Dry eye is rarely just “not enough tears.” For many people, it is a mix of inflammation, poor oil gland function, fast tear evaporation, lid changes, incomplete blinking, or tears that drain away too quickly. That is why artificial tears may help for a few minutes, then the burning, grittiness, redness, or fluctuating vision comes right back.
Key takeaways
- Dry eye often comes from several overlapping problems, including inflammation, clogged oil glands, incomplete blinking and tears that drain too quickly, so care starts with testing.
- Testing can measure tear volume and how fast tears break up, image the oil glands and check blinking, and the findings are read together.
- Many plans combine treatments, such as Vevye prescription drops for inflammation, intense pulsed light (IPL) for blocked oil glands and scleral lenses for stubborn cases.
- For severe eye pain, or pain with light sensitivity or blurred vision, call us for a same-day urgent visit, or go to an emergency room when we're closed.
At Cohenmehr Optometry in West Los Angeles, near Santa Monica, dry eye care starts with identifying which parts of the tear system are breaking down. From there, treatment can be built layer by layer, using options such as Vevye, IPL, OptiLIFT, punctal plugs, and scleral lenses when needed.
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Dry eye has different causes that often overlap
A stable tear film has three main jobs. It keeps the eye comfortable, protects the ocular surface, and creates a smooth optical surface for clear vision. When one part fails, the others often struggle too.
Common dry eye drivers include:
- Ocular surface inflammation
- Inflammation can make the tear glands and surface of the eye less stable and more reactive.
- Aqueous deficiency
- The eyes may not produce enough of the watery layer of tears.
- Meibomian gland dysfunction
- The oil glands in the eyelids may become clogged or produce poor-quality oil, allowing tears to evaporate too quickly.
- Lid and blink problems
- Incomplete blinking, lid laxity, or poor lid mechanics can prevent tears from spreading evenly.
- Excess tear drainage
- Tears may drain away before they can do their job.
This is why a complete plan for dry eye treatment in Los Angeles, eye pain, burning eyes, foreign body sensation, and fluctuating vision should begin with testing, not trial and error.
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Advanced testing helps pinpoint the right treatment targets
At Cohenmehr Optometry, dry eye evaluation may include advanced diagnostics and imaging to assess the tear film, eyelids, oil glands, ocular surface, and blink quality. The goal is to see what is actually happening, then match treatment to the underlying cause.
Testing looks at:
| What is being evaluated | Why it matters |
|---|---|
| Tear volume | Helps identify aqueous deficient dry eye |
| Tear stability | Shows how quickly tears break up between blinks |
| Meibomian gland structure | Helps detect gland dropout, blockage, or poor function |
| Lid position and blink pattern | Reveals incomplete blinking or lid laxity that can worsen symptoms |
| Ocular surface health | Helps detect inflammation, staining, or irritation |
| Rosacea-related signs | Can point to inflammation affecting the lids and glands |
No single test tells the whole story. The value comes from putting the findings together.
03
Vevye can target inflammation and aqueous deficient dry eye
Vevye, cyclosporine ophthalmic solution 0.1%, is a prescription medication used to help address dry eye disease related to inflammation. It is often considered when ocular surface inflammation is affecting tear production, comfort, or surface quality.
Inflammation can create a cycle. The eye becomes irritated, tear quality worsens, and the surface becomes even more sensitive. A medication such as Vevye may help calm that inflammatory cycle over time.
Vevye may be part of a plan when testing suggests:
- Ocular surface inflammation
- Aqueous deficient dry eye
- Chronic irritation despite lubricating drops
- Surface damage related to dry eye disease
Prescription anti-inflammatory dry eye treatment is not an instant numbing drop. It works differently from artificial tears and usually requires consistency. The right schedule and expectations should come from an eye doctor after an exam.
04
IPL can help evaporative dry eye and rosacea-related inflammation
Intense pulsed light, often called IPL, is commonly used in dry eye care for patients with meibomian gland dysfunction and evaporative dry eye. It may also help when facial or eyelid rosacea contributes to inflammation around the glands.
The meibomian glands produce the oil layer of the tears. When that oil becomes thick or glands become blocked, tears evaporate faster. The eyes may water, burn, sting, or feel gritty, even though they are technically “wet.”
IPL is aimed at improving the environment around the glands and reducing inflammatory triggers. It is often paired with gland expression or other lid therapies, depending on the exam findings.
IPL may be considered when there is:
- Thickened or poor-quality meibum
- Evaporative dry eye
- Eyelid margin redness
- Rosacea-associated inflammation
- Recurrent symptoms despite warm compresses or drops
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OptiLIFT can support glands, blinking, and lid tissue mechanics
OptiLIFT, using DMST/RF technology, is another option for patients whose dry eye involves gland function, lid mechanics, tissue tone, or incomplete blinking patterns. Depending on the mechanism being treated, it may help support meibomian gland function and improve how the lids interact with the tear film.
Dry eye can worsen when the lids do not spread tears properly. Even if the tear glands produce enough fluid, poor blinking can leave exposed areas on the eye. Lid laxity or weakened tissue support can also affect tear distribution and drainage.
OptiLIFT may be considered as part of a plan when evaluation shows:
- Meibomian gland dysfunction
- Poor blink quality
- Lid laxity contributing to symptoms
- Tissue changes affecting tear spread
- Evaporative dry eye linked to lid mechanics
For many patients, this type of treatment works best as one part of a broader dry eye plan rather than a stand-alone fix.
06
Punctal plugs help keep tears on the eye longer
Punctal plugs are tiny devices placed in the tear drainage openings, called puncta. Their purpose is simple: help tears stay on the eye longer.
They are often most useful for patients with aqueous deficient dry eye, especially when the eye is not making enough of the watery tear layer. By slowing drainage, plugs can help preserve natural tears and lubricating drops.
That said, plugs are not the right first step for every dry eye patient. If significant inflammation is present, trapping inflammatory tears may not feel good. This is why diagnostic testing matters. In some cases, inflammation is treated first, then punctal plugs are added later.
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Scleral lenses can protect the eye in stubborn cases
Some dry eye cases remain difficult even with medications, lid treatments, and tear retention strategies. For these recalcitrant cases, scleral lenses can be a strong option.
Scleral lenses are large custom contact lenses that vault over the cornea and rest on the white part of the eye. A fluid reservoir sits between the lens and the cornea, which keeps the eye consistently lubricated throughout the day.
They may be considered for:
- Severe dry eye symptoms
- Ocular surface disease
- Exposure-related dryness
- Irregular corneas with dryness
- Patients who need constant surface protection
Scleral lenses do not treat every underlying cause of dry eye, but they can provide a protective environment when the surface needs help staying hydrated and stable.
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Combination therapy is often the most effective path
Many dry eye plans combine treatments because the condition often has more than one cause. A patient may need Vevye to address inflammation, IPL to support blocked oil glands, OptiLIFT to improve lid mechanics, and punctal plugs to retain tears. Another patient may need only one or two of those options.
The right plan depends on the pattern seen during testing.
At Cohenmehr Optometry in West Los Angeles, near Santa Monica, the benefit of having advanced diagnostics, imaging, and multiple treatments available in one setting is that care can be tailored. The focus is not on forcing every patient into the same treatment. The focus is on finding the dry eye components that matter most and treating them in the right order.
Dry eye care works best when it is specific. If symptoms keep coming back, the next step is a closer look at the tear film, glands, lids, and ocular surface so treatment can target the real cause.
09
Questions patients ask about dry eye testing and treatment
How is dry eye diagnosed?
With an eye exam and several tests read together, since no single test tells the whole story. Your eye doctor may measure how many tears your eyes make and how long they take to dry up, and examine the structure of your eyelids. We also check how completely you blink, look for inflammation or staining on the eye's surface, watch for rosacea signs on the lids, and image the oil glands for blockage or dropout with our advanced diagnostics.
How do you treat dry eye?
We treat whichever parts of the tear system are failing, and many plans combine therapies because dry eye often has more than one cause. StatPearls describes a stepwise approach: lid hygiene with warm compresses first, next options such as IPL and punctal plugs, then therapeutic contact lenses. Depending on your testing, our dry eye treatment can also include Vevye (a prescription cyclosporine drop) for inflammation, IPL with gland expression for blocked oil glands, OptiLIFT for blink and lid mechanics, and scleral lenses for stubborn cases.
What are the types of dry eye?
Doctors traditionally group dry eye into two types, and many people have a mix. In aqueous-deficient dry eye, the eyes don't make enough of the watery layer of tears. In evaporative dry eye, the oil glands in the eyelids clog or make poor-quality oil, so tears evaporate too quickly. Inflammation, incomplete blinking or loose lids, and tears that drain away too fast can add to either one. Testing shows which type of dry eye is driving your symptoms.
Can dry eyes cause eye pain?
Yes. Along with burning and grittiness, dry eye can cause real pain. StatPearls describes it as sharp or dull, felt in the eye, behind it, or around the eye socket, and notes that the same irritation can bring on bouts of watering. Our plans for eye pain and burning start with testing, so treatment matches the cause. If the pain is severe, or comes with light sensitivity or blurred vision, call us for a same-day urgent visit, or go to an emergency room when we're closed.
Written by
Dr. Brandon Cohenmehr, OD
Specialty contact lenses, with a focus on Ortho-K, scleral lenses, and co-managing patients with keratoconus and other corneal disease. A graduate of SUNY College of Optometry.
About Dr. Brandon →
