In brief
What are dry eyes, and what helps?
Dry eyes (sicca syndrome) are a disorder of the tear film: it breaks up too early, and the eyes burn, feel gritty or water. In 86 % of those affected, the meibomian glands in the eyelid margin are involved. At EyeLaser Zürich, we measure the cause; IPL treatment costs CHF 400 per session, and three to four sessions are usually needed.
| Medical term | Sicca syndrome, keratoconjunctivitis sicca; ICD-10 H04.1 |
|---|---|
| Frequency | 5 to 50 % of the population depending on the study, more common in women (Stapleton et al. 2017) |
| Typical signs | burning, a gritty or foreign-body sensation, redness, fluctuating vision in the evening, paradoxically watery eyes |
| Most common cause | Meibomian gland dysfunction: too little oil in the tear film, involved in 86 % (Lemp et al. 2012) |
| Assessment | Tear film break-up time, meibography, examination of the eyelid margin and cornea |
| Treatment | Artificial tears, eyelid hygiene, anti-inflammatory drops, IPL treatment; treating underlying conditions as well |
| Health insurance | Ophthalmological assessment with a medical indication via basic health insurance (TARDOC); you pay for IPL yourself, CHF 400 per session, package of four for the price of three CHF 1’200 |
Dry eyes from screen work
When you concentrate on a screen, you blink much less often; in one measurement, five times less often on average than usual (Patel et al. 1991). Every blink spreads the tear film and presses a little oil out of the meibomian glands. Without blinking, the oil builds up, hardens and clogs the openings. Typically, the eyes burn in the afternoon and vision fluctuates.
IPL treatment takes around 20 minutes; the pupil is not dilated, and you can go back to work afterwards. In everyday life, breaks following the 20-20-20 rule and conscious blinking help.
Sicca syndrome: the medical term for dry eye
If someone gives you a diagnosis of sicca syndrome, this means dry eye. The full medical name is keratoconjunctivitis sicca — «sicca» is Latin for «dry», kerato- refers to the cornea and conjunctiva to the conjunctiva. Both are affected when the tear film no longer does its job: it breaks up too early, the eye surface is exposed and reacts with inflammation.
Medically, two forms are distinguished, and the distinction determines the treatment:
- Too little tear fluid (aqueous-deficient form): the lacrimal gland produces too little. This form is the less common one.
- Too rapid evaporation (evaporative form): the amount is right, but the oily layer is missing — the tears evaporate before they can work. This form accounts for by far the largest share of cases, and its cause lies in the meibomian glands.
This must be distinguished from Sjögren’s syndrome: an autoimmune disease in which the salivary glands are attacked as well as the lacrimal glands. People with Sjögren’s syndrome also have sicca symptoms — but not the other way round. The vast majority of people with dry eyes do not have Sjögren’s syndrome. If dry mouth and joint problems also occur, we investigate this and work together with rheumatology.
For you, one thing above all is important: sicca syndrome can be measured. We determine the tear film break-up time and make the meibomian glands visible, instead of treating symptoms alone.
What dries out the eye: the most common causes
The tear film consists of three layers: a mucous layer directly on the eye, a watery layer in the middle and the oily layer on top. If this balance is disturbed, parts of the cornea are left exposed. Common triggers are:
- Age and hormones: Over the years, the eye produces less tear fluid. Women often clearly notice the change during the menopause.
- Screens, heating and air conditioning: When you concentrate on a screen, you blink much less often; dry indoor air also draws moisture from the tear film.
- Medication: Certain active substances, for example from the group of beta blockers or antidepressants, can reduce tear production as a side effect. Therefore, never stop taking a medication on your own; talk to the doctor who prescribed it.
- General diseases: Rheumatic diseases and Sjögren’s syndrome, described above, can directly attack the lacrimal glands.
If sicca syndrome remains untreated for a long time, the inflammation can become established on the cornea (keratitis) and leave small defects on the surface. Signs you should take seriously: a foreign-body or gritty sensation, burning, red eyelid margins, blurred vision and glare in the evening — and, paradoxically, watery eyes.
Treatment in stages
- Artificial tears: preservative-free drops, for example with hyaluronic acid; gels or ointments for the night, because they stay on the eye longer.
- Eyelid hygiene: warm compresses liquefy the hardened oil in the meibomian glands; lipid sprays on the closed eyelid support the oily layer.
- Anti-inflammatory drops: on prescription, if artificial tears and eyelid care are not enough.
- IPL treatment: if eyelid care is not enough and the meibomian glands are the cause (see below).
When you should not wait: Severe pain, marked sensitivity to light, suddenly worse vision or a single, very red eye are not typical of dry eyes. Have this checked by an ophthalmologist on the same day, at night and at weekends via the emergency department of the hospital on duty. If you wear contact lenses, take them out until then.
Meibomian gland dysfunction: the medical core
The meibomian glands are located in the edges of the eyelids and supply the oily layer of the tear film. This layer slows evaporation. If the glands no longer work properly, this is called meibomian gland dysfunction, MGD for short. According to the DEWS II report, it is behind dry eyes in the large majority of cases — not a lack of tear fluid.
How it happens
The secretion in the glands hardens, and the openings at the edge of the eyelid become blocked. Without the oily layer, the tear film evaporates too quickly. The eye then produces more fluid and waters — even though it is dry. This is exactly why drops only help for minutes: they replace water while the oil is missing.
How blocked meibomian glands can be opened
Heat liquefies the hardened secretion, and pressure empties the glands. In everyday life, this is done with warm compresses and daily eyelid hygiene. If that is no longer enough, IPL treatment works at the same point: pulsed light warms the edge of the eyelid, opens the openings and reduces inflammation. Three to four sessions are usually needed for a stable result.
Why we measure first
Meibography shows the glands in the eyelid. It reveals how many are still intact and how far the loss has progressed. This determines whether eyelid care is sufficient or treatment makes sense — and it later shows whether anything has changed. If the eyelid margin is also inflamed, this is blepharitis, which should be treated as well.
Can you have laser eye surgery if you have dry eyes?
Often yes, but only after an assessment. Dry eyes are common before a laser procedure and can increase for a few weeks afterwards. At EyeLaser Zürich, we measure the tear film during the pre-examination and treat dry eyes beforehand, with IPL if necessary. Depending on the findings, a procedure without a flap or a lens may be more suitable. You can find the comparison of procedures for dry eyes in the guide Laser eye surgery despite dry eyes.
Further reading
- Milky discharge from the eye — where the discharge comes from and when it is harmless
- Inflammation of the eyelid margin (blepharitis) — the three forms, how long it lasts and what helps at home
- Eyelid hygiene step by step — warm compress and cleansing, 5 to 10 minutes a day
- Sicca syndrome — why drops often only help briefly and what lies behind it
- Dry eyes after cataract surgery — how long the eye waters and when you should contact us
