Gritty, burning or paradoxically watering eyes. Common, treatable, and occasionally a clue to something else.
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Dry eye disease is one of the commonest eye conditions there is — and one of the most consistently under-treated, because it is dismissed as trivial. It is not: it causes real discomfort, affects reading, driving and screen work, and it is progressive if ignored.
The single most confusing thing about it, and the reason it is so often missed: watery eyes are a very common symptom of dry eye. When the surface is irritated, the eye produces a flood of reflex tears — which are watery, drain straight away, and do nothing to fix the underlying dryness. If your eyes stream and you have been told that cannot be dryness, that is wrong.
Two other things worth knowing:
And one connection that is missed for years: dry eyes with a dry mouth, fatigue and joint pains may be Sjögren's syndrome, which is testable and considerably under-diagnosed.
Most people have some of both. The distinction matters because evaporative dry eye responds to lid treatment, not simply to more drops.
Worth reviewing, because it is rarely connected:
Preservatives in eye drops. Benzalkonium chloride, the commonest preservative, is toxic to the eye surface with repeated use. People buy drops, feel briefly better, use more, become more irritated — and conclude their dry eye is worsening when the drops are driving it.
The same applies to "redness relief" drops, which constrict blood vessels and cause rebound redness that is worse than the original. These should not be used regularly.
Dry eye is diagnosed from the symptom pattern, which a video consultation covers well — with the honest caveat that assessing the tear film properly needs a slit lamp.
None are needed for straightforward dry eye. Where the Sjögren's pattern is present we arrange autoimmune blood tests alongside inflammatory markers, full blood count and thyroid function, and refer to rheumatology where indicated.
Most high street optometrists can assess the tear film, examine the lid glands with a slit lamp and grade the surface — often the same day, and usually free. For dry eye specifically, that examination tells you more than we can from a video call, and many practices now run dedicated dry eye clinics.
Since most dry eye is evaporative, the highest-yield treatment is warm compresses, lid massage and lid cleaning, exactly as for blepharitis:
This is what most people are never told, and it does more than drops.
Seek same-day eye assessment for:
Call 999 or go to A&E for: a chemical splash — irrigate with plenty of clean water for at least 20 minutes first — sudden loss of vision, or severe eye pain with headache, nausea and haloes around lights.
Book an appointment for:
At a screen, blink rate falls by more than half and blinks become incomplete, so the oil glands are not expressed and the tear film breaks up. This is a genuine mechanism, not a wellness tip.
An eye bag, five to ten minutes, then massage towards the lash margin, then clean the lash line. For most people this does more than any drop, because most dry eye is caused by blocked lid glands rather than insufficient tears.
Antihistamines, antidepressants, beta blockers, diuretics and isotretinoin all cause dry eye, and people rarely make the connection. If your symptoms started after a new medication, say so — an alternative is sometimes available.
If you have dry eyes and a persistently dry mouth — needing water to swallow dry food, or increasing dental decay — particularly with fatigue and joint pain, ask about Sjögren's syndrome. It is an autoimmune condition, it is testable, and it is diagnosed years late in a great many people because the symptoms are treated separately by different clinicians.
Lubricating eye drops are available over the counter and are the treatment for most dry eye. They cost a few pounds, a pharmacist can advise on which type, and there is no need to pay for a consultation to obtain them. Your NHS GP and your optometrist both assess dry eye free.
Your optometrist is the better first stop. They have a slit lamp and can assess tear film quality and meibomian gland function properly, which we cannot do over video.
Where twenty minutes adds something is in the causes nobody looks for — and dry eye is unusual in how often it is secondary to something else. Medications are a frequent culprit: antihistamines, some antidepressants, diuretics, isotretinoin and beta blockers all dry the eyes, and a medication review sometimes solves it outright.
The other conversation worth having is about Sjögren's syndrome — dry eyes with a dry mouth, particularly alongside joint pain or fatigue, warrants blood tests rather than more drops. That connection is regularly missed for years.
Preservative-free drops are worth the extra cost if you use them more than four times a day, and that is worth knowing before buying a year's supply of the cheaper kind.
NICE Clinical Knowledge Summary, Dry eye disease, is the principal primary care reference — covering ocular lubricants as first-line, the stepwise approach by severity, lid hygiene for associated meibomian gland dysfunction, and the recommendation for preservative-free preparations with frequent use.
TFOS DEWS II (Tear Film and Ocular Surface Society Dry Eye Workshop) is the international consensus underpinning the classification into aqueous-deficient and evaporative subtypes, which determines whether lubricants or lid treatment does more.
The College of Optometrists clinical management guidelines cover assessment and staged management, and the Royal College of Ophthalmologists sets out referral criteria for severe or sight-threatening surface disease.
NICE CKS specifically lists drug causes of dry eye — antihistamines, antidepressants, diuretics, isotretinoin, beta blockers — and recommends reviewing them, which is the basis for the medication review point above.
This is the commonest confusion in the whole condition, and the answer is straightforward: when the surface dries out and becomes irritated, the eye floods with reflex tears. Those are watery, drain away immediately, and do nothing to lubricate. Watering is a classic symptom of dry eye, not evidence against it — and if you have been told otherwise, that was wrong.
Usually one of three reasons. They contain preservatives and you are using them frequently — which damages the surface and worsens dryness. You are using them only when uncomfortable rather than regularly. Or the real problem is your eyelid glands rather than tear volume, in which case warm compresses and lid massage will do far more than any drop.
Daily warm compresses with a proper eye bag — five to ten minutes, then massage towards the lash margin, then clean the lash line. Most dry eye is caused by blocked oil glands in the lids, and this is what unblocks them. A flannel is not hot enough and is why so many people conclude it does not work.
Very likely a major contributor. Blink rate falls by more than half at a screen, and blinks become incomplete. Deliberate full blinks several times an hour, regular breaks, and positioning the screen slightly below eye level — which narrows the eye opening and reduces evaporation — all genuinely help.
Quite possibly, and it is rarely connected. Antihistamines, antidepressants, beta blockers, diuretics and isotretinoin are all common causes. If your symptoms began after starting something new, mention it — an alternative may be available.
No. Those constrict the blood vessels, and when they wear off the redness returns worse than before — so people use more, and the cycle sustains itself. They treat appearance rather than the surface. Use preservative-free lubricants instead.
Worth asking if you also have a persistently dry mouth — needing water to swallow dry food, or unexplained dental decay — particularly with fatigue and joint pain. That combination suggests Sjögren's syndrome, which is testable with blood tests and is diagnosed years late in many people because the dry eyes and dry mouth get treated separately.
Usually not, and untreated it tends to progress. But it responds well to consistent treatment — lid hygiene, the right drops used regularly, environmental changes and blinking properly. It is a condition to manage rather than to cure, and most people become comfortable once the routine is established.
August 24, 2026
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Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
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Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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