DRY EYE DISEASE IN PAPHOS
Dry eye disease is more than simply having "dry eyes." It is particularly common among people who spend long hours on digital devices, wear contact lenses, have undergone LASIK or cataract surgery, or have underlying eyelid and ocular surface conditions. Symptoms may reflect tear film instability, reduced tear production, meibomian gland dysfunction, eyelid inflammation, blink pattern, eyelid position, or inflammation of the ocular surface itself. Dr Valentina Stavrou takes a diagnostic-led approach, using clinical examination and advanced tear-film imaging to identify the main drivers before planning treatment.
Understanding dry eye
The same symptoms can come from different patterns of tear-film change, which is why evaluation matters.
Dry eye can affect visual comfort, concentration, work productivity, and daily quality of life. Watery eyes can also be part of dry eye when an unstable tear film triggers reflex tearing.
The tear film is a layered structure that keeps the eye comfortable and vision clear. The lipid layer, produced by the meibomian glands, helps prevent evaporation. The aqueous layer hydrates and nourishes the ocular surface. The mucin layer helps tears spread evenly across the eye.
Dry eye symptoms can develop when any of these layers becomes unstable or insufficient.
Evaporative dry eye is the most common pattern. Tears may be produced in adequate volume, but they evaporate too quickly because the oily layer of the tear film is not functioning well.
The most common cause is meibomian gland dysfunction, where the eyelid oil glands become blocked, inflamed, or damaged.
In aqueous-deficient dry eye, the lacrimal glands do not produce enough watery tears. This can be associated with ageing, medications, hormonal change, autoimmune disease, Sjögren's syndrome, or previous ocular surgery.
Patients often describe persistent dryness, burning, foreign-body sensation, and difficulty with reading or driving.
Many patients have a mixed pattern: reduced tear volume, evaporative loss from MGD, eyelid inflammation, and ocular surface irritation may all be present together.
Treating only one component may leave symptoms unresolved. The purpose of evaluation is to identify the dominant contributors and prioritise treatment.
Microscopic Demodex mites commonly live on human skin and eyelashes. In small numbers they are usually harmless, but overgrowth can contribute to chronic eyelid inflammation, meibomian gland dysfunction, and persistent dry eye symptoms.
Typical clues include itching on waking, red or irritated eyelid margins, crusting around the eyelashes, recurrent styes or chalazia, and a foreign-body sensation. A classic sign is cylindrical dandruff: sleeve-like debris around the base of the eyelashes.
Contact lens wearers may develop burning, irritation, fluctuating vision, or discomfort toward the end of the day. Sometimes the lens contributes to tear-film instability; in other cases, underlying dry eye disease makes lenses increasingly difficult to tolerate.
Patients often describe lenses feeling dry after several hours, redness after removal, frequent need for lubricating drops, or gradually decreasing contact lens tolerance over time.
Long periods on computers, tablets, and phones reduce blink rate and often lead to incomplete blinking. This can increase evaporation, worsen MGD, and contribute to digital eye strain.
Air conditioning, office environments, and remote work can add to symptoms. Blink pattern can be assessed as part of advanced dry eye imaging.
The tear film is the first refractive surface of the eye. When it becomes unstable, vision can fluctuate, especially during reading, screen use, or driving.
Many patients notice that vision clears briefly after blinking and then becomes blurry again. In some cases, the issue is tear-film instability rather than a change in glasses prescription.
Hormonal change, especially during and after menopause, can influence tear production, meibomian gland function, and ocular surface inflammation.
This is one reason dry eye is particularly common in women aged 45-70, although it can affect patients of any age.
Dry eye can be associated with systemic conditions such as Sjögren's syndrome, rheumatoid arthritis, lupus, and thyroid eye disease.
When tear volume is significantly reduced or symptoms are unusually severe, the dry eye assessment may raise the question of whether systemic evaluation is needed.
Ocular rosacea can affect the eyelids and meibomian glands even when facial skin symptoms are mild. It may contribute to lid inflammation, gland obstruction, recurrent styes or chalazia, and chronic irritation.
Recognising rosacea-related eye disease is important because treatment often needs to address the eyelid margin as well as the tear film.
Some patients feel worst on waking. Morning dryness can be related to sleeping with the eyes slightly open, poor eyelid closure, CPAP airflow, or overnight exposure of the ocular surface.
These patterns are assessed differently from symptoms that mainly occur during screen use or late in the day.
Dry eye symptoms can become more noticeable after cataract surgery, especially when tear-film instability or MGD was already present before surgery.
Optimising the ocular surface can improve comfort and may also support more reliable measurements and visual quality around cataract care.
Allergy often causes itching, seasonal flares, swelling, and mucus, while dry eye more often causes burning, grittiness, fluctuating vision, and tear-film instability.
There is substantial overlap, and some patients have both. Examination helps avoid treating every irritated eye as allergy when dry eye or eyelid disease is the main driver.
Diagnostic evaluation
At the clinic, dry eye assessment combines ophthalmic examination with advanced imaging of the tear film, eyelids, and ocular surface.
Non-invasive tear break-up time measures how long the tear film remains stable after a blink. A shorter time suggests tear instability and often points toward evaporative dry eye.
Because this can be measured without dye, it gives information about the natural tear film.
Infrared imaging allows assessment of the meibomian glands inside the eyelids. This can show gland blockage, shortening, dropout, and more advanced MGD.
Seeing the gland structure can help explain why symptoms occur and why treatment sometimes needs to be ongoing.
Tear meniscus height helps estimate the volume of tears along the lower eyelid and may suggest aqueous-deficient dry eye when reduced.
Objective redness analysis can help document ocular surface inflammation and monitor response to treatment over time.
Assessment of tear-film behaviour and gland function helps determine whether poor oil production is contributing to symptoms.
Blink analysis is also relevant, especially for patients who spend long periods using computers, tablets, or phones. Incomplete blinking can worsen MGD, evaporation, and eye fatigue.
The dry eye work-up may include slit-lamp examination, corneal staining, eyelid margin assessment, tear quality evaluation, assessment for blepharitis and Demodex, and screening for associated ocular conditions.
Where useful, anterior segment imaging and epithelial surface analysis can also support interpretation of corneal surface change.
We use advanced dry eye diagnostics, including Oculus Keratograph 5M imaging, to evaluate tear break-up, tear volume, meibomian gland structure, redness, and blink behaviour.
More information about diagnostic technology is available on the Technology & Diagnostics page.
Treatment planning
Treatment is selected according to the pattern of disease, not simply the symptom label.
MGD is one of the most important causes of dry eye. Over time, oils within the glands can thicken and obstruct, leading to burning, redness, fluctuating vision, styes, chalazia, and chronic irritation.
Early treatment is important because advanced gland loss may be difficult to reverse.
For significant MGD, thermal pulsation treatment may help soften thickened gland secretions, support oil flow, and improve tear film stability.
It is often combined with eyelid hygiene, maintenance care, and treatment of inflammation when needed.
Some patients produce tears but lose them too quickly through normal drainage pathways. In selected cases, punctal plugs can help retain natural tears on the eye surface.
This quick in-office procedure may reduce dependence on artificial tears and improve lubrication when aqueous deficiency is part of the problem.
The eyelids play a central role in spreading tears and protecting the ocular surface. Ectropion can cause exposure-related dryness and watering, while entropion can cause lashes to rub against the eye.
When eyelid-position problems are present, they need to be considered as part of the dry eye plan.
Dry eye is common after LASIK and other refractive procedures. Corneal nerves involved in tear production can be temporarily affected, and pre-existing dry eye may become more noticeable.
Evaluation helps determine whether symptoms are related to reduced tear production, MGD, incomplete blinking, inflammation, or a combination.
Contact lenses interact directly with the tear film. They can disrupt tear-film stability, increase evaporation, alter blinking, contribute to MGD, and irritate the ocular surface in susceptible patients.
Treating the underlying dry eye pattern may improve comfort, visual quality, and wearing time. In more significant ocular surface disease, temporary reduction or interruption of lens wear may be advised while treatment begins.
Treatment pathway
Dry eye treatment is usually built in layers. The foundation may include blink awareness, eyelid hygiene, environmental changes, and appropriate lubricating drops. Intermediate steps may include treatment of inflammation, Demodex, blepharitis, or tear retention with punctal plugs. Advanced care may include thermal pulsation for MGD and management of eyelid-position problems when they affect the ocular surface.
The exact sequence depends on the examination findings, symptom pattern, and response to initial treatment.
When to seek evaluation
Many patients live with symptoms for years before receiving a structured evaluation.
Dr Valentina Stavrou provides evaluation and treatment for the full spectrum of dry eye disease, from mild irritation to complex ocular surface disorders.
The clinic evaluates tear quality, tear quantity, meibomian gland health, eyelid function, and ocular surface integrity to determine the underlying causes of symptoms rather than relying on a one-size-fits-all treatment strategy.
Dry eye myths and facts
Dry eye disease is often misunderstood because symptoms do not always match how the eyes look from the outside.
Excessive tearing is a common dry eye symptom. When the ocular surface is irritated, the eye may produce reflex tears that do not provide stable, lasting lubrication.
Dry eye becomes more common with age, but significant symptoms should not simply be accepted as normal. MGD, eyelid disease, inflammation, medication effects, and autoimmune conditions can often be identified and treated.
Artificial tears can relieve symptoms, but they may not address the underlying cause. Some patients need targeted treatment for gland dysfunction, inflammation, Demodex, eyelid-position problems, or tear drainage issues.
An unstable tear film can also affect vision. Many patients notice that vision clears after blinking and then becomes blurry again as the tear film breaks down.
Many patients produce enough tears but have poor tear quality. Meibomian gland dysfunction and excessive evaporation are among the most common causes.
Many patients with significant dry eye have eyes that appear relatively normal. Symptoms do not always correlate with visible redness, which is why tear-film testing and eyelid imaging can be valuable.
Modern dry eye care can be much more targeted than drops alone, using meibomian gland imaging, thermal pulsation, punctal occlusion, eyelid treatment, and management of underlying contributors where appropriate.
No. Dry eye disease can involve tear quantity, tear quality, meibomian gland function, eyelid position, inflammation, blink pattern, and the health of the ocular surface.
An unstable tear film can trigger reflex tearing. These watery tears do not necessarily have the right oil or mucin balance to keep the eye comfortable, so watering and dryness can occur together.
Imaging can assess tear film stability, tear volume, redness, blink pattern, and meibomian gland structure. These findings help identify whether symptoms are mainly evaporative, aqueous-deficient, inflammatory, or mixed.
Thermal pulsation may be considered when meibomian gland dysfunction is a meaningful driver of evaporative dry eye and the glands need heat and gentle pulsation to improve oil flow.
Yes. Ectropion, entropion, incomplete eyelid closure, and other eyelid-position issues can affect tear distribution, exposure, irritation, and ocular surface protection.
Yes. The tear film is the first refractive surface of the eye. When it breaks down between blinks, vision can fluctuate and may temporarily clear again after blinking.
Yes. Screen use reduces blink rate and often leads to incomplete blinking. This can increase tear evaporation, worsen MGD, and cause digital eye strain.
Hormonal change can affect tear production, meibomian gland function, and ocular surface inflammation. Dry eye is common in women during and after menopause.
Many cases of dry eye are chronic but can be managed successfully. The aim is to identify the underlying pattern, reduce symptoms, protect the ocular surface, and maintain improvement over time.