Treating dry eyes: drops, eyelid margin care, IPL — what makes sense when

The logic of the steps — and where this page begins

Dry eyes are not treated with one product but in steps. Which step comes first is decided by the findings: whether too little tear fluid is being produced, whether the tear film evaporates too quickly because the meibomian glands in the eyelid margin give off too little oil, whether the lids do not close completely — or whether several of these come together.

Why we measure first for that, and what follows from the result, is set out in full on the parent page: why we assess the tear film in dry eyes instead of guessing. This page does not repeat that. It starts where the decision has been made, and describes the individual measures as concretely as they are actually applied — at home at the washbasin and here in the consultation.

Two things hold across all the steps. First: what works on the cause takes weeks. Drops relieve at once, but only while they are sitting on the surface; everything else is judged after four to six weeks, not after four to six days. Second: the basis stays, even when something is added. A measure from a higher step does not replace the daily care, it adds to it — that is the commonest error of thinking with this condition.

And one point in advance, because it reaches almost every consultation: dry eyes can water, and copiously at that. That is not a contradiction but the response to an unstable tear film — the glands send a surge after it which does not hold the way it should. Why that is, and what else can lie behind it, is on the page watery eyes — when the eye runs and is dry all the same.

Eyelid margin care in practice: warm, stroke out, clean

If the oily layer of the tear film is the problem, the daily eyelid margin care is not an addition to the treatment but the treatment. It costs almost nothing and still often fails — practically never for want of will, almost always on three details.

1. Warming, and properly. A warming mask or a warm, damp compress on the closed lids, around ten minutes. What matters is that the warmth lasts: the thickened secretion in the glands only softens when it stays warm. This is exactly where it is decided whether the measure achieves anything. Comfortably warm is enough and hot is no better — test a mask warmed in the microwave on the back of your hand before putting it on, or you risk burns to the thin skin of the lid.
2. Stroking out, immediately afterwards. With the fingertip, stroke gently from inside the lid towards the lash line: on the upper lid from top to bottom, on the lower lid from bottom to top, with the eye closed. This is about emptying the glands, not about rubbing — light pressure is enough, and pressing hard only irritates the cornea.
3. Cleaning, in the right place. The eyelid margin is cleaned along the base of the lashes, not on the lid above it — with a clean damp cloth, a cotton bud or a lid-cleaning product, something fresh for each eye. Camomile tea expressly does not belong here.
4. Keep it up. Four to six weeks until something changes, and a reduced routine after that. Anyone who stops after ten days has not tested the method, only started it.

If there is an inflammation of the eyelid margin with blocked meibomian glands behind it, the same technique applies — there it is set out together with everything that belongs to the eyelid margin itself: what forms there are, what Demodex mites and rosacea have to do with it, and why the symptoms come back as soon as you stop. Dry eyes and an inflamed eyelid margin are so often the same picture in the consultation that we always assess the two together.

What comes in addition with a dry eye is the question of how the care works together with the drops. Two practical points: do not put drops in immediately before warming — what you put on is no longer there after ten minutes of compress anyway; the sensible order is warm, stroke out, clean and only then put the drops in. And the weight shifts with the form: if the tear film evaporates too quickly, the eyelid margin care is the treatment and the drops are the stopgap. If too little tear fluid is being produced, it is the other way round — then the eyelid margin care stays worthwhile but carries less, and the decision falls rather with the preparations and the measures further down this page.

Also worthwhile, and available without a prescription: no eye cosmetics directly on the lash line, replacing old products, screen breaks with a deliberate, complete blink, and directing draughts from fans, air conditioning and car vents away from the face. That replaces no treatment, but it takes work off it.

Anti-inflammatory treatment: when it is added

A dry eye is rarely only dry. If the ocular surface stays poorly wetted over months, a persistent irritation arises which in turn makes tear and gland function worse — a circle that moistening alone does not always break. That is exactly where anti-inflammatory treatment comes in, and that is why it is not prescribed on the first day but when the basic care and the choice of drops have been exhausted and the findings support it.

• Time-limited steroid drops can break a stuck cycle of irritation. They are a tool for weeks, not for months: prescribed by a doctor, with the intraocular pressure monitored and with an agreed end date.
• Ciclosporin eye drops are an option for the longer-term treatment of a chronically inflamed ocular surface. For many of the people using them they burn on going in during the first weeks, and they need patience — the effect can only be judged after months, not after weeks. Anyone who knows that beforehand stops too early less often. Prescription and follow-up checks belong together: at the start we agree when we will judge the effect.
• Treating the accompanying condition, where there is one behind it: rosacea of the facial skin, a disease of the eyelid margin, an underlying rheumatological condition. Without that, every local treatment stays a repair job.
• A review of your other medicines. Some frequently prescribed drug classes reduce tear production. Stopping them is therefore not automatically an option — but it is worth knowing the connection and discussing it with the doctor who prescribed them.

What we do not do here: let steroid drops run on permanently in a chronic condition because they feel good. With a state that lasts over years, what counts is what can be done over years.

What does not help — to be honest

With a condition that stays with you for years, a great deal of well-meant advice accumulates. Most of it only costs money; some of it does harm.

• Camomile tea compresses and eye baths. Camomile is a common contact allergen and irritates an already inflamed eyelid margin further. Warm is right — the infusion is not.
• Decongestant drops that make the eye white. They narrow the vessels and take the redness away for hours. They change nothing about the dryness, and with regular use the redness often comes back stronger once they are stopped.
• Putting drops in more often with preparations that contain preservatives. From around four applications a day the preservative itself becomes the problem — more of the wrong thing makes it worse, not better.
• Steroids from the leftover packet. The single most dangerous mistake on this list: intraocular pressure and an unrecognised infection of the cornea go unnoticed while the eye feels better.
• The warming mask once a week. A measure meant to be daily, applied weekly, gives not a weaker result but none.
• Food supplements as a replacement. Omega-3 preparations are often recommended; the evidence on them is mixed. Defensible as an addition, not as a replacement for eyelid margin care.

What is sensible and unspectacular, by contrast, is the surroundings: deliberate screen breaks with a complete blink, the screen rather below eye level, draughts away from the face, raising the humidity in dry rooms. That treats nothing, but it takes work off the treatment.

When you should not carry on trying

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:

• Pain in the eye — not burning or a gritty feeling, but pain
• Markedly worse vision that does not clear again after a blink
• Marked light sensitivity, which makes you screw up your eye
• A red eye and 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

These signs point to something other than a dry eye, for instance to an inflammation of the cornea, where hours to days count. We keep short-notice appointments free for that — +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. Waiting through the evening or over the weekend because it might be better tomorrow is the wrong decision with exactly these symptoms.

Not an emergency, but a reason to raise it: if not only the eyes are dry but the mouth as well — or if the symptoms have appeared newly and markedly within a few weeks, possibly with joint symptoms. Behind that there can be a disease that affects the whole body and is not treated at the eye. Tell us at the appointment; the further assessment then runs together with your GP.

And the quieter case: if you have kept up the care and the drops consistently for six weeks and it stays as it was, that is no reason to carry on as before — but the moment to look at the findings again. Request a consultation appointment online — or call us and describe what you have tried so far.