Dry eye disease affects several million people in France and accounts for a large share of eye care visits. It shows up as stinging, burning, a foreign-body sensation or paradoxical watering. Far from being a mere nuisance, it is a chronic inflammation of the tear film and the ocular surface that requires appropriate care. At the practice, I offer a comprehensive diagnosis and a personalized, step-by-step treatment plan, ranging from simple measures to innovative treatments such as IPL or topical cyclosporine.
Dry eye is much more than a nuisance: it is an imbalance of the tear film. According to the TFOS DEWS III report (2025, the most recent international reference), it is a multifactorial, symptomatic disease characterized by a loss of homeostasis of the tear film and/or ocular surface, in which tear film instability, hyperosmolarity, inflammation and neurosensory abnormalities are the etiological factors.
Your tears are not just a drop of water. They form a film made up of three layers:
A dysfunction in any one of these layers is enough to cause dry eye. In most cases of dry eye (about 50 to 85% depending on the study), the lipid layer (meibomian glands) is affected — this is the main cause of evaporative dry eye (TFOS DEWS II/III reports).
Hyposecretion — not enough tears (Sjögren's, age, medications). Evaporation — meibomian gland dysfunction (MGD), the leading cause.
Diagnostic key: Tear hyperosmolarity (> 308 mOsm/L) triggers inflammation, which in turn worsens dryness. It is a vicious cycle.
I use several tools to pinpoint the cause and severity of your dry eye, and tailor the treatment accordingly.
I offer a tailored, stepwise treatment based on the TFOS DEWS III 2025 management algorithm (Jones, Craig et al., Am J Ophthalmol). We start simple, then step up the treatment according to your profile and clinical response.
Strategy: I start at the step matching your OSDI severity. If the response is insufficient after 4-6 weeks, I move up to the next step. Be patient with timelines: cyclosporine brings its first benefits after 1 to 2 months.
During my time as Assistant Spécialiste at the Hôpital National des Quinze-Vingts (Paris) under Prof. Christophe Baudouin, I devoted a large part of my research to the still widely overlooked link between dry eye, itching and eye rubbing. My publications shed light on a key mechanism behind the chronic course of ocular surface diseases.
Journal Français d'Ophtalmologie · 2023;46(2):173-184
A comprehensive review of ocular itching and its link with eye rubbing: initial dry eye symptoms, onset of scratching, release of inflammatory cytokines, corneal damage, and perpetuation of the itch. A novel parallel with dermatological models helps explain why treating dry eye also means protecting the cornea.
Journal of Clinical Medicine · 2023;12(4):1529
Our prospective study of 153 patients highlights, for the first time, the cognitive and addictive behavioral dimension of eye rubbing in keratoconus and ocular surface diseases. Article featured by Ophthalmology Times, which supports a stronger educational approach with my patients.
IPL (Intense Pulsed Light) is an established treatment option for meibomian gland dysfunction (MGD), with a level of evidence now supported by several case series and reviews (Toyos, Reinstein, Cote/Cochrane). To learn all about this technology, read my article “IPL for dry eyes: the complete guide”.
Intense light pulses are absorbed by inflamed blood vessels and glands:
Effectiveness: improvement in symptoms and tear parameters (TBUT, OSDI) is reported in most patients after 3-4 sessions (Toyos 2015, Reinstein 2018).
The OSDI-6 is the short version of the Ocular Surface Disease Index, recommended by the TFOS DEWS III (2025) report. Six quick questions help assess the severity of your dry eye and guide your care.
First benefits after 1 to 2 months, full effect at around 3 to 6 months of regular treatment. It is crucial to persevere. If there is no improvement at 3 months, we consider a change of strategy.
Yes, benzalkonium worsens inflammation over the long term. Recommendation: PRESERVATIVE-FREE (single-dose vials or preservative-free multi-dose bottles). A simple but very effective change.
No. Mild warmth or discomfort is possible and well tolerated. 3-4 sessions of 15 min, 1 to 4 weeks apart. No downtime — just avoid the sun for 24 hours.
Contact lenses often make dry eye worse. I recommend removing them temporarily (2-3 months) during treatment, then gradually reintroducing them if comfort improves.
A tiny silicone or polymer plug placed in the tear duct opening (punctum). It reduces tear drainage and increases tear contact time. Well tolerated and easily removed.
This is the dry eye paradox. Hyperosmolarity triggers a reflex response (reactive tears) that does not lubricate properly. These are not true lubricating tears. A key sign guiding treatment.
There is no scientific evidence. The only validated approaches are eyelid hygiene, artificial tears, cyclosporine, IPL and punctal plugs. Do not delay effective treatment.
It depends on the cause. Hyposecretion due to Sjögren's = long-term treatment. Meibomian gland dysfunction responds well to IPL, often lasting 1-2 years. Goal: clinical stability and comfort.
No. We taper it once the inflammation is under control. Some patients stop after 1-2 years. Others, especially those with Sjögren's, need to continue. It varies from person to person.
Omega-3 fatty acids (oily fish, flaxseed oil, DHA/EPA supplements) have long been recommended. The DREAM study (New England Journal of Medicine, 2018, n ≈ 500) showed no statistically significant benefit over placebo in moderate to severe dry eye. The TFOS DEWS III (2025) report nevertheless acknowledges a moderate benefit in certain subgroups, particularly in meibomian gland dysfunction (MGD) with low dietary omega-3 intake. In practice, I may recommend them at an appropriate dose (2-3 g/day of DHA + EPA) alongside good eyelid hygiene, especially if your diet is low in oily fish.
Several simple, effective measures:
Dry sports (running, cycling, gym): no restrictions. Stay well hydrated and remember to use your artificial tears before and after exercise, especially in dry or windy weather.
Pool swimming: chlorine irritates a fragile ocular surface. I always recommend watertight swim goggles, and preservative-free tears after each swim. In severe dry eye or during an acute inflammatory phase, it is better to avoid public pools until the surface has stabilized.
Sea swimming and diving: use a suitable mask; artificial tears after swimming are still recommended.
A comprehensive ocular surface assessment allows me to identify the mechanism behind your dry eye and offer a tailored, lasting, personalized treatment.
This page is based on international guidelines. All sources can be verified.
Wolffsohn JS, Benítez-Del-Castillo JM, Loya-Garcia D, et al. TFOS DEWS III: Diagnostic Methodology. Am J Ophthalmol. 2025;279:387-450.
Jones L, Craig JP, Markoulli M, et al. TFOS DEWS III: Management and Therapy. Am J Ophthalmol. 2025;279:289-386.
Stapleton F, Argüeso P, Asbell P, et al. TFOS DEWS III: Digest. Am J Ophthalmol. 2025;279:451-553.
Perez VL, Chen W, Craig JP, et al. TFOS DEWS III: Executive Summary. Am J Ophthalmol. 2025;282:135-145.
Schiffman RM, Christianson MD, Jacobsen G, et al. Reliability and validity of the Ocular Surface Disease Index (OSDI). Arch Ophthalmol. 2000;118(5):615-621.
Cote S, Ahuja M, Chen Z, et al. Intense pulsed light (IPL) therapy for meibomian gland dysfunction. Cochrane Database Syst Rev. 2020;3(3):CD013559.
Toyos R, McGill W, Briscoe D. Intense pulsed light treatment for dry eye due to meibomian gland dysfunction. Photomed Laser Surg. 2015;33(1):41-46.
Craig JP, Chen YH, Turnbull PR. Prospective trial of IPL for meibomian gland dysfunction. Invest Ophthalmol Vis Sci. 2015;56(3):1965-1970.
Hage A, Knoeri J, Leveziel L, et al. From ocular itching to eye rubbing: a review of the literature. J Fr Ophtalmol. 2023;46(2):173-184.
Hage A, Knoeri J, Leveziel L, et al. EYERUBBICS: The Eye Rubbing Cycle Study. J Clin Med. 2023;12(4):1529.
The content of this website is for information purposes only and does not replace a medical consultation.