Stages of Dry Eye

Doctors grade dry eye from mild to severe, and the grading is genuinely useful because it decides the treatment - what fixes mild dry eye barely touches severe disease, and what severe disease needs is overkill for a mild case.

Mild. Symptoms come and go - gritty or tired eyes after long screen sessions or at day's end, fine in the morning. The eye surface still looks healthy on examination. Management is mostly habits: the 20-20-20 screen rule, conscious blinking, fixing the fan and AC airflow, and over-the-counter artificial tears as needed. Most screen-age dry eye lives here, and here it usually stays if habits improve.

Moderate. Symptoms are daily and start to interfere - burning through the afternoon, lenses no longer tolerable, vision that smears until you blink, waking with stuck or uncomfortable eyes. The eye surface now shows early changes: the tear film breaks up too quickly and there are tiny dry spots on the cornea when the doctor stains and examines it. Treatment steps up: scheduled (not occasional) lubricating drops, warm compress and lid massage routines, gels at night, and often a first prescription discussion.

Severe. Constant symptoms, significant staining and damage of the corneal surface, filamentary strands, sometimes inflammation that itself damages the tear glands - a cycle that feeds itself. This level needs an ophthalmologist leading care: prescription anti-inflammatory drops, procedures like punctal plugs, treatment of any underlying disease, and close follow-up. Untreated severe dry eye can scar the cornea - which is why "it's just dry eyes" should never be said about this stage.

The pattern to notice about your own eyes: symptoms that are creeping from occasional to daily, or drops that used to work and no longer do, mean the stage is shifting - and that is the moment to move from the chemist's shelf to a proper eye examination.