Dry eyes
When every blink scratches, guessing does not help. Measuring does.
Burning, a gritty feeling, tired eyes after a day at the screen — and a cupboard full of drops that change nothing? Dry eyes have measurable causes. We find yours before we treat.
Dry eyes are a system, not a single symptom
The tear film is not water on a surface but an interplay: a watery layer that wets the ocular surface, an oily layer above it that keeps the water from evaporating, and a lid that redistributes both with every blink. If one of those three fails, the eye burns — and it burns in the same way, whichever one it was. That is exactly why trying things out leads so reliably nowhere here: the sensation is one, the causes are several, and they call for different treatments. So what is needed first is not a recommendation but a classification.
This page is the overview of that, and it is deliberately not the treatment manual. What it sets out is which forms exist, how we tell them apart and what follows from the findings. What follows by way of treatment has been given a page of its own — and so has what does not belong here at all. The signpost below says which question is answered where.
A short signpost: which question is answered where
If you only know your symptom and do not know where to start — this way:
- It burns, it scratches, and a day at the screen makes it worse. That stays on this page: the two basic forms, the examination, the logic of the steps.
- The diagnosis is settled and you want to know what happens now. Then read what is actually treated in dry eyes, step by step — from artificial tears through eyelid margin care to punctum plugs and IPL.
- Your symptoms do not quite fit the picture. The eye overflows, the lids are stuck together in the morning, a lid no longer sits properly — the look-alikes and where they lead are further down.
- Pain, markedly worse vision or pronounced light sensitivity. Those do not belong to dry eyes. What applies then is also further down — and it belongs in an assessment today, not next week.
Everything else on this page answers the question that comes before all the others: which of the two basic forms predominates in your case — and whether something third is playing a part as well.
Two causes, two completely different treatments
'Dry eye' sounds like one problem — it is two. Either your eye produces too little tear fluid. Or, far more commonly: the oily layer of the tear film is disturbed because the meibomian glands along the lid margin are blocked — and then the tear film evaporates before it can protect anything. Both feel the same. Both need a different treatment. That is why every course of treatment here begins with a structured tear film analysis: break-up time, wetting, lid margin, meibomian glands, lid closure. If that analysis shows red, crusted or thickened eyelid margins, what usually lies behind it is eyelid margin inflammation, which takes the oily layer away from the tear film — and then eyelid margin care is as much a part of the treatment as the drops are.
The stepped treatment — explained honestly
- Step 1: suitable (not just any) artificial tears, lid margin care with warmth and massage, screen hygiene. For many people that is enough.
- Step 2: anti-inflammatory treatment where the ocular surface is irritated — time-limited and monitored.
- Step 3: for stubborn cases: additional measures, which we discuss openly in terms of benefit, effort and cost — including the option of not doing them.
These three steps are the short version, and that is what they should stay. Which artificial tear suits which form, how warmth, stroking out and cleaning at the eyelid margin actually work, and when punctum plugs or a course of IPL even come up for discussion, is described by the page on treating dry eyes, for each step separately. This page stays with the question that comes before it: what is wrong and why. Light therapy with OptiLight™ (IPL) has a page of its own: how it works, how it is carried out and who it is not suitable for.
What you will not hear from us: a promise of a cure. Dry eyes need patience and consistency. What you do get: a diagnosis that deserves the name, and a plan that fits your day. If you would like to make a start, you can book your tear film analysis appointment online.
Incidentally: behind 'dry eyes' there is sometimes an eyelid malposition — a lid that no longer closes properly, or no longer wets the eye. We check for it too, because we can treat both.
Look-alikes: what feels like a dry eye
Four pictures lie so close to the dry eye that they are regularly taken for it. Telling them apart is not a nicety: they are treated differently. Each has a page of its own — this section only says how you notice that you are better served there.
- The eyelid margin is inflamed. Lids stuck together in the morning, crusts on the lashes, eyes burning all day — and drops that help briefly and then no longer. Because an inflamed eyelid margin takes the oily layer away from the tear film, this is not a second illness alongside the dry eye but frequently its cause: why lid-margin inflammation is chronic and yet stays readily controllable.
- The eye overflows. Tears running down the cheek do not argue against a dry eye — they are often the answer to it: the unstable tear film sets off a surge that does not hold the way it should. Only then come a tear duct that can no longer manage the drainage, and a lid that no longer sits against the eye: what lies behind watery eyes and how the three groups are distinguished.
- The lower lid stands away. If the lower lid tips outward it no longer sits against the eye; the tear overflows instead of draining away, and what lies exposed dries out. This is not a question of appearance but the reason drops alone bring no lasting peace here: why an ectropion dries the eye out even though it waters constantly.
- The eyelid margin turns inward. 'It feels as though I have a grain of sand in my eye all the time' — that sentence describes dry eyes and equally an in-turned lid whose lashes drag across the cornea with every blink. The difference takes seconds to see at the slit lamp and cannot be worked out at home: how an entropion is recognised and why it belongs in an assessment.
These pictures do not exclude one another; quite the opposite. Dry eyes and an inflamed eyelid margin are so often the same picture in the consultation that we assess both together as a matter of course; and if a lid does not close fully we check for that too, because we can treat both. So the question at the examination is rarely 'either or' but: which part weighs how much — and what does one therefore start with?
When it is no longer a dry eye
Dry eyes are unpleasant and rarely dramatic. But there are symptoms that do not belong to them — and with which carrying on trying costs time that counts. Behind them there can be, for instance, an inflammation of the cornea, where hours to days count rather than weeks — and the picture that goes with it is a red eye that really hurts and sees worse than yesterday. These signs point to something other than a dry eye.
Call the same day with: pain in the eye rather than burning or a gritty feeling; markedly worse vision that does not clear again after a blink; marked light sensitivity; a red eye while wearing contact lenses — lens out and call; a whitish spot on the otherwise clear cornea; symptoms that come on suddenly and in one eye, with marked redness or purulent discharge. +41 44 500 69 00, Mon–Fri 08:00–12:00 / 13:00–17:30. Outside consulting hours the ophthalmic emergency service applies — contact it, or go directly to the emergency department of an eye hospital.
What happens at the first appointment
The first appointment is not a treatment but a measurement — and that is precisely its value. We look at what is actually going on at the eye: how long the tear film holds before it breaks up, how well the surface is wetted, what the eyelid margin and the meibomian glands look like, and whether the lids close fully. Out of that combination comes which of the two basic forms predominates — and with it, which step has any chance of changing anything.
That includes the usual ophthalmic examination, because a burning eye can have more than one cause. Which building blocks are available for that is on the overview page: what an eye examination measures besides this, and how it runs. Which of them is needed in your case is decided by the findings, not by a wish for completeness.
What to bring
- All the drops, gels and ointments you are using now or used last — the original packs, not names from memory. What decides is the composition, not the colour of the box.
- Your other medicines. Some commonly prescribed groups of active substances reduce tear production, and that rarely has any connection with the reason they were prescribed.
- What you have already tried, and for how long. The commonest reason for an 'it did not help' is not the wrong preparation but too short an application.
At the end there is no prescription on suspicion but a classification: which form is present, which step fits it, and how we will tell in four to six weeks whether it is working. If that classification turns out to be unspectacular — warmth, two movements of the hand, patience — then that is exactly what we say, and not the thing that sounds more like treatment.
How things go on from there — what each step achieves, what it asks of you and what it costs — is on the page on treating dry eyes, with each step described separately. And if you would like to start with the measurement, book the appointment for the assessment online.
Costs & health insurance
What does the insurer pay for — and what not?
Assessing dry eyes is billed through basic health insurance — and it saves you months of guessing at drops at your own expense.
| Service | Coverage | What this means for you |
|---|---|---|
Assessment & tear film analysis | Basic insurance (OKP) | Billed through basic health insurance — your deductible and co-payment apply as at any doctor's appointment. |
Drug treatment | Basic insurance (OKP) | Preparations covered under the Federal Specialities List are paid for; many artificial tears you pay for yourself — we tell you before writing the prescription. |
Extended treatments (step 3) | Partly self-pay | A written cost estimate before you decide. |
Our promise:Before any treatment you receive a complete, itemised cost breakdown in writing — before you decide. Nothing is added to it afterwards.
Related topics
Related conditions
Medically reviewed by PD Dr. med. Andrea von Rückmann
Frequently asked questions
- Because drops only help when they match the problem. Dry eyes come in two basic forms: too little tear fluid — or, far more often, a disturbed oily layer of the tear film, because the meibomian glands along the lid margin are blocked. In the second case the tear film evaporates too quickly; watery drops change little. Only the diagnostics show which treatment is worth having.
- In front of a screen you blink up to three times less often — the tear film breaks up before it is renewed. Add dry office air and air conditioning. The 20-20-20 rule helps (every 20 minutes, look into the distance for 20 seconds), but it does not replace an assessment if the symptoms persist.
- With meibomian gland disorders it is the basis of every treatment: warmth liquefies the congested secretion, gentle massage empties the glands. Done properly and regularly, that improves the tear film measurably. We show you the technique — in two minutes, not in a sales pitch for care kits.
- Usually not, but they should be taken seriously: a chronically irritated ocular surface can become inflamed and damage the cornea. And sometimes something else lies behind it — an eyelid malposition, an allergy, an underlying rheumatic condition. That is another reason the assessment belongs in ophthalmic hands.
- Honestly: dry eyes are often a chronic matter that can be controlled but not always 'cured'. The realistic aim is that the symptoms no longer govern your day. Anyone promising you quick guarantees usually means their own offering — not your eyes.
- Expect around 45 to 60 minutes: we measure the tear film, the lid margins and the ocular surface, rather than guessing at drops. You go home with a diagnosis and a concrete treatment plan — and you know beforehand what insurance covers.
- On this page. It sorts out which two basic forms exist and how we tell them apart — that is the question that comes before any treatment. If your diagnosis has already been made and you want to know what is actually done, the way leads to the page on treating dry eyes; there each step is set out separately, from artificial tears through eyelid margin care to punctum plugs and IPL. If your eye overflows, if the lids are stuck together in the morning or if a lid no longer sits properly against the eye, those are pictures of their own with pages of their own — you will find them above, in the section on look-alikes. And if you remain unsure: the sorting out is our job, not yours. That is what the first appointment is for.
- Yes, and that is the rule rather than the exception. A disturbed oily layer and too little tear volume occur together. An inflamed eyelid margin and a dry eye are so often the same picture in the consultation that we assess both together as a matter of course. And a lid that does not close fully dries the surface out on top of that — we check for that as well. So the question at the examination is rarely 'either or' but: which part weighs how much. That is what decides where one begins. Treat only the smaller part and the result disappoints, without the treatment having been wrong.
- All the drops, gels and ointments you are using now or used last — in their original packs and not as names from memory; what decides is the composition, not the colour of the box. And your other medicines: some commonly prescribed groups of active substances reduce tear production, and that rarely has any connection with the reason they were prescribed. It also helps if you can say what you have already tried and for how long — the commonest reason for an 'it did not help' is not the wrong preparation but too short an application.
- We do not begin with a preparation but with the findings: break-up time, wetting, lid margin, meibomian glands, lid closure. Only from those does it emerge which of the two basic forms predominates and which step makes any sense at all. That is not a judgement on an earlier treatment — it is the step that often gets skipped, because drops are quicker than measuring. Added to that, we are open about the cost: if inexpensive measures are enough, we recommend inexpensive measures; if a more elaborate step is up for discussion, we go through benefit, effort and cost beforehand — including the option of not doing it.
- By symptoms that do not belong to it: pain in the eye rather than burning or a gritty feeling; markedly worse vision that does not clear again after a blink; marked light sensitivity that makes you screw up your eye; a red eye while wearing contact lenses — lens out and call the same day; a whitish spot on the otherwise clear cornea; symptoms that come on suddenly and in one eye, with marked redness or purulent discharge. Signs like those point to something other than a dry eye, for instance to an inflammation of the cornea, where hours to days count rather than weeks. Outside consulting hours the ophthalmic emergency service applies — contact it, or go directly to the emergency department of an eye hospital.
Enough drops?
A structured assessment shows why your eyes are burning — and what actually helps. Usually one appointment is enough for a diagnosis and a treatment plan.
Or call us: +41 44 500 69 00 — Mon–Fri 08:00–12:00 / 13:00–17:30