"Dry Eye January": What's Really Going On?

Dry eye is far more common than many people realise, particularly for women in midlife. It’s also one of the most frequent complaints I see in clinic during the winter months, when symptoms often flare and previously manageable eyes suddenly feel uncomfortable, gritty or sore.

At its core, dry eye is a problem with the tear film – the thin, complex layer that coats the surface of the eye and keeps it comfortable, clear and protected. When this tear film becomes unstable or deficient, the surface of the eye is exposed, leading to irritation, blurred vision and inflammation.

The Menopause Connection

Hormonal changes play a significant role in eye health. During the perimenopause and menopause, falling oestrogen and androgen levels can affect the meibomian glands – the oil-producing glands along the eyelid margins. These oils are essential for slowing evaporation of tears.

When the meibomian glands don’t function properly, tears evaporate too quickly. This is known as evaporative dry eye and is particularly common in menopausal women. Many patients are surprised to learn that their symptoms are hormonally driven, but for many women, this is a key part of the picture.

Why winter makes symptoms worse

Cold weather brings a perfect storm for dry eyes:

• Central heating dries out the air

• Outdoor wind increases tear evaporation

• People blink less when it’s cold and uncomfortable

• We spend more time indoors, often on screens

  
  

Add air conditioning, prolonged screen use and reduced blink rate into the mix, and the tear film becomes increasingly unstable. It’s no coincidence that many patients report worsening symptoms between November and March.

What About Screen Time?

When we concentrate on screens – laptops, phones, tablets – our blink rate drops significantly. Blinking is essential for spreading tears evenly and expressing oils from the meibomian glands. Reduced blinking means poorer tear quality and faster evaporation, which is why dry eyes are so common in people who work at screens all day.

Why Assessment Matters

Dry eye is not a one-size-fits-all condition. The cause, severity and most effective treatment vary from person to person, which is why detailed assessment is so important. At our Worcester clinic we use the OS1000 Dry Eye device, a sophisticated diagnostic system that allows us to examine the tear film in detail. It assesses factors such as:

• Tear film stability

• Tear quantity

• Oil (lipid) layer quality

• Meibomian gland function

• Ocular surface health

This allows us to identify whether dry eye is primarily evaporative, aqueous-deficient, inflammatory – or a combination – and tailor treatment accordingly, rather than relying on guesswork.

Building A Treatment Plan

Effective dry eye management is usually layered and long-term, rather than a quick fix. Depending on the cause and severity, treatment may include:

• Lubricant eye drops: Preservative-free lubricants - like ones from Optase - help supplement the tear film and protect the ocular surface. Different formulations suit different types of dry eye, which is why personalised advice matters.

• Daily warm compresses and lid massage: Gentle heat applied to the eyelids helps soften oils within the meibomian glands, while massage encourages healthy oil flow. Done correctly and consistently, this can significantly improve tear quality.

• Punctal plugs: In patients with reduced tear production, tiny plugs can be placed in the tear drainage ducts to help tears stay on the eye surface for longer. This is a simple, in-clinic procedure.

• Topical immunosuppressive medication (Cyclosporin): For patients with inflammatory dry eye, particularly those with autoimmune features or significant surface inflammation, topical cyclosporin can help calm the immune response and improve tear production over time.

• Eye-Light IPL Technology: Combining IPL (Intense Pulsed Light) with LLT (Low Level Light Therapy) to provide an optimal, non-invasive treatment for a wide range of ocular surface conditions.

  
  

Dry eye isn’t just a minor irritation. Left untreated, it can affect vision quality, comfort and day-to-day life. The good news is that with accurate diagnosis and a tailored treatment plan, most patients experience significant improvement. If you’re navigating dry, uncomfortable eyes – particularly around the menopause or during the winter months – a proper assessment is the first and most important step.

If you’d like to book a dry eye assessment or discuss your symptoms, our team will be very happy to help. For further information, this month’s featured podcast, with Aaron Ng, explores dry eye disease in more depth. It's well worth a listen if you’d like to understand the condition more fully.