Dry eye: causes, treatment and pharmacy guide 2026

Dry eye is the most common eye problem I see in the pharmacy: grittiness, burning, intermittent blurred vision or tired eyes when reading or looking at screens. This is my 2026 pharmacy guide with real causes, how to tell it apart from other eye discomfort, how to choose the right artificial tears and the habits that genuinely move the needle.

What is dry eye and why does it appear?

Dry eye (also called dry eye syndrome or keratoconjunctivitis sicca) is a disturbance of the tear film that covers and protects the surface of your eye. It appears through two main mechanisms, and knowing which applies to you changes the treatment.

• Aqueous‑deficient dry eye: the lacrimal glands produce less tear fluid. Typical with older age, Sjögren’s syndrome, after eye surgery or medicines such as antihistamines.
• Evaporative dry eye: you produce tears, but they evaporate quickly. This is now the most frequent cause — screens, air conditioning, Meibomian gland dysfunction (underlying blepharitis).
• Mixed dry eye: a combination of both, very common from around 50 years of age.

Symptoms and when to see an ophthalmologist

Dry eye shows up with a recognisable pattern. Watch for these early symptoms — in most cases you can start with artificial tears and habit changes:

• Sensation of grittiness or a foreign body — the most specific symptom.
• Burning or stinging at the end of the day · intermittent blurred vision that improves when you blink.
• Eye fatigue with screens (computer vision syndrome) · mild red eye without yellowish discharge.
• Paradoxical reflex watering: occasional watering does NOT rule out dry eye.

See an ophthalmologist if you develop real pain, blurred vision that does not improve when you blink, yellow discharge, intense light sensitivity or if symptoms persist for more than 4 weeks despite correct treatment.

Causes and risk factors

It is rarely just one cause. Several factors build up until they unbalance the tear film:

• Screens: your blink rate drops from about 15 to 5–7 times/minute. Tears evaporate without being renewed.
• Age and hormones: from around 50 tear production falls. It is more frequent in postmenopausal women.
• Medicines: antihistamines, SSRI antidepressants, beta‑blockers, hormonal contraceptives, isotretinoin.
• Systemic diseases: Sjögren’s syndrome, rheumatoid arthritis, lupus, diabetes, thyroid dysfunction.
• Environment and contact lenses: air conditioning, central heating, dry wind, smoke, prolonged contact lens wear.
• Blepharitis and Meibomian gland dysfunction: blockage of the glands that provide the oily layer of the tear film — very underdiagnosed.

How is dry eye treated effectively?

The most effective dry eye treatment combines suitable artificial tears, eyelid hygiene and environmental changes. None of these works well in isolation.

• Baseline artificial tears: preservative‑free hyaluronic acid 3–6 times/day. Universal first line.
• Severe dry eye or night‑time symptoms: add an ophthalmic ointment before bed for prolonged protection.
• Evaporative component (blepharitis): daily eyelid hygiene with specific wipes + warm compresses for 5–10 minutes.
• Omega‑3 (EPA/DHA) supplements: can improve the oily layer in moderate–severe cases. Effect after about 2–3 months.
• Medical treatment: severe or refractory dry eye → ophthalmologist (topical ciclosporin, punctal plugs).

Artificial tears: how to choose and 5 key pharmacy options

Not all artificial tears are the same. Your choice depends on the type of dry eye, how often you use them and whether you wear contact lenses:

• HYLO COMOD 10ml: hyaluronic acid 0.1% without preservatives. Multidose COMOD system (6 months after opening). My baseline reference for mild–moderate dry eye.
• HYLO INTENSE 10ml: hyaluronic acid 0.2% + dexpanthenol. More viscous, for moderate–severe dry eye or persistent symptoms with HYLO COMOD.
• AQUORAL Noche Ointment 5g: night‑time ophthalmic ointment. Prolonged protection while you sleep, ideal if you wake up with grittiness or burning.
• Systane Ultra 10ml: polyethylene glycol + propylene glycol. An alternative to hyaluronic acid for screen‑related dry eyes or if hyaluronic acid feels tight.
• Artelac Rebalance 10ml: carbomer + electrolytes + vitamin B12. Restorative profile for chronic dry eye with signs of mild inflammation.

Drops vs night ointment vs omega supplement: how each one fits

A common mistake is expecting a single product to solve every type of dry eye. Each format covers a different need and they are often combined:

• Eyelubricant drops (daytime): on‑the‑spot surface hydration. Use 3–6 times/day. The foundation of treatment.
• Ophthalmic ointment (night): forms a protective film for hours. Reduces waking up with grittiness. Apply only before sleep (its thickness blurs vision).
• Ω-3 supplement: supports the oily layer of the tear film. Systemic effect after about 2–3 months. Complements but does not replace drops.
• Eyelid hygiene (wipes + compresses): essential if there is blepharitis or Meibomian gland dysfunction.

The combination I most often recommend in pharmacy: hyaluronic acid drops during the day + night‑time ointment + oral omega‑3 if symptoms persist after about 4 weeks.

Habits that really make a difference

Treatment from the pharmacy only goes so far. Your daily habits contribute as much or more to medium‑term results:

• The 20–20–20 rule with screens: every 20 minutes look at something 6 metres away for 20 seconds. This restores your blink rate.
• Conscious blinking + humidifier in rooms or offices with heating or air conditioning.
• Adequate hydration 1.5–2 L/day · diet rich in omega‑3 (oily fish 2–3 times/week, linseed, walnuts).
• Avoid smoke, dry wind and direct airflow to your face.
• Sufficient sleep: less than about 6 hours worsens dry eye. Surface repair happens at night.

If you adjust your habits and use suitable artificial tears consistently, most mild–moderate cases improve within about 4–6 weeks.

Frequently asked questions

Scientific references

• TFOS DEWS II Definition and Classification Report — https://www.tearfilm.org/dettnews-tfos_dews_ii_report/28_.htm
• AEMPS · Ficha técnica lágrimas artificiales con hialurónico — https://cima.aemps.es
• Cochrane · Omega-3 fatty acids for dry eye disease — https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011016.pub2