# Dry eye - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Hypromellose Eye Drops BP SmPC sections 4.1-4.4 (eMC product 457) · TFOS DEWS II Management and Therapy Report 2017 · Viscotears Liquid Gel SmPC sections 4.1-4.4 (eMC product 2310) - Verified date: 2026-08 ## Verified against - Hypromellose Eye Drops BP SmPC sections 4.1-4.4 (eMC product 457) - Viscotears Liquid Gel SmPC sections 4.1-4.4 (eMC product 2310) - Dry Eye Syndrome - disease-level clinical article (dry-eye-syndrome-clinical.txt) ## Treatment metadata - Hypromellose — eye - Referral & safety-netting (no drug therapy) - Carbomer — eye ## Complete treatment card ```text DRY EYE Sources: Hypromellose Eye Drops BP SmPC sections 4.1-4.4 (eMC product 457) · TFOS DEWS II Management and Therapy Report 2017 · Viscotears Liquid Gel SmPC sections 4.1-4.4 (eMC product 2310) Review status: REVIEWED against Hypromellose Eye Drops BP SmPC sections 4.1-4.4 (eMC product 457), Viscotears Liquid Gel SmPC sections 4.1-4.4 (eMC product 2310), Dry Eye Syndrome - disease-level clinical article (dry-eye-syndrome- clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (12) - Stinging, burning, or a pressure sensation in the eyes can occur - A sandy, gritty, or foreign-body feeling is a common complaint [foreign body] - Excess tearing (epiphora) can paradoxically result from the irritation dryness causes [eye discharge] - Sharp or dull pain may be felt in, behind, or around the eye [dry eye] - Redness is common and can rebound worse once over-the-counter vasoconstrictor drops wear off [redness] - Intermittent blurry vision with glare or haloes around lights at night is a frequent complaint - Fluctuating vision and trouble reading may be reported - Eyelids can feel heavy, or opening them may be difficult - Eyelid twitching can be reported - Contact lenses become uncomfortable or unwearable because of the dryness - Eyes feel tired, sometimes relieved briefly by closing them [fatigue] - Severe disease can leave a patient unable to produce tears when crying SIGNS - what you find (3) - Conjunctival redness may be seen but is nonspecific since many other causes of conjunctivitis produce it too [eye redness] - Incomplete blinking or nighttime lagophthalmos on exam can contribute to the disease - Anterior or demodex blepharitis frequently coexists and is checked for on lid exam TESTS (10) - A tear breakup time under 10 seconds is generally considered consistent with the diagnosis - The Schirmer I test without anesthetic diagnoses aqueous deficiency at under 5 to 10 mm of wetting after 5 minutes - A phenol red thread test uses cutoff values from under 10 to 20 mm of wetting - Fluorescein staining of more than five spots is a positive result for corneal damage - Lissamine green staining of more than nine spots is a positive result for conjunctival and lid-margin damage - Tear osmolarity of 308 mOsm/L or higher suggests mild-to-moderate disease, and 316 mOsm/L or higher suggests severe disease - A point-of-care test can detect elevated matrix metalloproteinase-9 in the tears - Meibomian gland expressibility is assessed by pressing the lid margin - normal glands yield clear meibum, dysfunctional ones turbid or viscous meibum - Testing can include Ro/SS-A and La/SS-B antibodies, along with antinuclear antibodies and rheumatoid factor - Diagnosis takes three things together: how much tear there is and how good it is, the state of the surface, and what the patient actually reports IF NOT THIS - what else fits (10) - Conjunctivitis - allergic, viral, bacterial, or parasitic/chlamydial - is on the differential - Anterior blepharitis is on the differential - Demodex blepharitis is on the differential - Cicatricial conjunctivitis, as in Stevens-Johnson syndrome or mucous membrane pemphigoid, is on the differential - Bullous keratopathy is on the differential - Contact lens-related keratoconjunctivitis is on the differential - Eyelid malposition such as entropion or ectropion, or an abnormality such as trichiasis, can lead to ocular surface disease and is on the differential - Keratitis - interstitial, filamentary, contact-lens related, or neurotrophic - is on the differential - It splits in two: an aqueous-deficient form where the lacrimal side under-produces, and an evaporative form where the tears do not stay - Mixed causes are common, so finding one mechanism does not rule the other out Source StatPearls "Dry Eye Syndrome" - disease-level clinical article Status traced to the source above 1. HYPROMELLOSE [1st line] Adult One or two drops topically instilled into the eye three times daily as needed, or as directed by a physician. - long-term as needed Peds 1-2 drops topically instilled into the eye three times daily as needed, or as directed by a physician. Source Hypromellose Eye Drops BP SmPC sections 4.1-4.4 (eMC product 457) Why Direct match - hypromellose artificial tears are the standard first-line treatment for dry eye of any cause. Caution Once a bottle is opened it keeps four weeks, no longer, however much is left in it. May cause transient blurring of vision on instillation. Do not drive or operate hazardous machinery unless vision is clear. First-line lubricant for mild-to-moderate dry eye; safe for long-term as-needed use. Use preservative-free drops if instilling more than 4-6 times daily. Remove soft contact lenses before instillation; wait at least 15 minutes before reinserting. If accompanied by dry mouth and joint pain, consider an underlying autoimmune cause (e.g. Sjogren's syndrome) and investigate or refer. RED FLAG - Eye pain, redness or a change in vision beyond the usual gritty, burning discomfort: rule out corneal involvement or another diagnosis. Egypt HYDROBLEND 0.32% EYE DROPS 10*0.5 ML SDU GLOBAL ADVANCED PHARMACEUTICALS... 15.00 EGP GENTEAL EYE DROPS 10 ML NOVARTIS > NO... 18.00 EGP OPTILUBRIC 0.32% EYE DROPS 30*0.5 ML SDU EVA PHARMA 96.00 EGP HYDROBLEND 0.32% EYE DROPS 30*0.5 ML SDU GLOBAL ADVANCED PHARMACEUTICALS... 108.00 EGP 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Dry Eye Syndrome - disease-level clinical article (dry-eye-syndrome-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Severe/untreated disease can progress to corneal complications (infectious keratitis, ulceration, scarring) causing vision loss - escalate rather than continuing a lubricant alone. 3. CARBOMER [2nd line] Adult Instil 1 drop of 0.2% eye gel into affected eye(s) 3-4 times daily and at bedtime Peds Instil 1 drop 3-4 times daily in children Source Viscotears Liquid Gel SmPC sections 4.1-4.4 (eMC product 2310) Why Higher-viscosity lubricant gel that stays on the ocular surface longer than a standard artificial tear, chosen for more severe or nocturnal dry eye symptoms. Caution Carbomer is a high-viscosity gel providing longer ocular residence time for severe nocturnal symptoms. May cause temporary blurred vision immediately after application. Refer to ophthalmologist if corneal ulceration or severe pain occurs. Soft lenses take up the preservative and discolour: out before the drop, back in no sooner than 15 minutes after. Once a bottle is opened it keeps four weeks, no longer, however much is left in it. It blurs vision for a while after each drop. Wait until it clears before driving. In case of any additional local ocular treatment (eg glaucoma therapy) there should be an application interval of at least 5 minutes between the two medications, Viscotears Liquid Gel always should be the last medication instilled. Egypt VIDISEC EYE GEL 10 GM MINA PHARM > ... 13.20 EGP THILOTEARS 3 MG EYE GEL 10 GM ALCON > NOVAR... 19.20 EGP OCCUPLUS EYE GEL DROPS 20 X 0.6ML SDU COC Farmaceutici > RX HEALTHCARE 300.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)