Dr Woo Jyh Haur, Senior Consultant from the Corneal & External Eye Disease Department at Singapore National Eye Centre (SNEC), answers your questions on the causes, symptoms and treatment for dry eyes.
Dry eyes affects around 5 to 10% of the population in Singapore and the prevalence increases with age.
Dry eyes (known medically as
dry eye syndrome) occur when your eyes do not produce enough tears, or the quality of the tears produced is abnormal and cannot adequately cover the surface of the eye.
Tears are made of a complex mixture of three basic layers – oil, aqueous and mucus, and are essential for good vision as they protect the eye from infection and help maintain a healthy and clear refractive surface.
Problems with these layers can cause dry eye syndrome. Other factors that can contribute to dry eyes include:
Age
Eyelid problems
Certain ocular and systemic diseases
Medications
Environmental factors,
History of certain eye surgeries,
Prolonged contact lens wear and
Hormonal changes
Dry eyes cause discomfort and if left untreated, severe forms of dry eye may lead to deterioration of your vision.
Other possible complications include, blurry vision, difficulty in keeping your eyes open, intolerance to contact lenses, corneal ulcers and conjunctivitis.
Common treatments of dry eye syndrome include lifestyle changes and the use of eye drops.
Lifestyle changes such as reduced contact lens wear, lowering of height of computer monitors, less exposure to air conditioning and a balanced diet with sufficient Omega-3 lipid components can have a positive impact on the control of dry eyes.
Using over-the-counter ocular lubricants can also help patients with no clinical damage to the ocular surface (staining or keratitis) to control their condition.
For more remedies and coping tips for dry eyes, read this article.
Severe dry eye can be treated using more sophisticated methods such as steroids, punctal occlusion or surgery to address the underlying cause.
If dry eyes discomfort is a frequent occurance for you, don't put up with it anymore. Get the right answers on how to get it treated. Ask our specialist during this limited-time Q&A now!
About Dr Woo Jyh Haur
Dr Woo is a Senior Consultant with the Corneal & External Eye Disease Department of the Singapore National Eye Centre (SNEC) and Head of SNEC Eye Clinic at Sengkang General Hospital (SKH).
He graduated from the National University of Singapore with a Bachelor of Medicine and Bachelor of Surgery in 2006, winning the Gold Medal and Book Prize in Ophthalmology. He trained at SNEC and obtained the Master of Medicine (Ophthalmology) degree in 2012.
Dr Woo holds a Master of Science degree in Evidence-based Health Care from the University of Oxford and is a qualified Fellow of the Royal College of Ophthalmologists (United Kingdom) and Royal College of Surgeons of Edinburgh by examination as well as a Fellow of the Academy of Medicine of Singapore.
Dr Woo has an active practice which specialises in cornea, anterior segment disorders and corneal transplantation in both adults and children, but also includes cataract surgery, refractive surgery and comprehensive (general) ophthalmology.
He also runs the Paediatric Cornea Service at both SNEC and KK Women’s and Children’s Hospital (KKH).
Questions and answers on managing dry eyes
1. Question by Kam
Dear Dr,
I have dry eyes very frequently but the eye specialist have found nothing wrong with them n I have been advised to use the eye drop Natural Tears frequently every day.
However my dry eyes kept coming back 1-2 hours after I dispensed my eye drops n I am wondering if the eye drops that I am using are strong enough to stop the frequent dry eyes that I am experiencing.
Pls advise what better ways to stop this dry eyes problem. Thanks.
Answer by Dr Woo Jyh Haur
Dear Kam, thanks for your post. Besides the tear substitutes, there are many other modalities of treatment for dry eyes.
Broadly, treatment may be divided in a few categories: tears substitutes, anti-inflammatory medications, measures to increase the accumulation of tears in the eyes, such as punctal plugs, and lifestyle measures such as lid hygiene, avoidance of ocular irritants, reduction of contact lens wear and general good habits, such as regular breaks between screen-time.
However, the treatment needs to be tailored and individualized to each patient’s condition, severity and underlying cause for dry eyes. This is best advised by an eye specialist.
2. Question by Eileen
Dear Doctor,
Will I go blind from dry eyes if I seek treatment too late? Thank you.
Answer by Dr Woo Jyh Haur
Dear Eileen, thanks for your question. Dry eyes, if severe and untreated, may affect vision. However, there are many treatment modalities available for dry eyes and permanent visual loss is rare. If you are experiencing symptoms of dry eyes, you should seek medical advice early.
3. Question by Lin Lin
Hi Dr,
I have been feeling eye pain frequently when I'm wearing contact lens around the past 2 years. (I usually wear contact lens just a few times per month.) It will feel alright at the start but out of nowhere it feels moderately painful when you try to blink, and you won't be able to even open your eyes, or even touch your contact lens in that eye at that moment. There'll be rapid tearing too. I could only close my eyes for quite a while with my hand over that eye and wait for some time, and it'll be alright again. And some time later during the day, it might just happen again.
I've been wearing contact lens for 19 years, previously there was none of this issue. (FYI: I've had retinal detachment with unknown cause at one eye 3 years after I started contact lens.)
Nowadays I will instil the Rohto eye drops before I wear my contact lens. It does help sometimes, but not always.
Answer by Dr Woo Jyh Haur
Hi Lin, thanks for sharing your experience. Your symptoms may be due to changes in your eyes which reduce your tolerance to contact lens, such as dry eyes and allergy. The symptoms may also be due to suboptimal fit and condition of your contact lenses. Do consult an eye specialist for an eye examination for a diagnosis of the underlying issues.
4. Question by Mr Ng
Hi Doctor,
I have dry eyes and this is causing blurriness in both eyes.
I have advanced glaucoma in both eyes too and have done laser surgeries including unsuccessful drainage implants in both eyes these past few years.
I use systane hydration and systane ultra tear drops to lubricate.
What is the practical difference between the two eyedrops?
I was told by an optometrist that the teardrops need 3 months to kick in before they can help my dry eyes and improve blurry vision.
Your comments appreciated. Thank you.
Answer by Dr Woo Jyh Haur
Hi Mr Ng, thanks for your sharing and question.
While I am unable to comment on any commercially available eyedrop formulation on this forum, artificial tear substitutes generally serve to lubricate and moisturise the surface of the eye, and in turn relieve dry eye symptoms on application.
In the context of your eye history, certain eyedrops for glaucoma (if you are on any) may also contribute to your dry eye symptoms. I would advise you to discuss these symptoms with your eye specialist as well.
5. Question by Eelin
Hi Dr,
What can I do with dry eyes? I have done lasik before and I am experiencing dry eyes and it tires me.
Answer by Dr Woo Jyh Haur
Hi Eelin, thanks for your question.
Many patients do indeed experience dry eye symptoms after LASIK surgery. There are many underlying mechanisms and causes for dry eyes and treatment needs to be tailored to the condition of each patient.
Common treatment for dry eyes may include tears substitutes, anti-inflammatory medications, measures to increase your tear lake such as punctal plugs, and lifestyle measures such as lid hygiene, avoidance of ocular irritants, and general good eye habits, such as taking regular breaks between screen-time.
Do seek medical advice for an eye examination before treatment specific to your eye condition can be recommended.
6. Question by P Wong
Hi Dr,
I have been using Eye Mo eye drops for many years to relieve syndrome of dry eyes.
Lately I discovered that Eye Mo wasn't as effective as before.
Could it be due to changes in my eyes reactions to chemicals in the eye drops?
Also, what other alternative eye drops that I can buy over the counter as a substitute.
Answer by Dr Woo Jyh Haur
Hi P Wong, thanks for your post.
While I cannot comment on specific commercial brands of eyedrops on this forum, tears substitutes containing preservatives, if used frequently, may result in more eye irritation in some patients. You may explore unpreserved tears substitutes which are available over the counter. Furthermore, your symptoms may also be related to a change in your eye condition and may require other treatments, beyond tear substitutes, which can be advised by an eye specialist.
7. Question by Mdm Goh
Dear Dr Woo, Greetings.
My husband suffers from dry eyes which make him so uncomfortable that he prefers to lie in bed most of the time and become; blurring his vision and makes him feel like he is losing his vision.
He is currently using eye drops to soothe his eye dryness.
His eye checks at NUH are normal. But yet he is in so much pain. I wonder if he has other eye conditions or psychological issues.
Please advise what is potentially happening and what else can be done to live like normal and be active. Thank you.
Answer by Dr Woo Jyh Haur
Dear Mdm Goh, Greetings to you too. Thanks for your post.
Some patients with dry eyes continue to experience symptoms and discomfort which disrupts their daily activities despite using tears substitutes and having stable findings on eye examination.
I would advise a review by an eye specialist to evaluate the underlying mechanisms and causes for dry eye before optimizing his treatment further.
8. Question by Sim
Dear Dr,
I have been applying Refresh Plus for my mother's eyes more as a precautionary measure rather than on the fact that she actually has dry eyes, which I do not know.
The rationale for my doing so is on the assumption that for one like her of 96 years would be prone to this eye condition when the body including the eyes would not be able to produce enough fluid on their own to moisturise. Should I continue to do so? Thank you.
Answer by Dr Woo Jyh Haur
Dear Sim, thank you for your question.
Many people do experience dry eyes with ageing due to various physiological changes. You may continue to instill preservative-free tears substitute for your mother, especially if she has symptoms of dry eyes.
9. Question by Vivek
Dear Dr Woo,
What are the ways in which I can avoid dry eyes and watery eyes?
Answer by Dr Woo Jyh Haur
Dear Vivek, thanks for your question.
To avoid dry eyes, you may first consider reducing ocular irritants (such as frequent use of eyedrops with preservatives) and to reduce contact lens wear (if applicable). Other options include unpreserved tears substitutes and having good eye habits, such as taking regular breaks from prolonged reading or screen-time.
Patients with dry eyes may at times experience reflex tearing and watery eyes. However, there are other causes for watery eyes including conditions related to the tear drainage system of your eyes. This can be evaluated and excluded by an eye specialist.
10. Question by Taryn
Hi Doctor,
I would like to check if there would be a cure for dry eyes and also long sightedness as I have gotten them both after a childbirth.
At 1st i thought it could just be some hormones changes but it stayed. Please advise.
Answer by Dr Woo Jyh Haur
Hi Tarlyn, thanks for your post.
There are many treatment options for dry eyes, including: tears substitutes, anti-inflammatory medications in some cases, measures to increase the accumulation of tears in the eyes such as punctal plugs, and lifestyle measures such as lid hygiene, avoidance of ocular irritants, reduction of contact lens use and general good eye habits with regular breaks between screen-time. However, the overall treatment needs to be tailored to your eye condition.
Long-sightedness is one of the refractive errors which can be corrected with the use of glasses. However, this needs to be confirmed with a refraction examination by an optometrist or eye specialist.
11. Question by Grachel
Dear Dr Woo,
I am glad to be able to ask you some questions.
I have been having dry eye at the age of 25 years old. Have went to do check-up and scan of my eye and everything is okay.
My symptoms include sharp pain randomly and tears. With eyes getting red like I have just cried.
At night also have dry eyes which also makes it itchy.
I am not sure what is happening for so long and it is not recovering. What should I do?
Hope that my question is being chosen. :)
Answer by Dr Woo Jyh Haur
Dear Grachel, thanks for your question.
There are many underlying mechanisms and causes for dry eyes. Often, symptoms for dry eyes may overlap with those of other eye conditions of the ocular surface such as allergic eye disease.
I would recommend having your eyes assessed by an eye specialist who can then treat the underlying cause and prescribe treatment specific to your condition.
12. Question by Ms Koh
Hi Dr Woo, I have some questions.
a) What kind of medications and hormonal changes would cause dry eyes
b) Would normal eye drops alleviate this problem? If so, any specific eye drops required or would common eyedrops like Eye Mo which has preservatives suffice?
c) Would staring at computer screen for a long time or looking/focusing intently at the screen cause dry eyes?
Answer by Dr Woo Jyh Haur
Hi Ms Koh, thanks for your questions.
a) There is a long list of medications which may cause dry eye symptoms by
reducing tear production. Some of the common medications include certain anti-histamines, decongestants, anti-depressants and medications for high blood pressure.
Broadly, the effect of hormone change on dry eye disease is in the context of menopause. Some patients with thyroid eye disease also experience dry eyes.
b) Mild symptoms of dry eyes can often be alleviated with the use of over-the-counter tear substitutes. If not, an eye examination is advised to look for any specific underlying cause before further treatment is recommended.
c) Yes, prolonged screen-time without regular breaks, and infrequent blink may exacerbate symptoms of dry eyes.
13. Question by Mdm Lee
Dear Doctor,
Recently, I experience dry eyes and it affects my blinking. Eyelids feel a bit stuck and requires conscious effort to blink.
Also noticed a light ring at the edge of the eye pupils.
I am aged 65. At close range, vision is now slightly blurry which previously was not. However, with some effort, I am still able to read without glasses. Short-sightedness is self-correcting well.
Should I be concerned or this is normal aging process? Appreciate your advice in this matter. Thank you very much.
Answer by Dr Woo Jyh Haur
Dear Mdm Lee, thank you for your post.
Many people do experience increased dry eye symptoms with ageing. Similarly, reduced vision at close range (presbyopia) is a common condition experienced by those over the age of 40 years. However, the symptoms you have described are not specific to these conditions alone.
I would recommend you get a full eye examination to exclude any eye disease (age-related or otherwise).
14. Question by Lim
Dear Dr Woo,
I’m 64 years old now. For the past 1 year, my eye vision has been deteriorating. In the morning when i wake up, my eyes were particularly dried & typical eye drop liquid didn’t help much.
What could be the contributing factors & how can I have my eye checked & rectified? Thanks.
Answer by Dr Woo Jyh Haur
Dear Lim, thank you for your post.
There are many causes of vision deterioration for patients in your age group, including age-related diseases such as cataracts, age-related macular degeneration and glaucoma.
Similarly, there are many mechanisms and underlying causes for dry eyes which needs to be evaluated before treatment specific to your eye condition may be prescribed.
For your symptoms of deteriorating vision and dry eyes, you consult an eye specialist for a full eye check and further advice.
15. Question by Kok Leong
Hi Dr,
My dry eyes get worse when sleep with Aircon at night time or dusty environment will cause my eyes to get very uncomfortable.
My question is: Will LipiFlow Thermal Pulsation System help to cure my dry eyes?
Answer by Dr Woo Jyh Haur
Hi Kok Leong, thanks for your question.
Being in a cold dry environment with air conditioning can cause dry eye symptoms in some patients. You may consider avoiding direct air blowing into your eyes from air conditioning and adding moisture to indoor air by using a humidifier.
The LipiFlow Thermal Pulsation System is a treatment for meibomian gland dysfunction, one of many underlying causes for dry eyes. I would advise you undergo a full eye examination by an eye specialist who can then recommend this treatment, if it applies to you.
16. Question by Chit Seng
Dear Dr Woo,
I read with interest the articles from SingHealth regarding dry eyes and am glad that Singhealth is giving us an opportunity to submit queries to you. Ever since my cataract operation on both eyes, I've been experiencing the following:
a sensation of having something in my eyes
it feels like something sticky on the edges of the eyes
it comes on quite frequently e.g. when I leave an airconditioned room to a non-air conditioned area or vice versa, or sometimes when my car air conditioning starts up after I start my car engine.
I've tried many different brands of eye drops for dry eyes but they don't seem to be able to clear the condition. They only give very slight relief. However, the condition stops whenever I put on a pair of glasses - almost immediately.
I'd like to know:
a) Is this really caused by dry eyes?
b) Will it get worse ?
c) How do I prevent it from deteriorating further?
d) Is there a permanent solution to the problem?
Thank you for your kind attention and look forward to hearing from you.
Answer by Dr Woo Jyh Haur
Dear Chit Seng, thanks for your questions.
There are many underlying mechanisms and causes for dry eyes. Often, symptoms for dry eyes may overlap with those of other eye conditions of the ocular surface. I would advise you obtain a full evaluation by an eye specialist.
If the diagnosis of dry eyes is confirmed, treatment specific to your condition, coupled with lifestyle measures such as good eye habits with reduced screen-time and regular breaks, will help to prevent any deterioration in the long run.
17. Question by Irene
Good morning Dr!
I am in my 60s and have RA and some of my questions are as follows:
a) Does taking Lutein supplements daily help with dry eyes besides eating the recommended food?
b) Is there a cure for dry eyes?
c) While being diagnosed as having dry eyes and doing yearly tests due to the medication I'm taking for RA, besides daily use of eye drops, is there anything else I can do to help myself?
d) Can one go for a cataract operation when one has dry eyes?
Thank you.
Answer by Dr Woo Jyh Haur
Dear Irene, thank you for your questions.
a) Lutein supplements is beneficial for some patients with age-related macular degeneration, but not specifically for dry eyes.
b) and c) There are many mechanisms and underlying causes for dry eyes. Treatment for dry eyes needs to be tailored to your eye condition. Besides the daily use of artificial tear substitutes, it is important that your rheumatoid arthritis condition remains under control. Other measures include avoidance of ocular irritants, and general good eye habits, such as regular breaks between screen-time. As rheumatoid arthritis and its treatment may affect the eyes in various ways, it is important for you to seek medical advice early, should you experience any change in your symptoms.
d) Dry eye disease should ideally be optimised before cataract surgery.
18. Question by Sivakumary
Hi Dr,
How do I know if I have dry eyes?
I had cataract surgery done 2016 n 2018. I have been going to Eye Centre on yearly basis. But this eye I discovered I have floats in my right eye.
Seen Dr and he told me that my sight is ok and floats are due to aging.
I am 70 yrs old with diabetic, high blood pressure and cholesterol. On medication at polyclinic.
Please advise about the floats. Thank you.
Answer by Dr Woo Jyh Haur
Hi Sivakumary, thanks for your post.
Common symptoms of dry eyes include stinging, itchy sensation in the eye, or sensation of having a foreign body in your eyes, redness, increased sensitivity to light, blurred vision, fatigue and watery eyes. However, these symptoms are not specific to dry eye disease alone and you should be assessed by an eye specialist before a diagnosis of dry eye is made.
For the floaters, they may be due to age-related changes in the eyes. However, floaters may also arise from more serious eye conditions such as retinal tears or detachment, inflammation and bleeding. It is reassuring that you have been assessed by an eye doctor.
However, should you have any worsening of your symptoms of floaters, you should seek medical advice immediately.
19. Question by Cassandra
Dear Dr Woo,
I’m 52yrs now and my dry eyes seem to be occurring more often now. I’ve started using those small daily disposable eye drops whenever it happens. Do I need to see an eye doc?
Answer by Dr Woo Jyh Haur
Dear Cassandra, thanks for your question.
If you experience symptoms of dry eyes which are not be completely alleviated by artificial tear substitutes alone, you should see medical advice by an eye specialist for further assessment.
20. Question by Mrs Wong
Hello Dr,
I have my cataract removed almost coming to 3 years and still experiencing dry eyes according to the Dr. Have been apply eye drops frequently.
Sometimes it cause blueness or a bit blockage to vision. Is there any treatment or medication? I am 73 years now.
Hoping to get some advice from you. Thank you.
Answer by Dr Woo Jyh Haur
Hello Mrs Wong, thanks for your post.
The “blueness” and “blockage to vision” are not likely related to dry eye disease. You should consult your eye specialist to evaluate these symptoms and look for the underlying cause.
21. Question by Joyce
Dear Dr Woo, I am 66 years old.
Since young I had eye problems.
- right eye retina detached in 1984. Likely due to high myopia
- on and off eyes tearing
- LASIK done on both eyes 10 years ago
- cataract surgery 10 years ago
- right eye macular hole surgery March 2024
After this macular hole surgery - my right eye in particular “ tears” . Yes I am seeing eye doctor. The tearing has reduced but most mornings it still has some tearing.
Also noticed LEFT eye vision has deteriorated after visiting an optometrist last weekend.
Pls advise:
- long term dry eyes treatment?
- prevent both eyes vision deterioration?
As I aged - my biggest fear is how to keep my eyes in the best condition as long as possible. I have no other illness. I am very sports active too.
Look forward to your reply Dr Woo.
Answer by Dr Woo Jyh Haur
Dear Joyce, thanks for your questions.
Common treatment for dry eyes may include tears substitutes, anti-inflammatory medications, measures to increase your tear lake such as punctal plugs, and lifestyle measures such as lid hygiene, avoidance of ocular irritants, and general good eye habits, such as taking regular breaks between screen-time. However, treatment needs to be tailored to your eye condition to address the underlying causes and mechanisms for dry eyes.
Considering that you have had various eye surgeries, you should maintain regular follow up with your eye specialist and seek medical advice immediately, should you experience any change in your eye condition (such as visual deterioration).
22. Question by Purnendu
Dear Dr. Woo,
My child is 12 years old and suffers from Dry Eye/ Itchy Eyes. We use Systane Ultra Eye Drops but it continues to come back. Kindly let us know what is the best way forward?
Answer by Dr Woo Jyh Haur
Dear Purnendu, thanks for your post and question.
The symptoms of itchy eyes may not be specific to dry eyes and may also be caused by other eye conditions common in children, such as allergic eye disease. You should bring your child for an examination by an eye specialist.
23. Question by Tony & Jennifer
Dear Dr Woo,
What causes dry eyes after cataract surgery? Any cure/ remedy?
Answer by Dr Woo Jyh Haur
Dear Tony & Jennifer, thanks for your question.
Symptoms of dry eyes are common after cataract surgery and they may be related to the inflammation, abnormality in the tear film, changes in corneal wound healing and occasionally, the eyedrops used after surgery. These symptoms usually improve over time and with the appropriate treatment.
Generally, treatment for dry eyes may include tears substitutes, anti-inflammatory medications, measures to increase your tear lake such as punctal plugs, and lifestyle measures such as lid hygiene, avoidance of ocular irritants, and general good eye habits, such as taking regular breaks between screen-time. However, treatment needs to be tailored to your eye condition and should be advised by your eye specialist.
24. Question by Camp Henry
Good afternoon Dr Woo,
Recent months, I have been having really bad dry eyes and used systane ultra to relieve the symptoms. The number of days between changing to a new 10ml bottle increases in frequency from 99 days to 24 days and the worst is 8 days apart. One day, I abstained from wearing a face mask and the frequency improves from 8 days to 12 days and then to 19 days.
My question is does wearing of face mask induce dry eyes syndrome?
Answer by Dr Woo Jyh Haur
Dear Camp Henry, thank you for sharing your experience.
There is evidence to suggest that the use of face mask may increase dry eye symptoms due to various mechanisms. However, a balanced view should be considered as the effect of face masks on the ocular surface and dry eyes is likely due to multiple factors, such as the pre-existing eye condition, dry eye severity, environmental factors, duration of mask wear and design.
The use of face mask should still be in line with general health guidance, as it protects against transmission of certain diseases.
25. Question by Tony
Hi Dr,
I have dry eyes for a long time and my vision is getting blurred as time progresses. I have been going for all sorts tests and eye drops/ gels but they offer little very short term relief.
I had my cataracts removed several years back and Al’s laser treatment to both eyes as they had developed ‘ veils’ at the back of the eyes a year or so after the cataract operations.
Can you advise what my problem is? Currently I am seeing eye doctor every 6 months. Thank you.
Answer by Dr Woo Jyh Haur
Hi Tony, thanks for your post.
There are other modalities of treatment for dry eyes beyond common formulations of artificial tear substitutes. The overall treatment should be tailored to your eye condition in order to address the underlying causes of dry eyes in your case.
The symptoms of “veils” may be due to floaters. They may be due to age-related changes in the eyes. However, floaters may also arise from more serious eye conditions such as retinal tears or detachment, inflammation and bleeding, among other causes.
You should discuss your symptoms with your eye specialist and seek medical advice immediately, should you experience any worsening of your symptoms.
26. Question by Gloria
Dear Dr Woo,
I have dry eyes on my left eye for a few years and I have checkup at Ng Teng Fong yearly but every time I tell the Dr about it, they'll give me different eye drops which does not help and I was told that my eyelashes are oily.
I have tears flowing automatically that friends think I'm crying. What can I do? Thank you.
Answer by Dr Woo Jyh Haur
Dear Gloria, thanks for your sharing.
There are many underlying mechanisms and causes for dry eye disease. There are also different treatment options beyond artificial tear substitutes. The tearing you experience may be related to dry eyes, but it may also be caused by other conditions, such as those related to the tear drainage in your eye.
If you continue to experience symptoms of dry eyes and tearing with the current treatment, you should discuss further with your eye specialist who may optimise your treatment to address the underlying cause.
Ref: H24
