Dry eye (keratoconjunctivitis sicca, KCS)

Dry eye (keratoconjunctivitis sicca) occurs due to loss of tear film homeostasis as a result of increased tear film instability and hyperosmolarity, leading to inflammation of the ocular surface. Prevalence increases with age, and is higher in post-menopausal women and people of East Asian ethnicity. Cases can be related to systemic inflammatory conditions, drug side effects, eyelid abnormalities or disorders of the meibomian glands. This Clinical Management Guideline outlines the aetiology, signs and symptoms and evidence-based recommendations for diagnosing and treating dry eye. It provides recommendations for non-pharmacological management and pharmacological treatment, and for when routine or urgent referral may be appropriate.

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What is dry eye disease?

Dry Eye Disease is a common condition where the eyes do not make enough tears, or the tears do not work properly. It affects many people in the later decades of life. Most cases have no apparent cause, but some are related to various inflammatory conditions, surgical treatment or as a side-effect of drug treatment. Some cases are caused by abnormalities of the eyelids or blinking, or by disorders of the Meibomian (oil) glands of the eyelid margin.

Patients complain of irritation of the eyes, a feeling that there is something in the eye, a discharge from the eye, and sometimes blurred vision. They notice that their symptoms are worse in windy or dry conditions or when irritants such as smoke are in the air. When they are examined in the clinic, they may be found to have reduced tear production or increased tear evaporation (sometimes due to lack of normal oil gland secretion). There may be damage to the surface of the eye produced by the increased saltiness of the tears.

How is dry eye disease managed?

Tears can be supplemented with various drops and ointments. Symptoms may also be improved by simple lifestyle measures such as taking regular breaks from screens, blinking more often, staying well hydrated, and avoiding dry or smoky environments. It is also possible to conserve natural tears by blocking the openings of the tear ducts, either temporarily with tiny plugs or permanently by surgery.  Where the problem relates to a disorder of the oil glands, treatment is directed to the eyelids.

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Last updated

Dry eye (Keratoconjunctivitis Sicca) (KCS) - 5 August 2026
The aetiology section has been comprehensively revised to reflect the updated definition, classification and epidemiology of dry eye disease (DED) in accordance with the recommendations of the recently updated Dry Eye Workshop III (DEWS III). The predisposing factors section has been expanded to include additional factors that contribute to the various pathophysiological processes underlying DED. The symptoms section has been updated to incorporate DEWS III recommended screening tools for assessing the key symptoms experienced in DED. The signs section has also been revised to set out the new DEWS III framework for investigating DED, including recommended diagnostic thresholds. The management section has been amended to provide additional clarity on the evidence supporting a range of interventions available for treating DED and associated eyelid abnormalities.

Version 17
Date of search 15.04.26
Date of revision 30.04.26
Date of publication 05.08.26
Date for review 14.04.28
© The College of Optometrists