Aqueous-Deficient Dry Eye: Causes, Symptoms, and Treatment Options

Aqueous-deficient dry eye happens when the lacrimal glands do not make enough of the tear film’s watery layer, which leads to dryness, burning, blurred vision, and irritation. At Barnet Dulaney Perkins Eye Center, we diagnose what is driving your symptoms and build a treatment plan that restores comfort and protects the ocular surface.

What Is Aqueous-Deficient Dry Eye

In dry eye disease, the tear film can fail for different reasons. In aqueous-deficient dry eye, the problem is underproduction of watery tears, often from lacrimal gland dysfunction. Aqueous deficiency can be related to Sjögren’s syndrome, or it can be non-Sjögren’s. Many patients also show evaporative features, so careful testing matters.

Why It Happens

Common contributors include autoimmune disease such as Sjögren’s syndrome, aging, systemic medications that reduce tearing, nerve or reflex pathway changes, and prior ocular surface inflammation or surgery.

How We Diagnose It

Your doctor combines symptoms with objective tests to confirm aqueous deficiency and to rule out urgent conditions

• Symptom scoring with OSDI, slit lamp evaluation, corneal and conjunctival staining
• Schirmer test to measure basal tear production
• Tear break-up time and meibomian gland assessment to quantify evaporative overlap
• Sjögren’s workup when appropriate

Symptoms You Might Notice

Dryness, burning, gritty sensation
Fluctuating or blurred vision that worsens with reading or screens
Light sensitivity and eye fatigue
Redness or discomfort that improves with frequent artificial tears

Treatment Options We Personalize To You

Foundational Care

• Ocular surface tune-up with preservative-free lubricants, environmental adjustments, and lid hygiene
• Treat compounding factors such as allergy, blepharitis, exposure, and medication triggers

Anti-inflammatory and Secretagogue Therapies

• Topical immunomodulators such as cyclosporine formulations and lifitegrast to calm inflammation and support tear production in patients who make too few tears
• Short, targeted courses of topical corticosteroids for flares as directed by your doctor

Conserving the Tears You Have

• Punctal occlusion with temporary or longer-term plugs or intracanalicular inserts to reduce drainage and keep tears on the eye longer.

This approach is commonly used in aqueous-deficient dry eye when appropriate.

Advancements in Office Options for MGD

Because meibomian gland dysfunction drives most dry eye, restoring healthy oil flow is essential. Our centers offer the following options to improve comfort and stability of the tear film, which can be layered with an aqueous-deficient plan Intense pulsed light. Light energy reduces eyelid margin inflammation and helps liquefy stagnant oils so the glands function better.

Many patients feel relief after the first few sessions. A typical series includes four treatments with personalized maintenance
Radiofrequency. Gentle electrothermal energy warms the eyelids to loosen thick oils and supports eyelid skin health. Radiofrequency is often paired with in-office gland expression for best results.

Note: IPL and RF are quick office treatments. While not usually covered by insurance, many patients use HSA or FSA funds.

Other Treatment Therapies

• Thermal pulsation and heat with expression systems to clear obstructed glands
• Lid hygiene and debridement with targeted Demodex care when mites are present
• Amniotic membrane therapy for advanced surface disease when appropriate

Natural healing options can bring relief as well. Read more here on natural relief options

Advanced Options for Severe Disease

• Autologous serum tears or platelet-rich preparations for trophic support when standard therapy is not enough. Your specialist will discuss expected benefits and limits.
• Scleral lenses to vault and protect the surface in recalcitrant cases, arranged through specialty referral

Your plan at Barnet Dulaney Perkins Eye Center is built around your diagnosis, your lifestyle, and your goals. We often combine several therapies for the best results.

When To Seek Care

Schedule an exam if dryness, burning, or blurred vision are persistent, if over-the-counter tears no longer help, or if you have autoimmune symptoms such as dry mouth, joint pain, or significant fatigue. Early evaluation helps prevent surface damage and improves quality of life.

What’s Next

A precise diagnosis is the first step to relief from aqueous-deficient dry eye. Our team will identify the drivers behind your symptoms and tailor therapy, from tear conservation to anti-inflammatory treatments and advanced options when needed. Ready to feel and see better. Schedule a dry eye evaluation with Barnet Dulaney Perkins Eye Center today.