Dry Eye & Meibomian Gland Disease

If your eyes burn, sting, feel gritty, look red, or water constantly — you’re not imagining it, and you’re not alone. Dry eye is one of the most common reasons patients come to see us, and it’s also one of the most misunderstood.

Here’s the part that surprises most people: “dry eye” doesn’t always mean you’re not making enough tears. In fact, the majority of dry eye — roughly 85% — is caused by a problem with the oil layer of your tears. That’s a condition called meibomian gland disease (MGD), and understanding the difference changes everything about how we treat it.

Man rubbing his tired eyes while working at a laptop — a common dry eye symptom

Your Tears Are More Complex Than You Think

Your tear film isn’t just water. It has three layers that work together:

The oil (lipid) layer — produced by tiny glands in your eyelids called meibomian glands. This outer layer keeps your tears from evaporating too quickly.
The water (aqueous) layer — produced by the lacrimal gland. This is the bulk of your tear film.
The mucin layer — helps tears spread evenly across the surface of your eye and stick to it.

When everything is working, these layers keep your eye surface smooth, comfortable, and healthy. When something breaks down, you feel it.

What Is Meibomian Gland Disease?

Your meibomian glands line the edges of your upper and lower eyelids — you have about 25–30 in each lid. Their job is to produce a thin, clear oil that coats the surface of your tears and keeps them from evaporating between blinks.

When those glands get clogged, inflamed, or stop working properly, the oil they produce becomes thick and waxy — or they stop producing oil altogether. Without that protective oil layer, your tears evaporate too fast, and your eyes become dry, irritated, and inflamed. That’s MGD.

And here’s the frustrating part: your eyes might actually water more, not less. When the eye surface dries out, your body tries to compensate by flooding the eye with watery, reflex tears — the same kind you produce when you cry. Those tears don’t have the right oil balance to actually fix the problem, so you end up with eyes that are simultaneously dry and watery. It makes no sense until you understand the oil layer.

MGD is also the underlying cause of most recurring styes and chalazia. If you keep getting bumps on your eyelids, it’s usually because your meibomian glands are chronically clogged and inflamed — not because of bad luck. We cover styes and chalazia in detail on their own page, but know that treating the MGD often stops the cycle.

Other Causes of Dry Eye

While MGD is the most common culprit, some patients do have reduced tear production (aqueous deficiency). This can be associated with:

Autoimmune conditions like Sjögren’s syndrome, rheumatoid arthritis, or lupus
Medications — antihistamines, decongestants, antidepressants, blood pressure medications, and hormone replacement therapy can all reduce tear production
Age — tear production naturally decreases over time, especially after menopause
Contact lens wear — long-term contact lens use can affect both tear quantity and quality (learn more about contact lenses)
Screen time — we blink about 60% less when staring at screens, which accelerates tear evaporation

Often, patients have a combination of both — reduced tear production and meibomian gland problems. That’s why a thorough evaluation matters before we start recommending treatment.

How We Figure Out What’s Going On

Not all dry eye is the same, so we don’t treat it all the same way. When you come in for a dry eye evaluation, we’re looking at the full picture:

Your symptoms and history — what bothers you, when it’s worst, what you’ve already tried
Tear film assessment — we evaluate the quality and stability of your tears, not just the quantity
Meibomian gland evaluation — we look at the glands themselves, assess the quality of the oil they’re producing, and check for signs of inflammation or gland loss
Ocular surface examination — we check the health of your cornea and conjunctiva for signs of dryness-related damage

This evaluation tells us whether you’re dealing with MGD, aqueous deficiency, or both — and it guides the treatment plan.

How We Treat Dry Eye

Treatment depends on what’s driving your dry eye and how severe it is. For many patients, it’s a combination of approaches — and we build the plan around what’s actually going on, not a one-size-fits-all protocol.

Starting with the basics

For mild dry eye, simple changes can make a real difference:

Artificial tears — over-the-counter lubricating drops to supplement your natural tears. We can recommend specific brands based on your type of dry eye (lipid-based tears for MGD, aqueous-based for tear deficiency).
Warm compresses — applying consistent heat to your eyelids helps soften and release clogged meibomian gland oils. We’ll show you how to do this effectively — most people don’t use enough heat for long enough.
Lid hygiene — keeping the eyelid margins clean reduces bacterial buildup and inflammation around the glands.
Environmental and lifestyle adjustments — humidifiers, screen breaks (the 20-20-20 rule), omega-3 fatty acids, and staying hydrated all support tear health.

Close-up of eye drops being applied — artificial tears are a first-line treatment for dry eye

Prescription options

When over-the-counter approaches aren’t enough:

Anti-inflammatory drops — prescription drops that target the inflammation driving the cycle of dryness and irritation.
Tear-stimulating medications — drops or oral medications that help your body produce more of its own tears.
Punctal plugs — tiny, painless plugs placed in the tear drainage openings to help tears stay on the eye surface longer. Think of it like putting a stopper in a drain.

In-office treatments

For moderate to severe MGD, in-office treatment can address the root cause in a way that drops and warm compresses can’t:

IPL (Intense Pulsed Light) therapy — this is one of the most effective treatments we offer for MGD. IPL uses gentle pulses of light to reduce inflammation around the meibomian glands, improve oil quality, and restore healthy gland function. It also treats the bacterial and inflammatory component of MGD at the source. We have a dedicated page with everything you need to know about IPL.

Common Questions About Dry Eye

It depends on the cause. If your dry eye is triggered by a temporary situation — a new medication, a dry winter, or a period of heavy screen use — it may improve when the trigger resolves. But MGD and chronic dry eye are ongoing conditions that benefit from consistent management. The good news is that with the right treatment, most patients get significant relief.

Over-the-counter artificial tears help some patients, but if your problem is MGD, adding more water to your eye doesn’t fix an oil problem. That’s why the evaluation matters — once we know what type of dry eye you have, we can recommend treatments that actually target the cause.

Yes, if it’s severe and left untreated over time. Chronic dryness and inflammation can lead to corneal damage, scarring, and in rare cases, vision changes. This is another reason not to just tough it out — especially if your symptoms are persistent or getting worse.

Screen time doesn’t cause MGD or aqueous deficiency directly, but it makes existing dry eye significantly worse. When you’re focused on a screen, your blink rate drops by more than half, and the blinks you do make are often incomplete. That accelerates tear evaporation. If you work on a computer all day, your dry eye will almost always feel worse by evening.

They’re different conditions, but they often overlap and can make each other worse. Allergies cause itching, watering, and redness — and the antihistamines people take for allergies can reduce tear production. If you have both, we address them separately.