Dry eye is the most under-treated condition we see at Pine Vision Care. Patients describe burning, stinging, watering (yes — watery eyes are often dry eye), light sensitivity, screen fatigue, blurred vision that comes and goes. They have usually been told to drop in artificial tears and toughen up.
The problem is that dry eye is not one condition. It is at least three distinct mechanisms — and treating the wrong one wastes your time and money.
The three types of dry eye
Aqueous deficient. Your eyes do not make enough tear fluid. Most common in autoimmune patients (Sjögren’s, rheumatoid arthritis, lupus). Diagnosed with a Schirmer test.
Evaporative. You make enough tears but they evaporate too fast — usually because your meibomian glands (the oil glands in your eyelid margin) are blocked. This is the dominant cause for ~85% of patients. Diagnosed with meibography imaging.
Mixed. Some of both, plus often an inflammatory component. Most common in long-term contact lens wearers and screen-heavy professionals.
What actually works
For evaporative dry eye: warm compresses with a moist heat mask, lid hygiene, and in moderate-to-severe cases, in-office IPL or low-level light therapy to restore meibomian gland function. For aqueous deficient: prescription anti-inflammatories like cyclosporine or lifitegrast, and punctal plugs in some cases. For all types: cutting screen time, hydrating, and addressing any underlying medical conditions.
Take our 7-question dry eye screener to see if you should come in for a workup.