Dr Shibal Bhartiya sees dry eye patients in Gurgaon at Marengo Asia Hospitals, Sector 56. She is fellowship-trained, evidence-based, and focused on finding the root cause, not just adding more drops.
Dry eye is one of the most undertreated eye conditions in India. Many patients spend months using drops that do not work. They see multiple doctors. They get the same prescription. Nobody explains why the eye is dry, or whether the actual cause has been identified.
5 Reasons Your Dry Eye Has Not Been Treated Properly
1. Nobody typed your dry eye
Dry eye has two main forms. Aqueous-deficient dry eye means the eye does not produce enough tears. Evaporative dry eye means tears evaporate too quickly because the meibomian glands (oil glands in the eyelids) are blocked or damaged. Evaporative dry eye causes 80% of all cases. Most patients are never told which type they have.
2. You received treatment for the wrong type
Lubricating drops help symptoms temporarily. They do not unblock or repair meibomian glands. If your problem is evaporative, drops will not fix it. The surface stays irritated. The cycle continues.
3. Your glands were never imaged
Meibography is a painless scan that shows whether your meibomian glands are healthy, blocked, or atrophied. Most patients with dry eye have never had this test. Without it, treatment is guesswork.
4. A systemic cause was missed
Hormonal changes at menopause, rosacea, autoimmune conditions, and long-term medication use all affect the tear film. Dry eye in these contexts needs a different approach.
5. Your glaucoma drops were not considered
Most glaucoma drops contain preservatives (most commonly BAK, benzalkonium chloride). Daily long-term exposure damages the surface of the eye. If you have glaucoma and dry eye together, the drops may be making the surface worse. This is treatable, but only if the connection is recognised.
Who Gets Dry Eye
| Who | Why | What to Look For |
|---|---|---|
| Screen-heavy professionals | Reduced blinking, incomplete blinks | Burning, blur at end of workday |
| Glaucoma patients | Preservative toxicity from daily drops | Gritty irritation, red eyes, drop intolerance |
| Post-LASIK patients | Corneal nerve damage during surgery | Persistent dryness since surgery |
| Women at perimenopause / menopause | Hormonal effects on gland function | Worsening dryness in mid-life |
| Ocular GVHD patients | Immune attack on ocular surface after transplant | Severe dryness, light sensitivity |
| SJS / TEN patients | Mucous membrane scarring from severe drug reaction | Extreme dryness, chronic eye surface damage |
What Doctors Often Miss
Watery eyes do not rule out dry eye. When the surface is irritated, the eye produces a reflex overflow of thin, watery tears. These tears do not lubricate. Constant watering with an underlying burning or gritty feeling is a classic dry eye presentation. Many patients are told their eyes cannot be dry because they water. This is incorrect.
Post-LASIK dryness is often undertreated. LASIK cuts corneal nerves. This reduces the eye’s ability to sense dryness and trigger reflex tearing. Post-LASIK dry eye can persist for months to years. Patients are rarely warned before surgery, and are often told it will resolve on its own. A structured evaluation is warranted if dryness has continued since the procedure.
Ocular GVHD requires specialist management. Ocular graft-versus-host disease is a serious complication of stem cell or bone marrow transplantation. It causes severe dry eye, conjunctival scarring, and progressive corneal damage. Standard lubricating drops are rarely enough. Early specialist referral changes outcomes.
SJS and TEN damage the surface permanently if untreated. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis destroy goblet cells, scar the conjunctiva, and cause some of the most severe dry eye seen in clinical practice. These patients need autologous serum drops, amniotic membrane therapy in acute phases, and long-term specialist follow-up. Standard drops do not address the underlying surface destruction.
When to Worry
See a dry eye specialist, not just a general ophthalmologist, if:
- You have been on lubricating drops for more than three months without clear improvement
- Your vision fluctuates or blurs after reading or screen use
- You have glaucoma and your eyes feel gritty, red, or irritated
- You have had LASIK and your eyes have felt dry ever since
- You are approaching or have passed menopause and dry eye is worsening
- You have had a bone marrow or stem cell transplant
- You have had Stevens-Johnson Syndrome or a severe drug reaction
What This Means for You
Dry eye is usually a chronic condition. It is not something to wait out. The right diagnosis changes everything, because it changes the treatment.
At this clinic, a dry eye consultation includes meibography (gland imaging), TBUT measurement, ocular surface staining, and lid margin evaluation. These tests are done at the first visit where possible. You will leave understanding what type of dry eye you have, why the drops have not worked, and what the plan is.
Treatment depends on findings. Options include preservative-free lubricants, Intense Pulsed Light (IPL) therapy for meibomian gland dysfunction, punctal plugs, and autologous serum drops for severe or treatment-resistant disease.
If you also have glaucoma, the two conditions are managed together. Preservative-free drop formulations are used where possible. The ocular surface and the optic nerve are both tracked.
Frequently Asked Questions
My eyes water constantly. How can I have dry eye?
Watering is one of the most common symptoms of dry eye. When the surface is irritated, the eye triggers a reflex overflow of thin, watery tears. These tears do not have the right composition to lubricate the eye. Constant watering with a gritty or burning feeling underneath is a classic dry eye presentation. The two are not mutually exclusive: they are often the same problem.
I have been using drops for months. Why is nothing working?
Lubricating drops relieve symptoms temporarily. They do not treat the cause. If your meibomian glands are blocked, damaged, or inflamed, drops will not resolve that. A proper evaluation identifies whether the glands are the problem, and then treatment can be directed at the glands, not just the surface.
Is IPL therapy safe for Indian skin?
Yes. IPL settings are adjusted based on skin tone and are safe across all Fitzpatrick skin types. Settings are individualised at each session.
How many IPL sessions will I need?
Most patients need three to four sessions, spaced three to four weeks apart. Patients with mild disease sometimes respond after two. Maintenance sessions every six to twelve months sustain the benefit.
I am on glaucoma drops. Can you treat my dry eye without stopping them?
Yes. This is a common situation. The approach involves switching to preservative-free formulations where possible, treating the ocular surface directly, and monitoring both conditions carefully. Stopping glaucoma drops is rarely necessary and is never done without a careful risk assessment.
Can dry eye be cured?
Dry eye is usually a chronic condition. With the right diagnosis and treatment, most patients achieve significant and sustained symptom relief. The goal is long-term control, not a single intervention.
About the Author
This article was written by Dr Shibal Bhartiya, fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator, Clinical Director at Marengo Asia Hospitals, Gurugram, known for ethical, patient-centred glaucoma care and independent glaucoma second opinions. She is also the Program Director for Community Outreach & Wellness; and for the Marengo Asia International Institute of Neuro and Spine.
She has published peer-reviewed research on glaucoma management, examining how treatment decisions should balance medical evidence, patient preferences, and long-term vision outcomes.
As Editor-in-Chief of Clinical and Experimental Vision and Eye Research and Executive Editor of the Journal of Current Glaucoma Practice (Pubmed Indexed, official journal of the International Society of Glaucoma Surgery), Dr Shibal Bhartiya brings editorial and research depth to every clinical decision. Her 200+ publications, including 90+ PubMed-indexed publications and 28 edited textbooks span glaucoma biology, surgical outcomes, health equity, and emerging diagnostics.
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