Dry Eye Treatment in Delhi, India

Dry eye, also known as dry eye syndrome, is a condition in which the eyes do not have sufficient moisture and lubrication to remain comfortable and function properly. It occurs when the quantity or quality of tears is inadequate to keep the surface of the eyes well-lubricated, leading to dryness and an imbalance in the tear film that protects and nourishes the eyes. Individuals experiencing persistent or worsening dry eye symptoms should consult an ophthalmologist as soon as possible, as chronic or untreated dry eye can lead to serious complications.

Based on the cause, dry eye can be categorised into the following types:

Aqueous Deficient Dry Eye

This occurs when the eyes do not produce enough tears to keep the surface of the eyes adequately moist. It is usually related to reduced tear production from the tear glands. There are two main subtypes of ADDE:

• Sjögren’s syndrome dry eye- An autoimmune disorder where the immune system attacks the lacrimal glands (small, almond-shaped glands that produce the watery part of tears)
• Non-Sjögren’s syndrome dry eye- This subtype is caused by changes that normally occur with age and other factors, rather than an autoimmune disease. 

Evaporative Dry Eye

Evaporative dry eye happens when the tears on the eye's surface dry out too quickly. This problem usually comes from issues with the small oil glands in the eyelids. These glands are supposed to make an oil that forms a protective layer over the tears, preventing them from evaporating too fast. When there isn't enough of this oil, tears disappear rapidly, leading to discomfort like blurry vision, tears that look foamy or oily, and a burning feeling in the eyes.

*The tear film is a thin layer of fluid that covers the surface of the eyes.

Mixed Dry Eye

Mixed dry eye, as its name suggests, is a common form of dry eye where an individual experiences a combination of both types: aqueous deficient dry eye and evaporative dry eye. This means that not only are the eyes not producing enough watery tears (aqueous deficiency), but the tears that are produced are also evaporating too quickly (evaporative dry eye) due to an unstable oily layer. This dual problem often leads to persistent and more severe symptoms because both essential components of the tear film are compromised simultaneously.

Dry eye can result from a variety of underlying factors that disrupt tear production. Here are some of them:

Age-Related Deterioration

As people age, the following age-related changes, in the eyes and the body contribute to reduced tear production and tear film stability:

• Lacrimal glands that produce the watery (aqueous) layer of tears become less active with age
• Meibomian glands, which produce the oily/lipid layer of the tear film, which slows tear evaporation, can shrink or become blocked over time, leading to reduced oil secretion
• In postmenopausal women, declining estrogen and androgen levels can affect tear production and quality

Mucin Deficiency 

Mucins are special proteins made by certain cells in the eye. They form the inner layer of the tear film that keeps the eyes moist. If there aren't enough mucins, the watery part of tears can’t spread smoothly over the eyes. This causes the tear layer to break up, leading to dry patches and faster tear evaporation. 

Certain Medications

Some drugs can cause dry eye by:

• Reducing tear production or altering tear composition
• Interfering with the signals that instruct the eyes to produce tears
• Causing inflammation in the tear glands or damaging cells on the eye surface

Eyelid Abnormalities

The eyelids protect the eye from drying out by reducing exposure to air, removing debris, and stimulating tear production. An eyelid abnormality can affect the eyelids, and they may not function properly. Here are some eyelid abnormalities that can lead to dry eye:

• Ectropion - The lower eyelid turns outward, leaving the eye exposed to air. As a result, tears evaporate easily. 
• Entropion - The lower eyelid turns inward, so the eyelashes rub against the eyeball, causing inflammation and damaging the tear film. 
• Lagophthalmos (inability to fully close the eyelids) - The eye stays partially open. This leads to excessive tear evaporation.

Tear Film Instability 

When the tear film breaks too quickly or doesn’t spread evenly over the eye surface, tears can’t stay in place long enough to protect and lubricate the eyes, leading to dry eye. Sometimes, the eyes may try to compensate by producing more tears, but they are often of poor quality.

Though dry eye can affect anyone, the following risk factors can increase the chances of it occurring:

Gender 

Women are more likely to develop dry eye due to the following reasons:

• Hormonal imbalances, during perimenopause and menopause, can alter the tear composition and lead to reduced tear production.
• Women are more likely to be affected by autoimmune diseases that affect tear production.
• Many women use contraceptive pills. Oral contraceptives can disrupt hormonal balance and lead to dry eye. 
• In women who wear makeup, eyelash extensions and eyeliner can affect the stability of the tear film. 

Contact Lens Use 

Here are some ways in which contact lenses can increase the risk of developing dry eye:

• Contact lenses constantly rub against the cornea and inner eyelids, irritating the ocular surface (the outermost structures of the eye that are in direct contact with the external environment) and causing inflammation 
• Lenses can reduce the amount of oxygen reaching the cornea. Low oxygen levels can affect the corneal epithelial cells and goblet cells (which produce mucin), leading to reduced mucin production 
• Soft contacts can absorb tears like a sponge or create a larger surface area for evaporation

Certain Diseases 

Some diseases, such as diabetes, rheumatoid arthritis, and systemic lupus erythematosus can increase the chances of dry eye occurring by:

• Damaging lacrimal glands 
• Causing chronic inflammation 
• Leading to tear film instability 

Ocular Surgery

Corneal nerves prevent dry eye by helping maintain a healthy tear film. Procedures such as LASIK, PRK, and cataract surgery can cut or damage corneal nerves. Nerve damage reduces tear production and blink reflex (rapid, involuntary closing of the eyelids in response to certain stimuli), leading to dry eye. 

Smoking

Cigarette smoke contains several toxic chemicals, including formaldehyde and acrolein, and heavy metals. These irritants damage the tear film — especially the lipid (oil) layer produced by meibomian glands — leading to faster evaporation of tears. Cigarette smoke can also increase the likelihood of dry eye occurring by affecting the ability of lacrimal glands to produce the aqueous (watery) component of tears.

Signs of dry eye can vary from one individual to another, depending on the severity of the condition and underlying cause. Here are some dry eye symptoms:

Dryness or Grittiness

When parts of the cornea are not adequately lubricated by the tear film, the eye's surface becomes exposed. This often leads to dryness and grittiness. Eyelid movements (especially blinking) cause friction over the dry corneal surface, triggering inflammation, which can worsen the symptom. 

Redness

In dry eye, insufficient or poor-quality tears expose the delicate corneal and conjunctival surfaces, leading to mechanical irritation and micro-damage. This triggers an immune response and blood vessels in the conjunctiva (the clear tissue over the white part of the eye) dilate to increase blood flow and immune activity, which leads to redness. 

A Burning or Stinging Sensation in the Eyes 

Dry eye can cause a burning or stinging sensation in the affected eye by:

• Reducing tear production
• Affecting the quality of tears (poor-quality tears can evaporate too quickly)
• Irritating the sensitive nerve ending
• Leading to increased salt level in tears 

Eye Fatigue

A damaged tear film leads to fluctuating or blurry vision and the vision system may be forced to overwork. As a result, the eyes may get tired. Excessive blinking caused by dry eye can lead to dryness, worsening the problem. 

Increased Light Sensitivity 

When the tear film breaks down, the nerves on the corneal surface get exposed and become more sensitive to light. Inflammation caused by dry eye often worsens photophobia (heightened sensitivity to light).

Timely and accurate dry eye diagnosis can help prevent complications, improving patient outcomes and quality of life. Here are some diagnostic techniques the doctors at Max Hospitals use to diagnose dry eye:

Clinical Assessment 

During a clinical assessment, the doctor asks their patient about their symptoms and medical history. They also examine the ocular surface to look for signs of dry eye such as incomplete blinking, redness and meibomian gland dysfunction. 

Schirmer’s Test

The objective of Schirmer’s test is to measure tear production. In this test, a standardised filter paper strip is placed in the lower eyelid (conjunctival sac) and the patient is asked to close their eyes. After 5 minutes, the amount of moisture absorbed by the filter paper strip is measured in millimeters.

Interpretation

• >15 mm: Normal
• 5–10 mm: Borderline
• <5 mm: Suggestive of dry eye (aqueous deficiency)

Tear Break-Up Time

TBUT helps doctors determine whether the tear film is stable. In this test, a doctor/ophthalmologist applies fluorescein dye (a fluorescent compound used by ophthalmologists to diagnose and evaluate different eye conditions) to the patient’s eye. The patient blinks and then keeps their eyes open and the clinician uses a slit-lamp microscope to see how long it takes for dry spots to appear.

Interpretation

• >10 seconds: Normal
• <10 seconds: Unstable tear film → suggestive of evaporative dry eye

Tear Osmolarity Test

This test is performed to measure salt concentration in tears. It involves collecting a sample of tears from the patient’s inferior lateral tear meniscus (outer lower corner of the eye) using a small handheld device known as the TearLab Osmolarity System. The device automatically analyses the collected sample. Once the analysis is complete, the osmolarity value (measured in mOsm/L) is displayed on the screen within a few seconds.

Interpretation

• Normal osmolarity: < 300 mOsm/L
• Mild to moderate dry eye: 300–320 mOsm/L
• Severe dry eye: > 320 mOsm/L

Ocular Surface Staining

In this test, a clinician applies fluorescein or lissamine green dye to the patient’s affected eye. As the dye mixes with the tear film and spreads across the ocular surface, the doctor uses a slit-lamp (a type of microscope) to observe pattern and intensity of staining, and areas affected by cell damage, tear film instability, or mucin deficiency.

Effective dry eye treatment targets the root cause of the condition, helping prevent complications. Here are some dry eye treatment options:

Artificial Tears and Lubricants

The first-line treatment for dry eye, artificial tears and lubricants relieve dry eye symptoms and protect the eye’s surface by:

• Adding fluid to the eye surface 
• Forming a protective layer over the cornea and conjunctiva
• Stabilizing the tear film layers
• Reducing inflammation and irritation 

Punctal Occlusion

The eyes have small openings called puncta (one in the upper and one in the lower eyelid corners) that drain tears into the nose. Punctal occlusion involves blocking one or more puncta (by inserting small plugs into them) so that tears stay on the surface of the eye longer. 

Anti-inflammatory Medications

If dry eye is caused by inflammation in the ocular surface and tear glands, a doctor may prescribe anti-inflammatory medications that can reduce inflammation on the eye surface by blocking a protein (LFA-1) involved in inflammation on the eye surface and preventing T-cell activation (T cells can trigger inflammation). 

Prescription Eye Drops

When artificial tears do not yield satisfactory results, a doctor may prescribe eye drops. Prescription eye drops can effectively treat dry eye disease by reducing inflammation on the eye surface, activating tear glands to stimulate tear production, or supplying nutrients that mimic natural tears.

Biologic Therapies

Often used in advanced or severe cases, biologic therapies target specific components of the immune system to reduce chronic inflammation and promote healing of the ocular surface.

*Biologics are protein-based drugs (often antibodies or cytokine inhibitors) derived from living cells. They’re designed to precisely block molecules or cells that drive inflammation.

Here are some simple yet effective tips to prevent dry eye:

Stay Well Hydrated

Adequate water intake is crucial for overall bodily functions, including the production of quality tears, which helps maintain eye lubrication.

Avoid Smoking

Smoke is a significant irritant and can directly contribute to dry eye symptoms and tear film instability, so avoiding it is key to eye health.

Boost Omega-3 Intake

Adding foods rich in omega-3 fatty acids, such as fatty fish or flaxseed, can support healthy tear gland function and help reduce inflammation associated with dry eye.

Limit Screen Time and Practice the 20-20-20 Rule

Staring at screens for long periods can lead to dry eye. To reduce their chances of developing dry eye, one should:

• Limit their non-work/recreational screen time to 2 hours a day
• To help prevent eye strain from digital screens, practice the 20-20-20 rule, wherein you need to look away from your screen every 20 minutes and focus on an object about 20 feet away for at least 20 seconds.
• Blink consciously while using a screen to distribute tears 

Create an Eyelid Hygiene Routine and Stick to it 

Poor eyelid hygiene can lead to blockage or inflammation in meibomian glands (produce the oily layer of the tear film that prevents rapid evaporation of tears). To prevent this from happening individuals should:

• Clean their eyelids everyday using a gentle cleanser
• Apply a warm compress to their eyelids 
• Gently massage their eyelids 

Manage Underlying Health Conditions

Health conditions such as diabetes, thyroid disease, and Sjögren's syndrome can cause dry eye. People with these conditions should see their doctor regularly for health check-ups and follow their instructions to manage dry eye symptoms.

If left untreated, dry eye can lead to the following complications:

Ocular Surface Inflammation and Damage

Dry eye disease doesn’t just result in discomfort — it triggers a self-perpetuating inflammatory cycle which leads to apoptosis (cell death), loss of goblet cells (play a crucial role in maintaining the stability of the tear film), and breakdown of the epithelial barrier (the protective layer of epithelial cells that covers the cornea and conjunctiva). 

Corneal Ulcers and Infections

Dry eye impacts tear film stability by affecting tear quality and quantity. An unstable, compromised tear film allows bacteria, fungi, viruses, and other microorganisms to adhere to the corneal surface and cause infections. If left untreated, an infection can lead to a corneal ulcer. 

Corneal Neovascularisation and Scarring

The cornea of a healthy person is avascular (does not have blood vessels). Chronic inflammation caused by dry eye triggers the release of pro-inflammatory cytokines (small proteins released by immune cells that cause inflammation) and angiogenic factors-molecules (usually proteins) that stimulate the formation of new blood vessels. These proteins and pro-inflammatory cytokines promote the growth of new blood vessels from the limbus (the cornea’s edge) into the normally clear cornea.

Contact Lens Intolerance

In dry eye, especially evaporative dry eye, the tear film breaks up faster than normal. This leads to increased friction between the contact lenses and the ocular surface, resulting in discomfort, grittiness, or pain, which can make wearing contact lenses almost impossible.

Can a dry eye condition affect vision permanently if left untreated?

Yes, if left untreated, dry eye can cause chronic inflammation and damage to the eye’s surface, which may lead to complications such as corneal ulcers, scarring, and vision impairment.

What lifestyle changes can help manage dry eye symptoms alongside treatment?

Yes, staying well-hydrated, maintaining eyelid hygiene, reducing screen time, using a humidifier, and protecting your eyes from wind and smoke can help manage symptoms.

Is dry eye more common in certain climates or environments?

Yes, dry and windy climates, air-conditioned environments, and high-altitude areas can increase tear evaporation, making dry eye more common in these settings.

Can wearing contact lenses worsen the dry eye condition?

Yes, contact lenses can increase dryness by reducing oxygen flow to the eyes and irritating the ocular surface, which can worsen dry eye symptoms.

How does hormonal imbalance contribute to dry eye in women?

Hormonal changes during perimenopause and menopause can affect tear composition and reduce tear production, making dry eye more likely in women during these stages.

Can dry eye be a side effect of using digital screens for long hours?

Yes, prolonged screen use can reduce blinking frequency, leading to faster tear evaporation and dry eye symptoms.

Is dry eye a progressive condition?

Dry eye can worsen over time if not managed properly, leading to increased discomfort and potential complications affecting the eye’s surface.

Can nutritional deficiencies contribute to dry eye development?

Yes, deficiencies in certain nutrients, such as omega-3 fatty acids and vitamin A, can affect tear production and quality, contributing to dry eye.

Are there any activities or habits that should be avoided when managing dry eye?

Activities that increase eye dryness, such as prolonged screen use, exposure to dry air, and smoking, should be minimised to help manage dry eye.

Can dry eye be completely cured, or is it a lifelong condition?

While dry eye can often be managed effectively with treatment and lifestyle changes, it may be a chronic condition requiring ongoing care to control symptoms and prevent complications.

Can a dry eye condition lead to permanent vision loss? 

In most cases, dry eye does not directly lead to permanent vision loss. However, if left untreated or in severe chronic cases, it can cause significant damage to the cornea, potentially leading to corneal scarring, ulcers, or infections. These severe complications, if not managed, could in rare instances impair vision.

How often should I see an eye doctor if I have a dry eye condition? 

The frequency of eye doctor visits for dry eye depends on the severity of your condition and the effectiveness of your treatment plan. Initially, more frequent visits might be recommended for diagnosis and to establish an effective management strategy. Once stable, annual or bi-annual check-ups are typically advised to monitor your eye health and adjust treatment as needed.

 Reviewed by Dr Ramandeep Kaur, Consultant – Ophthalmology, Eye Care, on 01 September 2025.