Book online

  |  02 9290 1899

The Science Behind Dry Eyes by Dr Jim Kokkinakis

Though dry eyes are something that can be experienced by […]

By Published On: 11 June 20133.4 min read

Though dry eyes are something that can be experienced by anyone, it is important to be fully aware regarding the real explanation behind this discomfort. How come this is a very common ailment for most people? What is the best way to handle this situation.

Dry eyes are a result of the lack of sufficient tears which will lubricate the front area of the eyes. Ideally, the thin layer of tears should lubricate the entire surface of the eyes when the person blinks. Good quality tears should have ample amount of lipids or fatty compound so that it would not evaporate quickly. The tear glands should be responsible in producing enough amount of tears so that dry eyes would not be triggered. If one of the aspects in tear production would not work properly, then dryness of the eyes can be felt.

In Australia recently a group of frustrated dry eye patients have set up their own website

It has one of the most extensive list of treatments possible for dry eyes that we have seen.  For a group of lay people to go to this much trouble about dry eyes, just proves to us how important it is to take dry eyes seriously.

Why does it need immediate attention?

Like any other irregularity in the body, dry eyes also have to be remedied. As it becomes worse, the symptoms would also escalate and among which include:

•    Pain when blinking
•    Gritty feeling inside the eyes
•    Eye redness
•    Irritation
•    Itchiness
•    Inability to endure wearing the contact lenses

Can it become worse over time?

The case of dry eyes from one person to another may vary a lot. Aside from that, the causes can also be very dissimilar. Among the reasons which trigger this problem include menopausal of women, old age, trauma to the eyes, dry climate, taking medications such as contraceptives, antihistamine and others.

More recent studies though have focused on the chronic dry eyes or CDE. This could lead to more serious discomfort and it is really important to set an appointment with an optometrist specialising in dry eyes. On top of the usual signs, patients with CDE can experience the following:

•    Stinging or burning sensation in the eyes

•   Headaches are more commonly reported among chronic dry eye sufferers.
•    Being highly sensitive even to low-key lighting
•    Having blurry vision and difficulty in seeing at night
•    Incessant itchiness
•    Pain
•    The dryness occur more often than usual

Can Chronic Dry Eye still be treated?

Optometrists would need to perform several tests before prescribing the right treatment for chronic dry eyes. In some cases, they can only give remedies because the problem does not really call for any serious procedures. Here are some of the common remedies from optometrists:

•    Use of artificial tears

•    Eye Mist Sprays are significantly more convenient and more effective than artificial tears.

•    Restructuring the tear ducts to preserve sufficient amount of tears in the eye’s surface. This is also called as punctual occlusion. It means that the two canals which drain the eyes of excessive tears would be narrowed or closed. Optometrists would temporarily plug these ducts to ensure if it would help the patient. If it works, then the optometrist can use permanent punctal plugs (which is preferable as they can be removed) or refer to an oculoplastic surgeon to cauterise the drains.
•    Gel for eye care can also be prescribed if the typical eye drops no longer work. This has longer retention which can prevent dryness more efficiently.
•    Ointments are often prescribed by doctors for night use only. When a person sleeps, the lubricant which should be in the eye’s surface can also evaporate. The ointment would prevent excessive evaporation of tears.

•    The reality though is for the chronic patient more specialised care is required:

Moisture goggles

Blinking exercises

Meibomian gland expression

Corticosteroids and Cyclosporine



Scleral Contact Lenses

These are just some of the more specialised treatments that can be considered.

Call us at the Eye Practice and make an appointment to see Dr Jim Kokkinakis on (02) 9290 1899.



  1. Jamie 28 June 2013 at 2:23 pm - Reply

    Jim, I think while there are many great treatments designed to address the symptoms of DES, the better angle to take is to look at the underlying reasons someone gets DES in the first place.

    Having suffered quite badly for several years myself, I’ve now completely turned the situation around by looking at my overall health. Addressing nutritional and hormone related problems. The inflammation has to start somewhere does it not? Chronic inflammation is rife in today’s world and is seen as the catalyst for many diseases.

    Years ago when I asked my Doctor about a C-reactive protein test, a simple blood test to assess general inflammation in the body, his response was. ” Let’s not do that because if its high we’ll have to go looking for the answer.”

    Therein lies part of the issue. There are few professionals prepared to dig that deep into your health for fear they may open the proverbial can of worms. This is why accountability for your own health and lifestyle is now paramount, though often few people are prepared to take the big steps that are really needed. It’s just easier to reach for the drops or the pills.

    I also came across some very interesting anecdotal evidence from a UK OD who was treating dry eye patients in his practice with high dose ascorbic acid – vitamin C. While not a magic bullet, he suggested the results were extremely successful in many cases.

    It’s true that dry eye cases are sometimes complex and multifaceted or as a result of lasik surgeries and so on. However, I believe the vast majority are as a result of a general poor state of health or a deficiency that creeps insidiously into your life.

    No one ever gets dry eyes due to a lack of cyclosporine or steroid drops in their system.

    Let’s hope that drug solutions are not the only thing we are armed with, as I can only see this becoming an epidemic of major proportions if this is the case.


    • Dr Jim Kokkinakis 9 July 2013 at 10:51 am - Reply

      Hi Jamie
      Thank you for your detailed response. The basis of your response is about inflammation within the body, which in turn can be an indicator of autoimmune disease. This certainly can be dietary, environmental, genetic or a combination of all.

      With any treatment we need to be mindful of placebo effect – in fact this can be so powerful as to have perceived benefit in up to 30% of treatments for any condition – shows you how powerful the mind can be. High dose Vitamin C (in my opinion) needs to be viewed with caution, as anything in excess can be toxic in the long term. As you say this is anecdotal and a proper control study is unlikely to be done properly as it is readily available and no pharmaceutical company will fund such a study.

      Inflammation is certainly part of dry eye syndrome- this evident because significantly more females suffer from dry eye and they are far more prone to auto immune disease and inflammation. I see this clinically every day. Diet is certainly an issue but only a part of the story. My clinic is in the middle of Sydney CBD and I see a huge proportion of computer users. Computer use combined with airconditioning (I believe) is the major cause of the dry eye epidemic we are experiencing today. If you then add dietary and genetic factors to this you then have a major part of the spectrum.

Leave A Comment

Free resources
Sign up
Latest news
Go to Top