Are Dry Eyes Simply Caused By A Lack Of Tears? – Interview With Jayden

This is another excerpt from our optometrist Jayden Simpson’s interview for our YouTube channel, this time on dry eye — one of the most common complaints we see at Ezekiel Eyes ,especially here in Perth.

A lot of people assume dry eyes simply means not producing enough tears, but Jayden explains why that’s often not the real story, and walks through the range of treatments available once the actual cause is identified.

Key Takeaways

• Most dry eye cases aren’t about too few tears — they’re about tears evaporating too quickly.
• The usual culprit is blocked oil glands in the eyelids, which normally help preserve moisture on the eye surface.
• Treatment starts with a conversation about symptoms, environment and lifestyle before anything more involved.
• Options range from eye drops and warm compress therapy through to IPL treatment for stubborn cases.

Is Lack Of Tears The Only Culprit For Dry Eyes?

“Most cases of dry eye aren’t caused by too few tears, but they’re actually caused by the tears evaporating too quickly.” — Jayden Simpson, Optometrist

Dry eye is genuinely common at the moment, and Perth’s climate doesn’t do us any favours — dry breeze isn’t kind to the front of the eye. It’s one of the most frequent complaints we see at Ezekiel Eyes, and the assumption a lot of patients walk in with is that it simply comes down to not producing enough tears.

For some patients, that is the case. But for many, the real issue isn’t quantity at all — it’s how quickly the tears they’re already producing are evaporating off the surface of the eye.

What’s Actually Going Wrong With The Tear Film?

“These oil glands are actually blocked. And because these oil glands are blocked, the patient’s not getting this oil into their tear film.” — Jayden Simpson, Optometrist

One of its key components for our tears is the oil component, produced by small glands called meibomian glands that run along the upper and lower eyelid margin. That oil layer sits on top of the tear film and slows down evaporation, in much the same way a pool cover stops water evaporating off the surface of a swimming pool.

When those glands become blocked, the oil doesn’t make it into the tear film properly, and evaporation speeds up as a result. A patient can be producing a perfectly normal volume of tears and still experience dryness, because the tears aren’t lasting as long as they should on the front surface of the eye.

So, it’s tear quality rather than tear quantity that tends to be the deciding factor in most cases we see, though it’s a genuinely nuanced area, and getting a proper look at the front surface of your eye at Ezekiel Eyes is the only reliable way to know what is actually going on for any given patient.

What Does Dry Eye Treatment Actually Look Like?

“We have something for everyone, I think, is the key message there.” — Jayden Simpson, Optometrist

Treatment starts with a conversation. We talk through when the symptoms show up, whether screen time makes things worse, what kind of environments the patient spends time in, whether they wear contact lenses, and whether they’re on any medications that might be contributing. That conversation alone often points to environmental triggers that can be improved with some fairly simple lifestyle adjustments.

If that’s not enough on its own, there are several ways to escalate. Eye drops are the most familiar option, though there are many different types. In some cases, steroid drops are used to bring down inflammation associated with the dryness.

For blocked oil glands specifically, warm compress therapy is a common next step. We use a heated mask called a Blephasteam to gently warm the eyelids and soften the blocked oil, followed by a manual expression using small forceps to help clear the glands and get them producing again. Patients are often given a heating mask to apply at home themselves between visits.

For more persistent cases, we also have access to IPL — intense regulated pulsed light therapy — which tends to be particularly effective for patients with ongoing oil gland dysfunction. It involves applying concentrated light to the eyelids to help stimulate the glands back into working properly, and it’s often followed up with the same warm compress and expression process described above.

Why Does Getting The Right Dry Eye Diagnosis Matter?

“It’s important to come in and have an assessment so that we can match the treatment to the cause rather than just throwing anything at what may be dry eyes?.” — Jayden Simpson, Optometrist

Dry eye is a genuinely multifactorial condition, and no single treatment works for everyone, because the underlying cause isn’t the same for every patient. Someone whose dryness is driven by blocked oil glands needs a very different approach to someone whose issue is closer to environmental or medication-related.

That’s really the point of getting an assessment before jumping to treatment — it allows Ezekiel Eyes Optometrists to be precise about what’s actually causing the dryness rather than working through a list of possible fixes and hoping one sticks. Once the cause is clear, matching the right treatment to it tends to get results a lot faster than a trial-and-error approach ever would.

Final Thoughts

If dryness has been a recurring issue for you, particularly if eye drops alone haven’t made much difference, it’s worth getting it looked at properly rather than continuing to guess. Book a consultation with us at Ezekiel Eyes.

Scheduling an appointment with us is straightforward and hassle-free. Simply give us a call at (08) 9386 3620, and our friendly staff will be happy to assist you in booking a convenient time for your consultation. Alternatively, you can click the “Request an Appointment” button to arrange a call-back.

YOUTUBE TRANSCRIPT

It’s a great question.

0:12

Yeah, dry eye is rampant at the moment, especially in Perth, Western Australia’s environment is not, not the friendliest for dryness. It’s a good question.

0:20

So look, to answer it simply, in some cases it is a matter of producing too few tears.

0:26

That’s the reality for some patients, but it is a lot more complex than that.

0:31

So most cases of dry eye aren’t caused by too few tears, but they’re actually caused by the tears evaporating too quickly.

0:41

So basically, we have our tear film, and one of the major components of our tear film is actually oil.

0:49

And these— this oil is sort of secreted by these glands called meibomian glands. Which run vertically on our upper and lower lids, and they produce this oil.

0:59

And again, it slows down the evaporation. But what happens in most cases of dry eye is these oil glands are actually blocked.

1:07

And because these oil glands are blocked, the patient’s not getting this oil into their tear film.

1:12

So they might be producing enough tears, but the bottom line is the tears are just evaporating too quickly.

1:18

So I guess the take This sort of take-home point is that often, rather than being about tear quantity, a lot of the case dry eye is about tear quality.

1:29

Most cases I see in clinic are caused by issues with the oil glands rather than the quantity of tears produced, but it’s quite a nuanced field, to be honest.

1:40

I think the best thing to do if you have dryness is go and see an optometrist, and then they can figure out what’s actually causing the dryness, because there’s so many different potential causes.

1:51

There’s a lot of subtleties to it. I think it’s better to get it checked behind the microscope. I always think in terms of analogies because it helps me understand things.

2:02

And the way I think of the oils that you mentioned, it’s like surface cover on a swimming pool.

2:08

You know, if you’ve got the surface cover on, stops the water from evaporating.

2:12

That oil, that layer, it kind of helps to prevent the moisture from evaporating from the surface of your eye, doesn’t it?

2:19

And if your oils— or if there’s something dysfunctional about the way that your eyelids are producing oils, then you don’t have that protective cover happening.

2:29

Is that kind of right? Close to that? Yeah, spot on. I’ll have to steal that one from you, Paul. That’s really good. It’s trademarked.

2:37

Yeah, you could. I’ll give you that one. So what kind of therapies do you have in the practice there that might help somebody with dry eye dysfunction?

2:49

Yeah, of course. So we see quite a lot of dry eye.

2:52

We have a sort of dry eye clinic out of my room at Ezekiel Eyes, which we’re quite fortunate to have.

2:58

As far as the treatments that we offer, truth be told, there’s so many different things we can do.

3:03

So the first thing we can do treatment-wise is just a conversation with the patient.

3:08

So we have a chat to them about the timing of symptoms, whether the symptoms get worse when they’re using the screens, what type of environments are they in, are they wearing contact lenses, are they taking any medications.

3:20

Basically, we use all that information to identify whether there’s any environmental triggers.

3:25

And then if there is any environmental triggers, obviously within reason, we try and improve things there just with lifestyle adaptation.

3:32

So the first treatment we offer As simple as it sounds, it’s, it’s just a conversation.

3:37

Now, if we try that and it’s still just not working, there’s so many different things we can escalate to. So we offer things such as eye drops.

3:46

Eye drops come in so many different types, it can be overwhelming for patients.

3:51

So the first thing we do is try and identify what type of dryness it is, so whether it’s tear quantity or if it’s tear quality, and then we basically recommend an eye drop.

4:01

Depending on how the front of the eye is looking.

4:04

There’s other special eye drops such as steroid eye drops to try and reduce some of the inflammation that dryness can sometimes cause.

4:12

There’s warm compresses, so we have a mask called a blephasteam, which basically gently heats up the front of the eye to try and melt some of that oil.

4:21

And then behind the microscope, we manually use small little forceps to try and force some of that oil out gently in the patient’s glands and get them working.

4:30

Again, we sometimes give patients homework and we get them to buy heating masks and then do that expression with a gentle massage themselves at home.

4:41

The other thing we have, which we’re really, really lucky to have at Ezekiel Eyes in particular, is we have something called an IPL machine, or more technically,

4:50

the one we have is an intense regulated pulsed light therapy machine, which is quite a mouthful.

4:56

Um, but that tends to be a very, very effective treatment for patients that have these dysfunctioning oil glands.

5:04

And basically what that involves is applying concentrated light to the eyelids, and then that tends to really, really help get these oil glands working and producing again.

5:14

And then we often follow it up, like I was saying, with this blephasteam mask, and then we do this gentle expression as well.

5:22

So just about anything you can think of, we probably have it there in terms of dryness. There’s so different options.

5:29

It’s similar to the contact lens conversation in that every patient is so individual, their triggers are so individual.

5:36

We have something for everyone, I think, is the key message there. So it sounds like there’s a, there’s a combination of answers here.

5:44

So there’s in-clinic therapies that you offer, there are products that people can take home and use, and perhaps there’s also education about lifestyle adjustments that are going to help as well.

5:56

Exactly.

5:56

It’s a really multifactorial, um, condition, so I think you have to approach it with that in mind.

6:03

Um, but I mean, the important thing is no matter what treatment we give, again, it’s important to come in and get an assessment so that you can match the treatment to the cause rather than just throwing everything at it.

6:14

I think you need to be a little bit more precise, and that’s sort of the approach that I try to take, is get an understanding of what’s actually causing the dryness before we try and blindly treat it.