Written for Stock My Medicine and clinically reviewed by Hajra Dhanchora, MPharm (GPhC 2216990).
Dry eye is the commonest thing an optician sees and the most under-treated, partly because the symptoms don't sound like dryness: gritty, sore, tired, red, and, confusingly, watering. It's also one of the few conditions where the pharmacy shelf genuinely works, provided you pick the drop for your kind of dry eye. Here's how to tell which kind you have and what to do about it.
What do dry eyes feel like?
A gritty or sandy feeling, as if there's something in the eye when there isn't; soreness and burning; redness; eyes that feel heavy and tired by the afternoon, especially at a screen; blurred vision that clears when you blink; light sensitivity; and eyes that stream in wind or cold. That last one catches people out: a dry eye surface irritates the eye into producing a flood of thin, watery tears that don't lubricate and run straight off. Watery eyes are very often dry eyes.
What causes dry eyes?
Tears are a three-layer film: a mucus base, a watery middle and an oily surface that stops the water evaporating. Dry eye happens when you make too little of the watery layer, or, far more often, when the oily layer fails and tears evaporate too fast. The things that tip it: screens (you blink a third as often when concentrating), heating and air conditioning, contact lenses, age (tear production drops after 50, and menopause makes it worse), blepharitis (inflamed, crusty lid margins that block the oil glands), smoking, and medicines including antihistamines, antidepressants, the pill and some blood pressure tablets. Dry eye that starts suddenly is usually a new medicine, a new environment or a flare of blepharitis.
Which eye drops are best for dry eyes?
"Artificial tears" covers four different products, and the right one depends on how dry you are and when it bothers you.
| Type | Best for | Examples | Notes |
|---|---|---|---|
| Hyaluronate drops | Most people, daytime use, contact lens wearers | Hycosan 0.1%, Hycosan Extra 0.2%, Alvita | Hold water on the surface longer than saline-type drops. Preservative-free: use as often as you like. |
| Liposomal spray | Evaporative dry eye, screen use, make-up wearers | Optrex ActiMist | Sprayed on closed lids; repairs the oily layer rather than adding water. No aiming. |
| Gel drops | Moderate dryness, evening use | Systane Gel, Blink Intensive | Thicker, last longer, blur for a minute after use. |
| Night ointment | Waking with sore, stuck eyes | Lubricating ointments | Applied inside the lower lid at bedtime; too greasy for daytime. |
Two rules. Use drops before the eye hurts, not after: four times a day for a fortnight, then as needed, beats one panic drop at 4pm. And preservative-free matters if you use drops more than four times a day or wear contacts, because the preservative in bottled drops irritates a dry eye over time. Our eye care range has all of these.
The fix most people skip: lid hygiene
If your lid edges are red, crusty or have tiny flakes at the lash roots, the oil glands are blocked and no drop will fully fix it. The routine: a warm compress over closed eyes for five minutes (a clean flannel in hot water, or a microwaveable eye mask), then massage the lids gently towards the lashes to push the oil out, then clean the lid margin with a lid wipe or cooled boiled water with a drop of baby shampoo on a cotton pad. Every day for a month, then a few times a week. It's dull, and it's the single most effective thing for evaporative dry eye.
Dry eyes and contact lenses
Lenses sit on the tear film and soak up part of it, so dry eye and lens wear feed each other. If your eyes are gritty by mid-afternoon, put a preservative-free hyaluronate drop in before the lenses go in and again at lunchtime, and take them out an hour before bed rather than at bedtime. Daily disposables dry the eye less than monthlies. On a bad day, in a dry office or on a flight, wear glasses instead. Never sleep in lenses, and never use a gel or ointment with lenses in. If a lens-wearing eye is red and painful, that's an urgent same-day problem, because infection under a lens moves fast.
Dry eyes at night and on waking
Some people's eyelids don't quite close in sleep, and a bedroom with the heating on dries the surface further, so the classic pattern is waking with eyes that feel glued, sore or scratched. A lubricating ointment inside the lower lid at bedtime holds moisture overnight; a gel drop is the lighter alternative. Keep the heating low, add a bowl of water or a humidifier, and do the warm compress in the evening rather than the morning so the oil glands are working overnight.
Small changes that help all day
Blink deliberately at the screen and follow the 20-20-20 rule: every 20 minutes, look 20 feet away for 20 seconds. Position the monitor below eye level so the lids cover more of the eye. Turn the car heater vents away from your face, use a humidifier or a bowl of water on the radiator in winter, and wear wraparound sunglasses in wind. Swap lenses for glasses on bad days. Drink water, eat oily fish, and don't smoke. If a medicine is the cause, ask a GP about alternatives rather than stopping it yourself.
When to see an optician or GP
See an optician (it's free for many people and they have better equipment than a GP for this) if drops and lid hygiene haven't helped after a few weeks, if your eyelids have changed shape or turn in or out, or if you have another condition such as rheumatoid arthritis or a thyroid problem. Ask for an urgent GP appointment or call 111 for a painful red eye, a red eye in a contact lens wearer, or signs of infection. Go to A&E for a sudden change in vision, severe pain with light sensitivity, or an injury. If the eye is sticky and gunky rather than dry, read our conjunctivitis guide instead. Our pharmacist can help you pick a drop.
Frequently asked questions
Can dry eyes cause blurry vision and headaches?
Yes to both. A patchy tear film scatters light, so vision blurs until you blink, and the squinting and strain that follow bring on a headache by late afternoon.
Can dry eyes be cured permanently?
Usually managed rather than cured, but if the cause is blepharitis, screens or a medicine, fixing that can get you to needing drops only occasionally.
Do omega-3 supplements help dry eyes?
The trials are mixed: some show a modest benefit for evaporative dry eye, the largest showed none. Oily fish twice a week is a reasonable, cheap thing to do; buying capsules specifically for dry eye is optional.
Can I use dry eye drops with contact lenses?
Preservative-free hyaluronate drops and the liposomal spray, yes. Gels and ointments, only with lenses out.