GPAtlas🧭 When to suspect
Dry eye disease (DED), also called keratoconjunctivitis sicca, is a common, chronic disorder of the ocular surface in which the tear film loses its homeostasis – through reduced tear production, excess evaporation, or both – producing tear-film instability, hyperosmolarity and surface inflammation. It is very common, affecting up to a third of people aged 65 and over, and is more frequent in women.
Suspect DED in any patient with persistent gritty, sore, burning or – paradoxically – watery eyes, often with transient blurring that clears on blinking. Symptoms are characteristically bilateral, worse towards the end of the day and in dry, windy, air-conditioned or screen-heavy environments. The two subtypes frequently overlap (mixed DED), which is the commonest real-world picture.
The two clinical priorities in primary care are to recognise the pattern and to exclude the dangerous mimics – a unilateral, red, painful or photophobic eye, or visual loss that does not clear with blinking, is not simple dry eye.
| Subtype | Mechanism | Typical associations |
|---|---|---|
| Aqueous-deficient | Reduced tear production by the lacrimal glands | Sjögren's syndrome (primary or secondary), increasing age, drugs, post-radiotherapy |
| Evaporative (commonest) | Excess evaporation – usually a deficient tear-film lipid layer | Meibomian gland dysfunction, blepharitis, rosacea, reduced blink rate (screen use) |
Source: College of Optometrists · TFOS DEWS II
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