> Source: https://www.thenycoptometrist.com/blog/dry-eye-evaluation-nyc (last updated 2026-07-24) # Dry, Gritty, Burning Eyes? What a Dry Eye Evaluation Finds (and What Actually Helps) **By Dr. Joanna Latek** · Published 2026-07-21 > Most dry eye isn't fixed by drops. The cause is usually meibomian gland dysfunction, and once we measure what's actually wrong, treatment gets specific. Here's what a dry eye evaluation finds. # Dry, Gritty, Burning Eyes? What a Dry Eye Evaluation Finds \(and What Actually Helps\) Dry eye is one of the most common reasons people come to see me, and one of the most undertreated. The pattern is always the same: a patient has been using over-the-counter drops for years, they help for twenty minutes, the burning comes back, and they've been told by someone — a friend, a pharmacist, a previous doctor — that "dry eye is just part of getting older." It's not. Most dry eye is treatable. The catch is that the right treatment depends on what's actually causing the dryness, and that requires a proper evaluation — not a guess, not a red-top bottle from the drugstore. ## Why "just use drops" rarely fixes dry eye Here's the thing I explain most often: "dry eye" isn't one condition. It's an umbrella term that covers at least two distinct problems, and most people have a mix of both. The 2025 TFOS DEWS III consensus report — the latest update from the international group of experts who define how eye care providers classify and treat this disease — reaffirms this two-part model and adds a growing emphasis on identifying which type dominates in each patient before choosing treatment. The first is aqueous deficiency — your lacrimal glands aren't producing enough of the watery layer of tears. This is more common with age, with certain autoimmune conditions like Sjögren's syndrome, and as a side effect of some medications. The second is evaporative dry eye — you're making enough tears, but they evaporate too fast because the oily top layer is missing or poor quality. The oil comes from glands in your eyelids called the meibomian glands, and when those glands aren't working well, tears lose their protective coating. Water evaporates in seconds, the eye dries out between blinks, and you feel it as grittiness, burning, or end-of-day discomfort. Most dry eye cases have a significant evaporative component. So when most patients reach for an over-the-counter artificial tear, they're hydrating the eye for twenty minutes and doing nothing for the underlying gland dysfunction. That's why the burning comes back. ## What we measure in a dry eye evaluation A dry eye evaluation is a separate, longer visit focused on figuring out which type of dry eye you have and how severe it is. I'll typically measure: **Tear volume** — using a Schirmer strip \(a small filter paper placed inside the lower lid for a few minutes\). Low volume points to aqueous deficiency. **Tear breakup time** — how many seconds your tear film lasts between blinks before dry spots appear. Healthy is over 10 seconds. Anything under 5 is a problem. I measure this with a yellow dye called fluorescein and the slit lamp. **Meibomian gland function** — I look at the glands directly, express a few to see if the oil flows, and grade the quality of the oil. Healthy oil is clear and olive-oil-thin. In meibomian gland dysfunction \(MGD\) it's often thick, cloudy, or toothpaste-like. **Tear osmolarity** — when available, I'll measure how salty your tears are. Elevated osmolarity is a marker of dry eye severity and helps track whether treatment is working. **Ocular surface staining** — I use dyes \(fluorescein and lissamine green\) to stain the cornea and conjunctiva, which shows damaged cells. Dry spots on the cornea show up as green dots under the slit lamp. I also look at your eyelids for signs of blepharitis \(inflammation of the lid margins\), Demodex mites \(more common than people think, and treatable\), and rosacea, which often travels with MGD. The point of all this is to stop guessing. Once I know whether the problem is volume, evaporation, inflammation, or some combination, treatment gets specific. ## The real cause of most dry eye: meibomian gland dysfunction If I had to point to one cause for the dry, gritty, burning eyes most of my adult patients describe, it's meibomian gland dysfunction, or MGD. Your meibomian glands sit in rows along your upper and lower eyelids — about 25 to 40 in the upper lid, 20 to 30 in the lower. Every time you blink, they secrete a thin layer of oil \(meibum\) onto the tear film. That oil is what keeps your tears from evaporating between blinks. The glands can become blocked, the oil can thicken, and over time the glands themselves can atrophy and die. Once gland tissue is gone, it doesn't grow back. This is why early treatment matters — we can recover function in blocked glands, but we can't regenerate lost ones. Risk factors for MGD read like a list of modern life: heavy screen time \(we blink about 60% less when staring at screens\), contact lens wear, hormonal changes \(perimenopause and menopause are major triggers\), rosacea, certain medications including some antidepressants and acne treatments, and aging. Contact lens wearers in particular tend to develop MGD over time — if your lenses feel fine in the morning and terrible by evening, that's a classic sign, and the contact lens exam includes an MGD check. If you wear scleral or specialty lenses, dry eye is almost always part of the picture. There's also a strong overlap between dry eye and screen-related headaches and facial tension. Some of my dry-eye patients also benefit from a Neurolens evaluation when the eye strain is part of a larger binocular issue. ## IPL, punctal plugs, and what's worth it There's a lot of marketing around dry eye treatments. Let me be honest about what works. **Warm compresses and lid massage.** The foundation of MGD treatment. Twice a day, a heated mask over closed eyes for 10 minutes, followed by gentle lid massage. This is boring and effective. Most patients skip it because it's slow. Don't skip it. **Lid hygiene.** Lid wipes or sprays containing hypochlorous acid reduce the bacterial load on the lid margin and help with inflammation. Tea tree oil-based treatments are used when Demodex mites are the issue. **Preservative-free artificial tears.** Use as needed. The key words are preservative-free — the preservatives in standard bottles, when used more than four times a day, become toxic to the cornea. If you're using drops daily, get the single-use vials. **IPL \(intense pulsed light\) therapy.** This is the treatment that actually reverses MGD in many patients. IPL applied to the skin around the eyes reduces inflammation, opens blocked glands, and improves oil quality. Multiple sessions over a few months. A 2025 systematic review and meta-analysis of the current evidence confirmed IPL produces significant, measurable improvement in both symptom scores and tear break-up time for MGD-related dry eye, consistent with several earlier meta-analyses — making it one of the better-supported in-office treatments I offer, not just a trend. It works best for moderate-to-severe MGD. It's an investment and not always covered by insurance, but for the right patient it changes things. **Punctal plugs.** Tiny plugs placed in the tear drainage ducts to keep tears on the eye longer. Quick, in-office, reversible. Helpful for aqueous deficiency, less so for pure MGD. **Prescription drops.** Cyclosporine \(Restasis, Cequa\) and lifitegrast \(Xiidra\) reduce inflammation and improve tear production over weeks to months. They sting at first for some patients. They're prescription for a reason — they're meant for the inflammatory form of dry eye, not occasional irritation. **Omega-3 supplements.** The evidence here is genuinely mixed. The large DREAM study in 2018 found omega-3 supplementation was no better than placebo for dry eye overall, and a 2024 randomized trial focused specifically on MGD-related dry eye reached a similar conclusion — a re-esterified triglyceride omega-3 formulation was not superior to a grape-seed oil control over 12 weeks. Clinical experience still suggests a subset of patients notice some benefit, but at this point two well-designed trials agree that omega-3s aren't a reliable fix on their own. I'm honest with patients about this — it's a low-risk add-on, not a guaranteed fix. ## A daily routine + products that actually move the needle If you take one thing from this post, it's this: dry eye is a chronic condition that responds to routine. Two weeks of consistency beats two months of on-and-off effort. A reasonable starting routine for most of my evaporative dry-eye patients: - **Morning:** warm compress for 10 minutes, then a lid hygiene spray or wipe. - **During the day:** preservative-free artificial tears as needed \(every few hours, not just when it hurts\). - **20-20-20 rule:** every 20 minutes, look 20 feet away for 20 seconds. And remember to blink — sounds silly, but most screen users barely do. - **Evening:** omega-3 supplement with dinner, another warm compress if you can manage it. - **Monthly:** check your routine. If you're not improving in six weeks, we should escalate. For specific product categories worth considering: preservative-free tears in single-use vials \(look for carboxymethylcellulose or hyaluronic acid as the active\), hypochlorous acid lid spray, a heated eye mask designed for MGD \(not a washcloth — they don't hold heat long enough to melt thickened oil\), and a high-quality omega-3 with at least 1000mg combined EPA and DHA in re-esterified triglyceride form. I give specific brand recommendations in the office after seeing your glands — what works for one patient doesn't always work for another. And if routine care isn't enough, that's what the evaluation is for. We measure, we target, we escalate to IPL or prescription drops if needed. There's no reason to just live with it. If you've never had a comprehensive eye exam, that's also a good place to start — many patients first learn their dry eye is treatable during a routine visit. ## Thinking about dry eye? I see patients at Eye & Health in the East Village. If you'd like a proper dry eye evaluation — one that figures out what's actually causing your symptoms and what will help — you can book online — usually within the week. _This is not medical advice. Please consult your eyecare professional or schedule an eye appointment today._ --- ### Bibliography Jones, Lyndon, et al. "TFOS DEWS III: Management and Therapy Report." American Journal of Ophthalmology, vol. 279, 2025, pp. 289-386. Peira, S., et al. "Effectiveness and Safety of Intense Pulsed Light Therapy for Dry Eye Symptoms Due to Meibomian Gland Dysfunction: A Systematic Review and Meta-Analysis." Acta Ophthalmologica, 2025. Eom, Youngsub, et al. "Re-Esterified Triglyceride ω-3 Fatty Acids in Dry Eye Disease With Meibomian Gland Dysfunction: A Randomized Clinical Trial." JAMA Ophthalmology, vol. 142, no. 7, 2024, pp. 617-624. Cote, Samantha, et al. "Intense Pulsed Light (IPL) Therapy for the Treatment of Meibomian Gland Dysfunction." Cochrane Database of Systematic Reviews, no. 3, 2020, CD013559. Asbell, Penny A., et al. "n-3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease." New England Journal of Medicine, vol. 378, no. 18, 2018, pp. 1681-1690.