Dry Eye Syndrome: Causes, Symptoms, and Treatment in Ontario
Dry eye syndrome is one of the most common eye conditions in Canada, affecting an estimated 30% of adults. It is chronic but highly manageable with the right diagnosis and treatment plan.
Updated · Dr. Kristin Heeney
Dry eye syndrome affects an estimated 30% of Canadian adults and is the most common reason people visit an eye care clinic. Despite its name, dry eye frequently causes excessive tearing — the eye produces reflex tears in response to irritation, but these are not the right kind to lubricate the ocular surface.
Understanding the tear film
A healthy tear film has three layers:
- Mucin layer (innermost) — secreted by goblet cells; helps tears spread evenly
- Aqueous layer (middle) — produced by the lacrimal gland; provides hydration and nutrients
- Lipid layer (outermost) — produced by meibomian glands; prevents evaporation
Dysfunction in any layer causes dry eye, but meibomian gland dysfunction (MGD) — affecting the lipid layer — is responsible for approximately 80% of cases.
Risk factors
Dry eye is more common in:
- Adults over 50, particularly post-menopausal women
- Contact lens wearers
- Heavy screen users (reduced blink rate)
- People in air-conditioned or heated offices
- Those taking antihistamines, antidepressants, blood pressure medications, or hormonal contraceptives
- People with autoimmune conditions (Sjögren's syndrome, rheumatoid arthritis, lupus)
- Those who have had LASIK or other refractive surgery
Symptoms
- Stinging, burning, or scratchy sensation
- Feeling of something in the eye (foreign body sensation)
- Sensitivity to light
- Red eyes
- Blurred vision that clears with blinking
- Difficulty wearing contact lenses
- Watery eyes (paradoxical tearing)
Symptoms tend to worsen in the afternoon, in wind, in low-humidity environments, or after prolonged screen use.
How dry eye is diagnosed
Your optometrist will evaluate:
- Tear break-up time (TBUT) — how quickly tears evaporate from the corneal surface
- Schirmer test — measures the volume of tears produced
- Slit lamp examination — assesses the cornea, conjunctiva, and eyelid margins for signs of damage or MGD
- Meibography — imaging of meibomian glands (available at many Ontario clinics)
Treatment options
Over-the-counter
- Preservative-free artificial tears — lubricants without benzalkonium chloride (BAK), which can worsen dry eye with frequent use. Use as often as needed.
- Warm compresses — apply a warm, moist cloth to closed eyelids for 10 minutes to soften meibum and improve gland function. Lid scrubs follow to clean the margins.
- Omega-3 fatty acids — evidence supports their role in reducing inflammation and improving meibomian gland function. Look for high-EPA/DHA supplements.
Prescription
- Cyclosporine eye drops (Restasis, Cequa) — reduce corneal inflammation; require 3–6 months for full effect
- Lifitegrast (Xiidra) — an integrin inhibitor that reduces inflammation; faster onset than cyclosporine
In-office procedures
- LipiFlow thermal pulsation — heats and massages the meibomian glands from inside the eyelid; a single 12-minute treatment can improve gland function for 12–24 months
- Intense pulsed light (IPL) — light energy applied to the skin around the eyes reduces inflammation and improves meibomian gland function; typically 3–4 sessions
- Punctal plugs — small silicone plugs inserted into the tear drainage canals to retain tears on the ocular surface; reversible and effective for aqueous-deficient dry eye
Most in-office treatments are not covered by OHIP but may be partially covered by extended health benefits.
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Book an appointment →Frequently Asked Questions
- What causes dry eye syndrome?
- Dry eye has two main causes: insufficient tear production (aqueous deficient dry eye) or poor-quality tears that evaporate too quickly (evaporative dry eye). Evaporative dry eye, caused by meibomian gland dysfunction, accounts for roughly 80% of cases. Common contributors include age, hormonal changes, screen use, contact lens wear, certain medications, and environmental factors.
- What are the symptoms of chronic dry eye?
- Symptoms include persistent dryness, stinging, burning, or grittiness in the eyes, excessive tearing (reflex tearing), sensitivity to light, blurred vision that fluctuates with blinking, redness, and difficulty with contact lens wear. Symptoms often worsen later in the day or in dry or windy environments.
- Is dry eye syndrome a permanent condition?
- Dry eye is typically a chronic condition, but symptoms can be managed effectively and in some cases significantly reduced. Mild cases may resolve with lifestyle changes and over-the-counter drops. Moderate to severe cases often require prescription treatments or in-office procedures. Early diagnosis and consistent treatment prevent progression.
- What is meibomian gland dysfunction?
- Meibomian glands line the upper and lower eyelids and produce the oily layer of the tear film that prevents evaporation. In meibomian gland dysfunction (MGD), these glands become blocked or atrophied, reducing oil production and causing tears to evaporate too quickly. MGD is the primary cause of evaporative dry eye.
- What treatments are available for dry eye in Ontario?
- Treatment options include preservative-free artificial tears, warm compresses and lid hygiene, omega-3 supplementation, prescription cyclosporine eye drops (Restasis or Cequa), intense pulsed light (IPL) therapy, LipiFlow thermal pulsation (for meibomian gland dysfunction), and punctal plugs to reduce tear drainage. Your optometrist will recommend a treatment plan based on the severity and underlying cause.
Author
Dr. Kristin Heeney, OD — Pending clinical review
Optometrist, Spadina Optometry
Dr. Kristin Heeney earned her Doctor of Optometry from the University of Waterloo and holds certification in the treatment and management of ocular disease, with clinical training at Baltimore's Omni Eye Specialists and early-career practice in Austin, TX before returning to Toronto in 2001. She maintains an active practice in King West and has a particular focus on ocular disease, contact lenses, and cataract and refractive surgery.