What you always wanted to know about ... the DRY EYE 


Symptoms & Causes of the Dry Eye - Dry Eye Treatment - What Can I Do About a Dry Eye? - Dry Eye Therapy - 


Dry Eye Disease is a chronic irritation and damage to the ocular surface - the moist tissue on the front of the eye with the eyelids.

It is typically triggered by a lack of tear film on the eye. 

The ophthalmologist refers to this disease as keratoconjunctivitis sicca, ie " dryness inflammation of the cornea and conjunctiva ".  

THERAPY : => Timely and adequate treatment of dry eye is important to avoid permanent damage to vision
The good news is that every patient can do a lot to help ease the symptoms of dry eye.

Dry Eye Disease is very common and can have many different causes

Dry Eye Disease is the most common disease in ophthalmology . About 1/6 of the population is affected on average, but sometimes much more.

Not every dry eye is properly recognized , as the symptoms are often uncharacteristic at first and the onset is often creeping.

The incidence is increased in women and it generally increases with older age . This indicates an influence of hormones and aging processes.

Conditions that can also lead to a dry eye are, eg:

  • Disorders of the eyelids and blinking
  • Chronic lid inflammation (blepharitis) and
  • various skin diseases  (rosacea, atopic dermatitis etc.) as well
  • inflammatory rheumatic diseases 

What are the SYMPTOMS of Dry Eye Disease ? - How do I recognize a Dry Dye?

Most Dry Eye symptoms are explained by the irritation of the eye:


  • feeling of dryness 
  • foreign body sensation
  • sandy-gritty irritation
  • photophobia
  • rubbing and redness
  • burning and pain

This leads to ... "glued eyes", " tired eyes " or "heavy eyelids".   PAIN can occur:

  • on the surface of the eye itself
  • He is also often in the environment of the eye or
  • even felt behind the eye.

Blurred Vision

In dry eye, the homogeneous stable tear film on the eye is disturbed. Apart from wetting, It is important for a good visual acuity. Therefore, many patients have vision problems like

  • blurry vision
  • fluctuating visual acuity or
  • glare
THERAPY => Visual disturbances of the dry eye typically improve , or even disappear temporarily, after one or several powerful eye blinks, that spread a new and stable tear film - This is also a good test of whether visual disturbances are caused by tear film disorders.

WATERY Dry Eye and Epiphora

Other reasons for a wet eye and tears over the edge of the lid can be:

  • if the eyelid is altered, in its shape or position, and the tear film can not be held on the eye anymore ... or ... 
  • when the outflow of tears into the nose no longer works normally because the edge of the lid protrudes slightly from the eye.

THERAPY => This may be useful for a close examination and maybe a small ophthalmic eyelid surgery.

What is the CAUSE of the Dry Eye Disease ? - Where does Dry Eye Disease come from ?

The eye irritation is typically triggered by disruption of the tear film.

What is the Tear Film ?


How is the tear film made ?

  • the thin, even layer of tears on the eye in the open eyelid
  • is formed by the blink of the eyelids
  • that pull the tear fluid on the eye into a thin film
  • this is stable only for a short time
  • and must then be renewed by a new eyelid blink

What does the tear film consist of ?

  • from the secretions of the 3 types of glands at the ocular surface.
  • the main part consists of the water from the lacrimal gland behind the upper eyelid.
  • the surface is produced by a thin layer of oil from the MEIBOMIAN glands in the eyelids and it reduces the evaporation of water
  • the mucus from the individual goblet cells in the conjunctiva connects as the lowest layer the water to the cell surface

Where does the tear film go ?

  • with each new blink of the eye, the 'old' tears are sucked through the lacrimal puncture on the nasal side of each eyelid and led towards the nose. 

What is the function of the tear film?

  • it keeps the tissue moist,
  • it contributes to nutrition, regulation and health
  • it 'smears' the sliding movement of the eyelids over the eyeball and
  • it is important for a clear vision. 

A tear deficiency can be caused by a deficiency in the amount or in the composition and quality of tear production by the glands of the eye.

Rarely is there first a tissue disorder, which then later disturbed the tear film. This can happen in chronic inflammatory disease, for example in rheumatic diseases or in the immune reaction after bone marrow transplantation (graft-versus-host disease, GvHD).




Aqueous Deficiency ... in the tear film

A lack of water can be caused by a reduced production of watery tears through the lacrimal gland. A pure lack of water due to a disturbance of the lacrimal gland is very rare.

Much more common is water loss due to increased evaporation of the tear water on the ocular surface. This occurs in case of lack of oil and due to dehydrating environmental influences. 

THERAPY => Aqueous eye drops , with or without added oil, are a useful therapy. 
... They should be used as needed and often enough, up to 1x per hour. An even more frequent use of aqueous eye drops is usually not useful, as this can reduce the effect of your own (residual) tears and thereby the irritation of the eye can be worse. 

Oil Deficiency  ... in the tear film

Most often, not the water of tears is missing first, but the superficial layer of oil on the tear film, which reduces the evaporation of the water.

Lack of oil is usually caused by a dysfunction of the meibomian glands in the eyelids . When the glands clog, oil is missing and the watery tears evaporate faster, leaving the eye dry. Meibomian gland disorders are very common and increase with age.  

THERAPY => Eye drops that contain oil or a lipid spray can help here. 
Above all, it is important to improve the function of the oil-producing meibomian glands in the eyelids . This is done by a physical eyelid therapy (with warming, massage, cleansing), which the patient himself performs regularly at home to improve the blockage and damage to the glands.

Blinking Deficiency ... prevents the tear film

The regular eyelid strike is necessary

  • to form the tears into the thin tear film on the eye ... and ...
  • to squeeze out a small droplet of oil from the meibomian glands to retard water evaporation and make the tear film more stable

Rare blinking and incomplete blinking  are common causes of a tear film disorder. 

  • With rare blinking the tear film is renewed too rarely - it then breaks open and the eye becomes dry.
  • In case of incomplete blinking  ("nervous eye blink") the eye is not completely closed and only the upper part of the tear film is renewed - the lower part of the eye surface remains dry, therefore there are the first and the most frequent damage.

"Office Eye" / "Eye Office" combines many disruptive factors

The Office Eye  is a fast-growing form of dry eye in "modern" office work environments . This can add up several harmful effects and thus lead faster to a dry eye. This form of dry eye not only affects the elderly but also occurs more frequently in younger people .

Concentrated visual work, e.g. on the computer screen, is accompanied by rare blinking and therefore easily leads to a dry eye.

The danger of a dry eye will be even greater if  

  • concentrated visual work (e.g computer, television, driving)
  • in a dry environment  (air conditioners) and / or
  • takes place in draft (fans) and / or
  • dust particles or smoke in the air are, as well
  • mental stress prevails and maybe in addition with
  • insufficient drinking volume

In this condition desiccating environmental factors and perhaps negative internal influences on the tear production are added to an unstable tear film .

THERAPY => Awareness of the blink habit and, if necessary, change of the eyelid blink pattern are important for a sufficiently frequent and complete eyelid strike. Furthermore, deliberate blink exercise can be useful at work - there are even computer apps as a reminder. Also, avoidance of dry working environments, sufficient breaks and sufficient drinking volume are helpful.

The dry eye is prone to AGGRAVATION without treatment

Tear Film Deficiency 

A tear disorder creates or exacerbates the irritation of the ocular surface.


An irritated ocular surface, in turn, worsens the stability of the tear film on the damaged ocular surface.

Therefore, Dry Eye Disease has a tendency to aggravate itself if not treated adequately.






THERAPY => An interruption of the harmful self-aggravation (Vicious Circles) can be done by: 
  • Supplementation of tear fluid with aqueous eye drops (tear substitute), with and without oil
  • nourishing gels or ointments overnight
  • avoidance or limitation of triggering stimuli
  • eyelid therapy / treatment of the eyelids to improve the meibomian gland function


If the ocular surface is permanently irritated, as typically occurs in the Dry Eye Disease, this can trigger an inflammatory reaction. 

The inflammation is actually intended as a defense of the eye against the irritating agent. But if the inflammation occurs permanently, then it can increase the self-aggravation of the dry eye.

THERAPY => here an anti-inflammatory therapy by the ophthalmologist may be useful.
The ophthalmologist you trust and, for severe cases, specialized Sicca centers, have even more valuable therapy options available for you.