surface with Dr. Selina McGee
Dry Eye Procedures: What and How to choose with Dr. Elise Kramer
Dry Eye Treatments
Frequently asked questions
- Why don’t dry eye symptoms match the clinical signs?
- Neurosensory abnormalities and corneal nerve sensitization can produce prominent symptoms with minimal signs, or vice versa. This is why guidelines recommend combining symptom questionnaires with objective testing.
- What is the most common cause of dry eye?
- Evaporative dry eye due to meibomian gland dysfunction is the most common form, so evaluating and treating the meibomian glands is central to management.
- Do anti-inflammatory drops help dry eye?
- Yes. Because inflammation drives the dry eye cycle, agents such as topical cyclosporine or lifitegrast, and brief courses of corticosteroid, are used to interrupt it in moderate to severe disease.
References & further reading
Related conditions
Meibomian Gland Dysfunction
Meibomian gland dysfunction (MGD) is a chronic, diffuse abnormality of the meibomian glands, commonly characterized by terminal duct obstruction and changes in glandular secretion, and it is the leading cause of evaporative dry eye disease. Because the meibomian glands supply the lipid layer that stabilizes the tear film, their dysfunction leads to accelerated evaporation, instability, and ocular surface inflammation.
Clinical overviewCornea & Ocular SurfaceBlepharitis
Blepharitis is a common, chronic inflammation of the eyelid margins that contributes substantially to ocular surface disease and dry eye. It is broadly divided into anterior blepharitis, affecting the lash base, and posterior blepharitis, involving the meibomian glands. Management centers on consistent lid hygiene and targeting the underlying inflammatory or infectious contributors.
Clinical overviewCornea & Ocular SurfaceConjunctivitis
Conjunctivitis is inflammation of the conjunctiva with viral, bacterial, allergic, and toxic causes. It is one of the most frequent reasons for acute eye visits, and distinguishing the underlying cause is essential because management differs markedly. Most acute infectious conjunctivitis is viral and self-limited, and thoughtful evaluation reduces unnecessary antibiotic use.
Clinical overview