Dry eye is not just about having “too little water” in the eye. Instead, it’s a condition where the balance of the tear film and ocular surface is disturbed. When this balance is upset, the eye can no longer stay comfortably lubricated, leading to irritation, blurred vision, and discomfort.

There are two main types of dry eye, although in reality, they often overlap:

1. Evaporative Dry Eye

This occurs when the tears evaporate too quickly. The most common cause is a problem with the oil layer of the tears, which normally prevents evaporation. When this layer breaks down, the tears become salty and concentrated, raising the osmolarity (saltiness) of the tear film. Over time, this stresses and injures the surface cells of the eye.

2. Aqueous-Deficient Dry Eye

Here, the eye simply does not produce enough tears. This is often linked to autoimmune conditions such as Sjögren’s syndrome, or as a side effect of certain medications that reduce tear production. Without enough natural tear volume, the eye becomes dry and irritated.

3. The Vicious Cycle

In most patients, these two processes are not separate - they feed into each other. Increased evaporation makes the eye more inflamed, which in turn reduces tear production. This cycle of inflammation, instability, and injury makes dry eye a chronic, ongoing condition rather than a one-off problem.

Breaking the Cycle

Effective dry eye treatment is all about interrupting these vicious circles. By improving tear quality, supporting natural tear production, and calming inflammation, we aim to restore balance to the ocular surface and give lasting relief.

At WA Eyecare, we believe effective dry eye management begins with a comprehensive assessment. Using advanced diagnostic tools, we evaluate whether your symptoms are driven more by evaporative dry eye (tears drying too quickly) or aqueous-deficient dry eye (not enough tears being produced).

Diagnosis Through Treatment Response

Often, the two types are intertwined. In these cases, the most accurate way to understand the cause is to begin treatment and carefully monitor how your eyes respond. Your progress helps guide us toward the true underlying problem.

Starting With Evaporative Causes

Most treatment pathways begin with managing the meibomian glands - the tiny oil-producing glands in your eyelids. These glands release meibum, which keeps tears from evaporating too quickly. When the glands become blocked or the oil quality deteriorates, inflammation builds, making the eyes feel dry and irritated.

Managing Inflammation at the Source

By treating meibomian gland dysfunction (MGD) and related lid diseases, we can reduce the inflammatory mediators released into the eye. This not only improves comfort but also protects the delicate ocular surface from ongoing stress.

Aqueous-Deficient Dry Eye

When low tear production plays a role, treatment is often more straightforward. This may involve lubricating eye drops, punctal plugs (to conserve natural tears), or systemic approaches in cases linked to autoimmune conditions.

Advanced Lid Inflammation Treatments

Lid inflammation is often associated with ocular rosacea. For these patients, we use Intense Pulsed Light (IPL) therapy, which reduces abnormal blood vessels and decreases inflammatory triggers. IPL is also effective at stimulating healthier meibomian gland function, improving the quality of meibum.

Supportive & In-Clinic Therapies

To reinforce long-term success, we offer several targeted treatments:

• Meibomian Gland Expression (MGX) – applying gentle heat and pressure to unblock glands, restoring the natural flow of oils.

• ZEST lid cleaning – a professional-grade deep cleaning to reduce bacteria and debris along the eyelid margin.

• Ocular supplements – such as omega-3 fatty acids, which improve meibomian gland secretions.

• Regular home care – including warm compresses and lid hygiene to maintain progress..

Dry eye management is a journey, not a one-time fix. At WA Eyecare, we guide you through a structured treatment plan designed to stabilise your eyes, reduce symptoms, and improve long-term comfort.

Your First Appointment

Our first consultation focuses on understanding the full picture of your eye health. We consider not just your eye examination, but also your general health, medications, work and home environment, and diet. This helps us identify the key factors contributing to your dry eye condition.

Initial Treatments and Assessment

The first two treatment visits are often trial-based. We perform a variety of in-clinic procedures and closely observe how your eyes respond. This early feedback helps us tailor the plan specifically to your needs.

Core In-Clinic Therapies

For many patients, Intense Pulsed Light (IPL) and/or lid-based treatments provide the strongest in-office results. To maintain these benefits, we usually combine them with home-based care and supplementary therapies such as eyelid hygiene, warm compresses, or ocular supplements.

Frequency of Visits

• Initial phase: Appointments are closer together (every 4–7 days) to establish control.

• Stabilisation phase: Once improvement is seen, visits are spaced to every 1–2 weeks.

• Maintenance phase: As stability is achieved, we gradually extend the time between appointments to see how long you can stay comfortable without intervention.

Realistic Outcomes

It’s important to understand that for most people, dry eye can be managed but not cured. Our goal is to keep symptoms under control and prevent flare-ups.
However, there are exceptions. For example, in younger patients or those with recurrent styes, early treatment can sometimes achieve long-term remission lasting several years. The earlier we intervene, the better the outcomes usually are.

Fees and Transparency

Because dry eye treatments are considered a specialised service, there are usually out-of-pocket costs that cannot be claimed through Medicare. The exact fees can vary depending on the type and complexity of your dry eye condition, as well as which treatments are most suitable. We believe in complete transparency — all costs will be explained clearly at your first appointment, so you can make informed decisions about your care before committing.

The modern understanding of dry eye disease has advanced significantly with the TFOS DEWS II/III reports, which emphasise that dry eye is a multifactorial condition involving tear film instability, hyperosmolarity, inflammation, and neurosensory abnormalities. These factors interact in a self-perpetuating cycle, explaining why the condition often becomes chronic if not properly managed.

Gender Differences in Dry Eye

Research consistently shows that women are more likely than men to suffer from dry eye disease. Hormonal influences, particularly changes in androgens and estrogens, play a significant role in tear film regulation and meibomian gland function. This helps explain the higher prevalence of dry eye in women, especially after menopause.

Surface Inflammation and Gland Dysfunction

Ongoing ocular surface inflammation gradually damages the meibomian glands, altering both their structure and the quality of their secretions (meibum). Over time, this compromises the lipid layer of the tear film, accelerating evaporation and amplifying symptoms.

Impact on Lacrimal Glands

Chronic inflammation doesn’t just affect the eyelids — it can also damage the lacrimal glands, reducing aqueous tear production. This dual effect (impaired oil layer + reduced aqueous output) pushes patients further into the vicious cycle of dry eye disease.

Neurosensory Alterations

Another important factor is that symptoms may persist even after visible inflammation has been treated. This is thought to result from chronic changes in the corneal nerves, which become hypersensitised or damaged over time. As a result, some patients continue to experience discomfort despite improvements in tear film quality.

Hormonal and Systemic Influences

Hormonal changes — particularly in women — remain one of the strongest contributors to dry eye risk. In addition, systemic health and medications can tip the balance. A classic example is iatrogenic dry eye from long-term glaucoma treatment, particularly where topical drops contain preservatives such as benzalkonium chloride (BAK), which are toxic to the ocular surface.

Surgical Triggers

Ocular surgery is another important driver. Procedures such as cataract, refractive, or even eyelid surgery can disrupt the ocular surface environment. Post-operative inflammation, reduced corneal sensitivity, and mechanical disruption often tip a borderline ocular surface into chronic dry eye disease.