If you know a little bit about dry eye, you know dry eye is commonly treated as a tear problem. When that happens, doctors prescribe artificial tears. And when those don't work, they prescribe thicker tears. And then those fail, thus causing prescription drops to enter the picture.
Now, for many people, that approach never fully works as symptoms keep despite the fact they try a whole host of different products. Frustrating, right?
This is largely due to the fact that most dry eye is not caused by insufficient tears. Rather, it's caused by chronic inflammation of the eyelids--particularly at the lid margin where the tear film is formed.
Understanding this difference changes how dry eye should be treated. And it explains why many standard solutions fall short.
Most Dry Eye Is Evaporative, Not Tear Deficient
Just a minority of dry eye cases stem from actual reduced tear production. The majority--however--are evaporative dry eye. Here, you find that tears are produced but they subsequently evaporate too quickly to protect the eye.
The most common driver of this evaporation stems from meibomian gland dysfunction (i..e, MGD). This condition makes it so that oil-secreting glands along the eyelids become blocked or inflamed.
These meibomian glands line the upper and lower eyelid margins and produce the lipid layer of the tear film. Through that same respective lipid layer, it's able to prevent tears from evaporating off the eye surface.
When these glands fail, everything breaks down. The tear film becomes unstable. Moisture evaporates faster. The eye surface becomes irritated. Inflammation feeds back into the eyelids. It's a waterfall of terrible things.
This creates a recursive-loop cycle. The more inflamed the eyelids become, the worse the glands function. Subsequently after that loop, the worse the glands function, the more the eyes dry out and become inflamed.
The Eyelids Are Skin, And They Can Be Diseased
The eyelid margin is not just a passive border but living skin with its own complex biology.
It contains oil glands that secrete lipids. It has hair follicles where eyelashes grow. It hosts a resident microbiome of bacteria and microscopic mites. It has an active immune response that can trigger inflammation.
Over time, that same debris builds up gradually along the lash line and gland openings. Dead skin cells, oil residue, bacteria, and mite byproducts build up. This material can thus form biofilm.
Biofilm is a structured community of microorganisms encased in a protective matrix. It traps bacteria and shields them from the immune system. It protects inflammatory triggers from being cleared away naturally.
Most importantly, biofilm makes symptoms chronic rather than occasional. Once established, biofilm-driven inflammation does not resolve with artificial tears alone. The source of the problem is on the eyelid, not in the tear volume.
Why Many Dry Eye Treatments Irritate or Stop Working
Common treatments often rely on suppression or controlled injury to manage inflammation.
Antibiotics on the other end of the spectrum can reduce bacterial load temporarily. They kill off surface bacteria but they don't disrupt biofilm structure. How this impacts patients later is bacteria can re-establish once treatment ends.
Tea tree oil and hypochlorous acid work by inducing controlled tissue stress. They kill pathogens through oxidative damage. This approach can be effective but often comes with side effects. Those side effects being reports of burning or stinging during application. Redness and irritation here are common with long-term tolerability also being an issue.
Rebound symptoms after stopping treatment are also frequent. The treatment may quiet inflammation temporarily, but it doesn't address why the inflammation keeps returning.
A Better Long Term Strategy: Restore the Eyelid Environment
For chronic conditions, the goal should not be repeated suppression but rather finding ways to restore and maintain balance to that respective tissue environment.
That means disrupting biofilm without damaging skin or supporting the eyelid's natural barrier function. Or reducing inflammatory signaling at the source. It means maintaining comfort so treatment is actually sustainable over time.
This is the same shift dermatology has made in managing chronic skin conditions if you take a close look at it. The field has moved away from constant chemical aggression with an emphasis on barrier-first care that works with the skin's biology rather than against it.
For eyelids, this approach relies moreso on a gentle, consistent hygiene rather than episodic aggressive treatments. That way, you are able to prevent biofilm from re-establishing rather than constantly trying to kill it off with harsh agents.
This requires a different product philosophy. The formulation needs to be effective at disrupting biofilm and debris. But it also needs to be gentle enough for daily use without causing irritation or compromising the skin barrier.
Why Daily Eyelid Hygiene Matters
Eyelid inflammation develops gradually over months and years. It also improves gradually when addressed correctly.
Consistent daily care can reduce biofilm buildup before it becomes established. It keeps gland openings clear so oil can flow normally. It improves the quality of meibum secretions over time. It stabilizes the tear film by addressing the root cause.
Most importantly, it reduces symptom flares over time rather than just masking them temporarily.
The key is consistency. You cannot scrub your eyelids once a week with a harsh agent and expect lasting results. Biofilm re-establishes quickly. Inflammation returns. The cycle continues.
Daily gentle hygiene breaks this cycle. It prevents biofilm from gaining a foothold. It maintains gland function. It keeps inflammation in check without requiring aggressive intervention.
Effective eyelid care should not burn, sting, or redden the skin. Discomfort reduces compliance. Without consistency, chronic inflammation returns. The treatment becomes useless.
Rethinking Dry Eye Care
If dry eye is driven primarily by eyelid inflammation then treatment must focus where the problem starts. Not just where symptoms appear.
Artificial tears may still play a role in managing acute symptoms. Prescription therapies may still be necessary in severe cases. But if patients fail to address their eyelid health at the root, many patients will find themselves stuck in cycles of short-term relief and long-term frustration.
The traditional model treats dry eye as a tear deficiency problem. Add more moisture. Add thicker moisture. Add prescription moisture that changes tear composition.
But if the fundamental issue is gland dysfunction driven by eyelid inflammation, then adding moisture is treating the symptom, not the disease. Kind of like how one would mop the floor while the sink overflows...over and over again.
Understanding dry eye as an inflammatory eyelid condition opens the door to more sustainable solutions by shifting focus from managing symptoms to addressing root causes. Additionally, this benefits even moreso by optimizing long-term tissue health over short-term suppression.
This doesn't mean artificial tears are useless. It means they work better when combined with proper eyelid hygiene. Regarding prescription therapies, these are more effective when the eyelid environment is healthy. It means the entire treatment approach becomes more coherent and effective.
The Path Forward
For patients stuck in the cycle of temporary relief and recurring symptoms, the answer may not be a stronger treatment but trying to find and utilize a smarter one.
Treatment that works with eyelid biology rather than against and as a result be sustained daily without side effects. Treatment that addresses biofilm and inflammation at their source.
This requires rethinking what effective dry eye care looks like via shifting focus from the tear film to the eyelid margin. Moreover, prioritizing long-term consistency over short-term intensity too.
Ultimately, the goal is to have symptom relief and restore normal eyelid function in tandem so those same symptoms stop recurring in the first place.
Want to learn more about eyelid hygiene and inflammation-first dry eye care? Explore our educational resources or speak with your eye care professional about a lid-focused treatment approach.
