Why aren't my dry eye drops working?

Usually because they are the wrong type for your dry eye. Most dry eye is evaporative, caused by a poor oily tear layer from meibomian gland dysfunction. Plain watery artificial tears give only brief relief because they do not replace the missing oil. Lipid-based drops, warm compresses and lid hygiene target the actual cause.

What are the best eye drops for dry eyes?

There is no single “best” eye drop for dry eye, as treatment depends on the underlying cause. According to the TFOS DEWS III framework, dry eye is a multifactorial disease involving tear film instability, inflammation, and ocular surface damage. For many patients, preservative-free lubricating eye drops are recommended as first-line therapy, particularly for frequent or long-term use. An optometrist can help select drops based on tear quality, evaporation rate, and ocular surface findings.

How often should I use eye drops for dry eyes?

The frequency of eye drop use depends on symptom severity and the type of drop used. Preservative-free drops may be used multiple times per day, whereas preserved drops should be used less frequently to avoid ocular surface irritation. If drops are needed more than 4–6 times daily, clinical guidance generally recommends preservative-free formulations and a dry eye assessment.

Can you use eye drops too often?

Yes. Overuse of preserved eye drops can worsen dry eye symptoms by disrupting the tear film and irritating the ocular surface. DEWS III emphasises minimising preservative exposure and addressing underlying causes—such as meibomian gland dysfunction or inflammation—rather than relying solely on frequent lubrication.

What is the difference between Polytears, Systane, and Hylo eye drops?

Polytears, Systane, and Hylo are lubricating eye drops, but they differ in formulation, viscosity, and preservative status. Some are better suited for mild, intermittent dryness, while others are designed for more persistent symptoms or contact lens wear. Brand name alone does not determine suitability; clinical evaluation does.

Are preservative-free eye drops better for dry eyes?

For many patients, yes. Preservative-free eye drops are commonly recommended for moderate to severe dry eye, frequent use, contact lens wear, and sensitive eyes. DEWS III highlights that long-term preservative exposure can contribute to ocular surface irritation in some people.

Can contact lens wear make dry eye worse?

Contact lenses can exacerbate dry eye symptoms by disrupting tear film stability and increasing evaporation. However, with appropriate lens materials, care systems, and compatible eye drops, many contact lens wearers can remain comfortable. Drops labelled as safe for use with contact lenses are typically preferred during lens wear.

How do I know which eye drops are right for me?

Dry eye is not a single condition. Effective management requires identifying whether symptoms are driven by evaporation, aqueous deficiency, inflammation, or eyelid disease. A dry eye assessment—including tear stability, ocular surface staining, and meibomian gland evaluation—helps guide targeted treatment rather than trial-and-error.

Are thicker eye drops better than watery ones?

Not always. Thicker drops may provide longer relief but can blur vision and may not be ideal for daytime use. Thinner drops may be better tolerated but may require more frequent application. DEWS III supports matching drop viscosity to symptom pattern and lifestyle needs.

Can dry eye be treated without eye drops?

Yes. While lubricating drops are commonly used, DEWS III emphasises a stepwise approach that may include eyelid hygiene, heat therapy, management of meibomian gland dysfunction, environmental modification, and lifestyle changes such as reducing prolonged screen use. Eye drops often remain part of treatment when symptoms affect comfort or visual quality.

When should I see an optometrist for dry eyes?

Seek professional assessment if symptoms are persistent, worsening, or affecting activities such as reading, screen use, or driving. Ongoing reliance on eye drops without improvement suggests an underlying issue that may require targeted treatment.

Evaporative Dry Eye & MGD: Why Your Drops Aren't Working

Q: What is meibomian gland dysfunction (MGD)?

The meibomian glands along the eyelid margins secrete the oil that stabilises tears. In MGD these glands get blocked or the oil thickens, so the tear film breaks up too quickly. The result is eyes that water more from reflex tearing while still feeling dry.

Q: What actually helps evaporative dry eye?

Warm compresses and lid hygiene to clear the glands, lipid-based drops such as NovaTears or Systane Balance to support the oily layer, manuka honey products as an adjunct, omega-3 nutrition for some people, and in-practice treatments for stubborn cases. Matching the treatment to the mechanism is what makes the difference.

Author: Jagrut Lallu, BOptom (Hons), MSc Specialty Lenses (Hons), FIAOMC. Therapeutic Optometrist & Contact Lens Specialist. Founder, New Zealand Eye Research Centre; Partner, Rose Optometry.

Published by the New Zealand Eye Research Centre. General information only — not a substitute for a personalised assessment.

If you have tried artificial tears and your eyes are still gritty, burning or watery, you are not alone — and the reason is usually simple: most dry eye is evaporative, and watery drops alone do not fix an evaporative problem. Here is what is actually going on, and what works.

Two different problems, two different fixes

Your tear film has a watery layer and an oily (lipid) layer on top. The oily layer stops the watery layer evaporating. Dry eye comes in two broad types:

Aqueous-deficient — not enough watery tears. Less common.
Evaporative — enough watery tears, but they evaporate too fast because the oily layer is poor. This is the majority of cases, and it is usually driven by meibomian gland dysfunction (MGD).

What is MGD?

The meibomian glands along your eyelid margins secrete the oil that stabilises your tears. In MGD these glands get blocked or the oil thickens, so the tear film breaks up too quickly. The frustrating result: your eyes water more (reflex tearing) while still feeling dry. Watery drops give only brief relief because they do not address the missing oil.

What actually helps evaporative dry eye

Warm compresses & lid hygiene — heat softens the blocked oil; lid cleaning clears the gland openings. This is the foundation.
Lipid-based drops — products designed to support the oily layer (rather than plain watery tears) give longer relief. NovaTears and Systane Balance are both formulated for evaporative dry eye and MGD.
Manuka honey products — have evidence as an adjunct for MGD-related dry eye and blepharitis.
Omega-3 nutrition — may support gland function in some people.
In-practice treatments — for stubborn MGD, professional options can restore gland function.

The key point

If your drops are not working, it is usually because they are the wrong type for your dry eye — not because dry eye is untreatable. Matching the treatment to the mechanism is what makes the difference, and that starts with an assessment of your tear film and glands.

Talk to us

At Rose Optometry we assess meibomian gland function directly and build a targeted plan. Backed by the New Zealand Eye Research Centre, our focus is on treating the cause, not just masking the symptom. Book a dry eye assessment if this sounds like you.

References

Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017;15(3):276–283.
Nelson JD, Craig JP, Akpek EK, et al. TFOS DEWS II Introduction. Ocul Surf. 2017;15(3):269–275.
Albietz JM, Schmid KL. Randomised controlled trial of topical antibacterial Manuka honey for evaporative dry eye due to meibomian gland dysfunction. Clin Exp Optom. 2017;100(6):603–615. PMID: 28585260.

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