Dry eye is the most under-diagnosed condition I see in my clinic. Patients come to me for LASIK or cataract surgery consultations; I examine their tear film, and I find dry eye disease that has been quietly causing discomfort for months or years — often attributed to “eye strain,” “too much screen time,” or “Dhaka’s air quality.”
Dry eye syndrome in Bangladesh is extremely common — and it is getting more prevalent. Air conditioning in offices and homes, smartphones and screens, contact lens overuse, increasing pollution, and a rising rate of diabetes all contribute to a city that is quietly hard on tear films. Understanding what dry eye actually is — and what genuinely helps — is what this article is for.
What is Dry Eye Syndrome?
Dry eye syndrome (DES) — clinically called Dry Eye Disease (DED) — is a chronic condition of the ocular surface in which the eye either does not produce enough tears, or produces tears of insufficient quality to maintain a stable, protective tear film over the cornea.
Dry eye syndrome affects approximately 10% of people between the ages of 30 and 60, and 15% of adults over age 65. In urban Bangladesh — with its combination of air conditioning, high screen exposure, contact lens use, and pollution — the prevalence is likely significantly higher.
The tear film has three critical layers:
- Lipid layer (outermost) — produced by the Meibomian glands in the eyelids; prevents tear evaporation
- Aqueous layer (middle) — produced by the lacrimal gland; provides hydration and nutrients
- Mucin layer (innermost) — produced by goblet cells; helps tears adhere to the corneal surface
A breakdown in any of these three layers — most commonly the lipid layer — results in an unstable tear film, increased evaporation, and the symptoms of dry eye disease.
The Two Types of Dry Eye — Why This Matters for Treatment
Understanding which type of dry eye you have determines which treatment will actually work. Many patients spend years using the wrong drops for the wrong type.
Type 1 — Aqueous Deficient Dry Eye (ADDE)
The lacrimal gland does not produce enough watery tears. Accounts for approximately 10–20% of dry eye cases. Associated with autoimmune conditions (Sjögren’s syndrome, rheumatoid arthritis, lupus), certain medications (antihistamines, antidepressants, beta-blockers), and post-LASIK nerve damage.
Type 2 — Evaporative Dry Eye (EDE)
The most common type — accounting for 80% of dry eye disease. Caused by Meibomian Gland Dysfunction (MGD), where the eyelid glands fail to secrete sufficient lipid, causing the tear film’s protective layer to thin and tears to evaporate too quickly.
In Dhaka specifically, evaporative dry eye is dominant — driven by air conditioning, screen exposure, contact lens overuse, and environmental pollution.
“When a patient tells me their eyes are dry and burning in an air-conditioned office, their first instinct is to buy lubricating drops from a pharmacy. That helps temporarily — but it does not address why the tears are evaporating. In most cases, the answer is Meibomian Gland Dysfunction, and that requires a specific treatment approach — not just more drops.”
— Dr. Ashraful Huq
What Causes Dry Eye in Dhaka?
Environmental Factors
- Air conditioning — the single biggest dry eye trigger in Dhaka’s office and home environments; dramatically reduces ambient humidity and increases tear evaporation
- Pollution and particulate matter — Dhaka’s dust, vehicle emissions, and industrial particulates irritate the ocular surface and destabilise the tear film
- Seasonal changes — winter months reduce humidity further; summer heat increases evaporation
Lifestyle Factors
- Screen use — reduces blink rate by up to 60%, leading to inadequate tear film renewal and increased evaporation
- Contact lens wear — lenses disrupt tear film stability; long wearing hours and poor hygiene accelerate Meibomian gland changes
- Incomplete blinking — during focused screen work, many people partially blink, preventing full spreading of the lipid layer across the cornea
Medical Factors
- Diabetes — damages nerves supplying the lacrimal gland and corneal surface, reducing both tear production and corneal sensitivity
- Thyroid eye disease — causes incomplete eyelid closure and corneal exposure
- Autoimmune conditions — Sjögren’s syndrome, rheumatoid arthritis, and lupus directly affect lacrimal gland function
- Vitamin A deficiency — affects goblet cell density and mucin production
- Post-LASIK nerve disruption — corneal nerve damage after LASIK reduces the reflex arc driving lacrimal secretion. This is why I recommend SMILE surgery for patients with pre-existing dry eye — SMILE preserves significantly more corneal nerve fibres. For patients with severe dry eye, ICL surgery — which does not touch the cornea at all — carries essentially zero dry eye risk
Medications That Worsen Dry Eye
- Antihistamines (common in Bangladesh for allergy)
- Antidepressants and antipsychotics
- Beta-blockers and diuretics
- Oral contraceptives
- Isotretinoin (acne treatment)
Symptoms of Dry Eye Syndrome
Dry eye symptoms are frequently misattributed to “tired eyes” or “phone addiction.” The specific symptoms are:
- Burning, stinging, or scratching sensation — worst in air-conditioned environments
- Redness that worsens through the day
- Gritty sensation — as if something is in the eye
- Blurred vision that fluctuates and clears with blinking
- Sensitivity to wind, smoke, or air conditioning
- Difficulty wearing contact lenses for extended periods
- Eye fatigue during prolonged reading or screen use
The paradox symptom — watery eyes: Many dry eye patients present with excessive watering. This occurs because the unstable tear film triggers a reflex watering response — but reflex tears lack the lipid component needed to stabilise the tear film, so the eye remains dry despite the watering.
How Dry Eye is Diagnosed
A proper tear film assessment is essential before treatment is prescribed. Guessing the type and prescribing the wrong drops is one of the most common causes of treatment failure. At BEH, my assessment includes:
Tear Film Tests:
- TBUT (Tear Break-Up Time) — normal >10 seconds; <5 seconds indicates significant instability
- Schirmer’s test — measures aqueous tear production; <5 mm indicates aqueous deficiency
- Meniscometry — measures tear meniscus height at the lower eyelid margin
- Fluorescein staining — reveals areas of corneal surface damage
Meibomian Gland Assessment:
- Slit-lamp lid examination — assesses gland orifice plugging, lid margin irregularity, and meibum quality
- Meibography — infrared imaging to visualise gland structure and identify permanent gland dropout
Ocular Surface Assessment:
- Lissamine green staining — reveals conjunctival surface damage not visible with fluorescein
- Corneal sensitivity testing — reduced in post-LASIK and diabetic patients
Best Treatment for Dry Eye in Dhaka — What Actually Works
Treatment must be matched to the type and severity of dry eye. There is no single drop that works for everyone.
Step 1 — Artificial Tears and Lubricating Drops
- Carboxymethylcellulose (CMC) drops — e.g. Refresh, Tears Naturale. Good for aqueous-deficient dry eye. Widely available in Bangladesh
- Sodium hyaluronate drops — e.g. Hycosan, Hylo-Forte. Superior retention time on the ocular surface; preferred for evaporative dry eye
- Lipid-containing drops — e.g. Systane Balance, Clinitas Soothe. The correct choice for most Dhaka patients with MGD; replenishes the deficient lipid layer
- Preservative-free drops — essential for patients using drops more than 4 times daily; preservatives in multi-dose bottles cause ocular surface toxicity with frequent use
“The most common mistake I see is patients using whichever drop is most prominently stocked at their local pharmacy — usually a CMC-based drop — for what is actually Meibomian gland dysfunction. What they need is lipid replacement, warm compression, and lid hygiene. Drops alone will not solve MGD.”
— Dr. Ashraful Huq
Step 2 — Warm Compression and Lid Hygiene
For Meibomian Gland Dysfunction — the most important non-drop treatment.
10 minutes of warm compression (40–45°C) twice daily softens the thickened meibum inside the Meibomian glands. Follow with lid massage and lid hygiene — cleaning lid margins with diluted baby shampoo or commercial lid wipes (e.g. Blephaclean). This combination is the most effective and most affordable first-line treatment for MGD-driven dry eye.
Step 3 — Anti-inflammatory Treatment
In moderate to severe dry eye, inflammation of the ocular surface is both a cause and a consequence of tear film instability:
- Topical cyclosporine A (0.05%) — e.g. Restasis. Reduces ocular surface inflammation and increases goblet cell density. Takes 3–6 months for full effect
- Short-course topical steroids — 2–4 week course of loteprednol for acute flares, bridging to cyclosporine. Requires IOP monitoring. Never self-prescribed
- Omega-3 supplementation — 2–3g EPA/DHA daily improves Meibomian gland secretion quality; results after approximately 3 months of consistent use
Step 4 — Environmental and Lifestyle Modification
- Reduce AC exposure where possible; use a humidifier in the office or bedroom
- Apply the 20-20-20 rule during screen use — every 20 minutes, look at something 20 feet away for 20 seconds and blink fully
- Adjust screen position below eye level to reduce exposed ocular surface area and slow evaporation
- Limit contact lens wear to 8–10 hours maximum; switch to daily disposables
- Stay hydrated — systemic dehydration reduces aqueous tear production
Step 5 — Advanced Treatments for Severe Cases
- Punctal plugs — tiny silicone plugs inserted into tear drainage openings, increasing tears on the ocular surface. Simple and reversible
- Autologous serum eye drops — made from the patient’s own blood serum; contains growth factors and proteins that closely mimic natural tears; particularly effective in severe aqueous deficient dry eye and post-LASIK cases
- Intense Pulsed Light (IPL) therapy — targets abnormal blood vessels contributing to Meibomian gland inflammation; strong clinical evidence for MGD
- Meibomian gland probing and expression — mechanical opening of blocked gland orifices under slit-lamp
Dry Eye and Vision Correction Surgery — What Every Patient Must Know
LASIK can worsen pre-existing dry eye. The corneal flap severs nerves driving lacrimal secretion — post-LASIK dry eye affects an estimated 20–40% of patients in the first 3–6 months and can persist longer in those with pre-existing disease.
For patients with significant dry eye considering vision correction, I recommend SMILE or ICL depending on their eye profile — both carry substantially lower dry eye risk than LASIK. If you have dry eyes and are considering any refractive procedure, thorough pre-operative tear film assessment is not optional.
Dr. Ashraful Huq’s Clinical Perspective
Dry eye is one of those conditions where the gap between patient suffering and available treatment is entirely unnecessary. Most patients with dry eye in Dhaka have never had a proper tear film assessment — they have simply been buying drops and managing symptoms on their own.
The majority of cases I see are driven by Meibomian gland dysfunction — a condition that responds well to warm compression, lid hygiene, lipid-replacement drops, and omega-3 supplementation. These are simple, inexpensive interventions. Patients who have been suffering for years often see significant improvement within 4–6 weeks of a correct diagnosis and proper treatment plan.
If your eyes are regularly burning, gritty, or tired — especially in air-conditioned environments or after screen use — do not assume it is simply “Dhaka’s air.” Come for a proper assessment. In most cases, the treatment is simpler than you expect.
Frequently Asked Questions
What is the best eye drop for dry eye in Bangladesh?
The best drop depends on your type of dry eye. For Meibomian gland dysfunction, lipid-containing drops such as Systane Balance or Clinitas Soothe are most appropriate. For aqueous-deficient dry eye, sodium hyaluronate provides superior retention. Preservative-free drops are essential if using drops more than 4 times daily.
Can dry eye be cured permanently?
Dry eye is a chronic condition managed rather than cured in most patients. However, consistent treatment with warm compression, lid hygiene, appropriate drops, and lifestyle modification achieves excellent long-term symptom control for the majority of patients.
Does air conditioning cause dry eye?
Yes. Air conditioning is the primary environmental driver of dry eye in Dhaka — it reduces humidity and accelerates tear evaporation, particularly in patients with Meibomian gland dysfunction. Using a humidifier alongside AC and taking regular breaks significantly reduces this effect.
Can I have LASIK if I have dry eyes?
It depends on severity. Significant dry eye is a contraindication to LASIK — but not to SMILE (lower dry eye risk) or ICL surgery (no corneal involvement). Dr. Ashraful Huq assesses tear film thoroughly before recommending any refractive procedure. Read more: LASIK vs SMILE vs ICL — which is right for you?
Is dry eye related to screen use?
Yes. Screen use reduces blink rate by up to 60%, causing incomplete tear film spreading and increased evaporation. The 20-20-20 rule and conscious full blinking during screen use significantly reduces this effect.
How long does dry eye treatment take to work?
Lubricating drops provide immediate temporary relief. Warm compression and lid hygiene show improvement within 4–6 weeks of consistent use. Cyclosporine A takes 3–6 months for full effect. Omega-3 supplementation takes approximately 3 months. Consistency is the most important factor.
Related articles:
LASIK vs SMILE vs ICL: Which Eye Surgery is Right for You? →
SMILE Eye Surgery in Bangladesh — Flapless, Lower Dry Eye Risk →
ICL Surgery in Dhaka — Vision Correction Without Touching the Cornea →
Confronting Corneal Ulcers: Causes, Treatment & When to See a Specialist →
Color Blind Lens in Bangladesh: Can Color Blindness Be Corrected? →
📞 Book a Dry Eye Assessment with Dr. Ashraful Huq
BEH Dhanmondi: 01705-879995 | BEH Zigatola: 01797-105780
WhatsApp: +880 1841-788371 | drashrafulhuq.com
Saturday–Thursday, 9am–9pm