Dry Eyes
Dry eyes: symptoms, causes, and the treatments that work
Dry eye is one of the most common conditions we see at Rose Optometry in Frankton, Hamilton, and one of the most under-treated. Most people with dry eyes have tried drops from the supermarket, found they help for ten minutes, and concluded that dry eyes are something you live with. They are not. Dry eye is a real, measurable disease of the tear film and the eye's surface, it has identifiable causes, and the causes can be treated. This page explains what it is, how to tell which kind you have, and what actually helps — written by the team that runs the region's dry eye clinic.
Book a Dry Eye Evaluation online: open our online booking — the Dry Eye Evaluation is preselected; just choose a time. It is a paid, focused assessment and the fee is confirmed when you book. Prefer to talk? Call 07 847 3195.
Dry eye symptoms
Dry eyes rarely feel simply "dry". More often people describe:
- Gritty, sandy or scratchy eyes, as though there is something in them.
- Burning or stinging, especially first thing in the morning or late at night.
- Tired, heavy eyes by the end of the day, worse at a screen or in air conditioning.
- Blurred vision that clears when you blink.
- Watery eyes — yes, really. See why watery eyes are usually dry eyes.
- Redness, light sensitivity, and stringy mucus in the corner of the eye.
- Contact lenses that are no longer comfortable by afternoon.
- Drops that help briefly and then stop helping.
The two kinds of dry eye — and why it matters which one you have
Your tear film has a watery layer, made by the lacrimal gland, and an oil layer on top of it, made by the meibomian glands in your eyelids, which stops the water evaporating. Dry eye happens when either fails.
Evaporative dry eye (the common one)
The oil layer is thin or missing because the meibomian glands are blocked or damaged — meibomian gland dysfunction (MGD). Tears evaporate between blinks, the surface dries, and the eye becomes inflamed. In a clinic-based study, 86% of people with dry eye had signs of MGD. Ordinary lubricating drops do not fix this, because the problem is oil, not water. This is the kind that blepharitis feeds, and the kind that responds to gland treatment.
Aqueous-deficient dry eye
The lacrimal gland does not make enough of the watery layer. This is the kind associated with Sjögren's syndrome and other autoimmune conditions, with some medicines, and with age. It is less common on its own, and many people have a mix of both.
The two look identical from the outside and feel much the same. Telling them apart takes measurement, and it decides the treatment — which is why we measure before we treat.
What causes dry eyes
- Screens. You blink about a third as often at a screen, and each blink is less complete, so the tear film breaks up and the glands are not squeezed.
- Age and hormones. Dry eye becomes more common from the forties on, and menopause is a common trigger.
- Eyelid disease. Blepharitis, Demodex mites and rosacea all block and inflame the meibomian glands.
- Medicines. Antihistamines, some antidepressants and blood-pressure tablets, isotretinoin for acne, and hormone treatments all reduce tears or thicken meibum.
- Contact lenses, particularly long-term soft lens wear.
- Environment. Air conditioning, heat pumps, wind, dust, low humidity, and long-haul flights.
- Eye surgery. Laser vision correction and cataract surgery can reduce corneal sensation and tear production for months.
- Autoimmune and general conditions. Sjögren's syndrome, rheumatoid arthritis, thyroid eye disease, diabetes.
- Eye makeup worn along the waterline, and incomplete removal, block gland openings.
- CPAP masks that leak air across the eyes overnight.
How dry eye is diagnosed
Guessing from symptoms is how people end up on the fifth bottle of drops. At a Dry Eye Evaluation at Rose Optometry we measure the tear film with TearCheck (how quickly it breaks up, how much tear there is, how well you blink), photograph the meibomian glands with meibography to see how many are blocked or lost, measure tear osmolarity with ScoutPro — the saltiness of the tears, a core marker of dry eye disease — stain the surface with dyes to show damage, and examine the lid margins for blepharitis and Demodex. Fifteen minutes, nothing uncomfortable, and at the end you know which kind of dry eye you have and how severe it is. Every measurement is repeated at review so you can see whether treatment is working.
Dry eye treatment
Eye drops — the right kind
Drops help, when they are the right drops. For evaporative dry eye you need a lipid-containing or oil-based drop that supports the oil layer, not a thin watery one. For aqueous deficiency, a hyaluronate-based drop that holds water on the surface. Preservative-free is better for anyone using drops more than four times a day or wearing contact lenses. Decongestant "red eye" drops make dry eye worse. We stock the drops we prescribe in our online store and will tell you which one, not just "use drops".
Eyelid care
A warm compress that is warm enough and long enough (ten minutes — a heated eye mask beats a flannel), daily lid cleansing from our lid hygiene range, and treating blepharitis or Demodex if they are present. Devices open the glands; this keeps them open.
Treating the glands
Where meibography shows blocked glands, we treat them directly, in clinic: IPL (intense pulsed light) to reduce the lid inflammation that blocks them; LipiFlow to warm and clear them in a single twelve-minute treatment; Blephasteam as a gentle first-line or maintenance therapy; low level light therapy; and BlephEx lid cleaning where blepharitis is part of it. All are available at 38 Lake Road, so you are not sent to Auckland.
Prescription treatment
Our optometrists are therapeutically qualified and can prescribe short courses of anti-inflammatory drops to calm an inflamed surface, and other prescription treatments where the assessment calls for them.
Severe and stubborn dry eye
For an eye surface that has broken down and will not heal, we offer amniotic membrane treatment in clinic. For severe dryness that ordinary measures cannot control, a scleral contact lens that holds a reservoir of fluid over the cornea can transform comfort. And where the cause sits outside the eye — an autoimmune condition, a medicine that could be changed — we work with your GP or specialist.
What to expect
Dry eye is a chronic condition, managed rather than cured, but managed well most people reach the point where their eyes stop being something they think about. A typical plan is an assessment, a home routine and the right drop, a device treatment if the glands need it, and a review at three months with the same measurements so you can see the difference in numbers as well as in comfort. We see dry eye patients from Hamilton, Cambridge, Te Awamutu, Morrinsville, Huntly, Raglan and across the Waikato, and accept referrals from GPs and other optometrists. Rose Optometry is a founding member of the Dry Eye Specialist Group, a network of independent, optometrist-owned dry eye clinics across New Zealand.
Frequently asked questions
Can dry eyes be cured permanently?
No — and be wary of anyone who says otherwise. Dry eye is chronic. But the cause can be treated so that symptoms largely disappear and the glands you have are protected, and that is a very different outcome from a lifetime of drops.
What are the best eye drops for dry eyes in NZ?
It depends on which kind of dry eye you have. Lipid-based drops for evaporative dry eye; hyaluronate drops for aqueous deficiency; preservative-free for frequent use. A drop that suits one person is useless for another, which is why we measure first. Our article on choosing the right eye drops goes through the options.
Is dry eye syndrome serious?
Usually not sight-threatening, but it is not trivial either. Untreated, the surface of the eye becomes chronically inflamed, meibomian glands are lost permanently, and severe cases can damage the cornea. It also makes contact lens wear and eye surgery outcomes worse. Early treatment is easier and cheaper than late treatment.
Why are my eyes so dry in the morning?
Usually because the lids do not close fully overnight, or because blepharitis and blocked glands leave the surface unprotected while you sleep. A thicker night-time gel or ointment and a lid routine help; the assessment tells us which.
Can I wear contact lenses with dry eyes?
Often yes, once the dry eye is under control. Daily disposable lenses in modern materials are kinder to a dry eye, and for severe cases a scleral lens can actually protect the surface. Treat the dry eye first; the lens then has a chance.
Do screens cause dry eyes?
They make it worse rather than cause it outright. You blink less and less completely at a screen, so the tear film breaks up and the glands are not expressed. Blink deliberately, take breaks, and treat the glands.
Do I need a referral?
No. Book a Dry Eye Evaluation online — the appointment is preselected; just choose a time.
Rose Optometry, 38 Lake Road, Frankton, Hamilton. 07 847 3195
References
- Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017;15(3):276-283. PMID 28736335.
- Stapleton F, Alves M, Bunya VY, et al. TFOS DEWS II Epidemiology Report. Ocul Surf. 2017;15(3):334-365. PMID 28736337.
- Wolffsohn JS, Arita R, Chalmers R, et al. TFOS DEWS II Diagnostic Methodology Report. Ocul Surf. 2017;15(3):539-574. PMID 28736342.
- Lemp MA, Crews LA, Bron AJ, Foulks GN, Sullivan BD. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea. 2012;31(5):472-478. PMID 22378109.
- Jones L, Craig JP, Markoulli M, et al. TFOS DEWS III: Management and Therapy. Am J Ophthalmol. 2025;279:289-386. PMID 40467022.
Rose Optometry's dry eye clinic is led by Jacqueline Rowe — BSc Chemistry, BOptom. Partner Optometrist, Rose Optometry; New Zealand Eye Research Centre. Last reviewed August 2026.
Frequently asked questions
In NZ an optometrist can calculate the prescription for glasses, fit contact lenses, diagnose and treat eye conditions and infections with medication. They can also manage ocular injuries including removing foreign objects. If surgery or specialist treatment is required they can refer to an ophthalmologist (eye surgeon), hospital, or other health care specialist. NZ-trained optometrists must complete a 5-year degree at the University of Auckland before becoming registered.
A dispensing optician has formal training in optical dispensing. They are qualified to help a client choose frames, read a prescription, discuss lens options, take measurements, order and fit glasses.
An ophthalmologist is a medical doctor who has specialised in the treatment of serious eye disease and ocular surgery such as cataract removal. They do not typically prescribe glasses or contact lenses.
While payment is generally required on the day of appointment, we do offer a number of payment options including Afterpay, Genoapay, QCard, and GoCardless.
No. We are closed on public holidays and long weekends as we believe our staff should have the chance to enjoy this time with friends and family.
If your eyes are straightforward, almost any good optometrist can look after you well, and we would rather say that than pretend otherwise. Come to us when something is not straightforward: a prescription that will not settle, a cornea that has changed shape, a child whose short-sightedness is moving faster than it should, an eye surface that has stopped being comfortable, or a diagnosis you have been given but do not understand. Those problems are decided by measurement, and measuring them properly needs instruments most practices do not have.
Yes, and you do not need to justify it. A second opinion is not a criticism of whoever saw you first — very often they were right, and what you actually needed was the finding explained and the numbers put in front of you. What we can add is measurement. We can image the layers of your cornea and retina, map the epithelium, quantify how far your cornea sits from normal, measure the length of your eye and check your tear film objectively. That turns “something is not right” into a number, and a number either explains the problem or rules it out. Bring any previous scans, prescriptions and letters. Comparison against your own past results is often the most valuable thing in the room.
Usually. Complex is what this practice was built around — keratoconus, corneal grafts, irregular corneas after surgery or injury, severe dry eye, high prescriptions, and eyes that have been told they are not fittable with contact lenses. The Rose K lens for keratoconus was designed in this practice, and lenses of that family are now the most frequently prescribed in the world for the irregular cornea. If we cannot help, we will tell you at the first appointment and tell you who can, rather than taking you through a course of treatment that was never going to work.
Waiting is the one thing that cannot be undone. Short-sightedness is axial — the eye is physically growing too long — and that length does not come back. What treatment does is slow the rate of growth, so the earlier it starts the more length is saved. We measure axial length directly on two independent biometers and plot it against normal growth curves, which means we can see a child drifting off their expected curve before the prescription changes. There is a free 15-minute myopia chat if you want to understand the options before committing to anything. It is worth being precise about what we are all trying to achieve. Myopia control does not stop a child's eyes changing and no practice should tell a parent it will. What it does, reliably and across many published trials, is slow the rate at which the eye lengthens — and because the risk of retinal detachment, myopic maculopathy and glaucoma in later life rises with every extra millimetre, slowing that growth is how a child is kept out of the range where sight is genuinely at risk. After seventeen years of focusing on this, we are now seeing children on customised plans whose axial length is not progressing at all over a monitoring period, and in some cases measurements that come back slightly shorter than the ones before them. That is our own clinical observation in our own patients rather than a trial result, and it has to be read carefully, because the choroid thickens when treatment is working and part of an apparent reduction can be that thickening rather than the eye itself shortening. That is precisely why we measure both. We are not yet able to tell a parent that we can stop myopia in its tracks, and we will not say it until we can.
Two things: we measure it before treating it, and we hold every current treatment technology in one building. Most dry eye is treated on the basis of symptoms, which is why drops so often fail. A tear film can be failing because the oil layer is blocked, because the water layer is short, because the surface is inflamed, or because the lids are the problem, and those need different treatments. We assess the tear film objectively with TearCheck — tear film stability, the oil layer, lid and gland imaging, and an inflammation measure — and measure tear osmolarity, the saltiness of the tears, which is the closest thing to a laboratory number for dry eye. Then we treat the cause. Rose holds intense regulated pulsed light for inflammation and gland function, LipiFlow thermal pulsation to clear blocked meibomian glands from the inner lid surface, Blephasteam controlled-humidity warming, Tixel thermomechanical treatment for the lids, and Rexon-Eye quantum molecular resonance for the more severe and treatment-resistant cases. At the time of writing, and to the best of our knowledge, no other optometrist or ophthalmologist in New Zealand has all of these available under one roof. We say that as a statement of fact rather than a boast, and we would be glad for it to stop being true. Dry eye is one of the most common and most under-treated conditions we see, and there are far more people living with it than one practice can look after. Any practice wanting to build this kind of service has our encouragement and our help — please contact us for co-management, and send us the cases you are not yet set up for. Why holding all of them matters is simple. A practice with one dry eye machine will offer you that machine. Holding all of them means the assessment decides the treatment, rather than the equipment deciding it — and when the first approach does not work, the next one is in the next room rather than in another city.
Yes — from around six weeks of age. Babies and toddlers are tested with Cardiff acuity cards and retinoscopy, neither of which needs the child to read a letter, name a picture or say a word. Most of the findings that matter in a young child cause no symptoms and are invisible to a parent, which is exactly why they need looking for.
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