TFOS DEWS III: What the Latest Dry Eye Report Means for You (and Your Eyes)

What is TFOS DEWS III?

TFOS stands for Tear Film & Ocular Surface Society – an international group of leading dry eye researchers and clinicians.

DEWS means Dry Eye Workshop, and DEWS III is the newest update, following the well-known DEWS II report from 2017.

The DEWS III management report reviewed over 1,000 scientific studies, so it reflects the strongest evidence available today.

In short:

DEWS III sets out the most up-to-date, evidence-based approach to treating dry eye.

The biggest change: dry eye isn’t treated “by severity” anymore

In the past, dry eye treatment was often a step-ladder approach:

1. start with lubricating drops

2. if no improvement, move to the next step

3. and so on…

But this doesn’t always work well, because dry eye isn’t just “mild vs severe”.

Dry eye is usually caused by multiple factors at the same time

DEWS III supports a more modern approach:

✅ identify what’s actually causing your dry eye
✅ treat those causes directly
✅ combine treatments where needed
✅ review and adjust over time

That’s why today dry eye care is more personalised than ever.

Dry eye can change over time (and may flare up)

Another important point in DEWS III is that dry eye disease is often:

• long-term

• variable

• affected by lifestyle and environment

Many patients notice “flares” – for example:

• in winter when heating is on

• in summer with wind/pollen

• after long screen time

• after illness or stress

• during menopause

• after eye surgery

This means dry eye care should be treated more like asthma or eczema:

you need a plan that adapts – not just one-off drops.

Why some people have symptoms but “everything looks normal”

One of the most helpful advances in DEWS III is that it recognises something patients have said for years:

“My eyes feel awful – but I’ve been told they look fine.”

DEWS III highlights that some patients experience dry eye pain because of nerve sensitivity.

This is sometimes called:

• neuropathic ocular pain

• neuroinflammation

• central sensitisation

You don’t need to remember the terms, but what matters is this:

✅ your symptoms are real
✅ dry eye is not always visible early on
✅ treatment may still be needed even if tests are borderline

What actually causes dry eye?

DEWS III looks at dry eye from two angles:

1) What is happening in the eye?

These are the main processes involved:

• tear film instability (tears don’t stay on the eye properly)

• increased evaporation

• inflammation

• surface damage

• nerve sensitivity

2) What is driving it?

This is what causes those problems, for example:

• meibomian gland dysfunction (MGD) (oil glands in the eyelids not working properly)

• blepharitis

• demodex mites

• contact lens wear

• screen use/low blink rate

• medications

• allergies

• systemic health issues (such as autoimmune disease)

This is why a good dry eye assessment looks at:
✅ the tears
✅ the lids
✅ the eye surface
✅ general lifestyle and health

So what treatments are now recommended?

DEWS III doesn’t just focus on eye drops. It includes a wide range of options, depending on what’s causing your dry eye.

Here are the main categories, explained in patient-friendly language.

1) Lifestyle changes (yes, they really matter)

This is not “just advice” – it’s part of treatment.

DEWS III strongly supports lifestyle changes because they can reduce flares and improve comfort long-term.

Examples:

Screen use & blinking

If you use screens regularly:

• blink less

• blink incompletely

• evaporate tears faster

Helpful actions include:

• regular breaks (20-20-20 rule)

• blink training (we can guide you)

• improving screen height/position

Environment

• avoid direct airflow from fans or car vents

• consider a humidifier if heating dries the air

• wear wraparound sunglasses outdoors

Sleep

Poor sleep affects tear quality and inflammation.

2) Tear replacement (lubricating drops)

Dry eye drops are still valuable – but DEWS III highlights that formulation matters.

Drops may include:

• hyaluronic acid (hydration)

• lipid-containing drops (evaporative dry eye)

• trehalose/ectoine (surface protection)

DEWS III also highlights:
✅ preservative-free drops are often better long-term

3) Eyelid and oil gland treatment (MGD)

For many patients, the main problem is oil glands in the eyelids.

If oil isn’t flowing properly:

• tears evaporate quickly

• eyes become inflamed

• dryness worsens

Treatments can include:

• warm compresses and lid massage

• lid hygiene/cleaning routines

• hypochlorous sprays

• in-clinic therapies (see below)

4) Anti-inflammatory treatment

Inflammation is now recognised as a core driver of dry eye – not just a “side effect”.

In some cases, we may recommend prescription options such as:

• short courses of steroid eye drops (for flares)

• immunomodulating drops (such as ciclosporin)

These can be very helpful for patients whose eyes are stuck in a cycle of irritation and inflammation.

5) Oral treatments (where appropriate)

For some patients, especially those with gland dysfunction or rosacea-type lids, oral medication can help.

Example: low-dose doxycycline (not as an “antibiotic course” in the usual way, but for its anti-inflammatory effect).

6) Healing/regenerative treatments (for severe cases)

DEWS III includes treatments used when the eye surface needs deeper healing support, such as:

• autologous serum eye drops (made from the patient’s blood)

• platelet-rich plasma (PRP)

These are specialist treatments, but the evidence base is growing.

7) In-clinic device treatments (a major area of growth)

DEWS III includes a much stronger evidence base for modern device-based care, including:

IPL (Intense Pulsed Light)

Often used for MGD and inflammation.

LLLT (Low Level Light Therapy)

A newer option with very encouraging evidence for certain types of dry eye.
In some comparisons, LLLT has shown an even stronger effect than IPL, and can also be used in combination.

Other lid procedures

Depending on the cause, options can include:

• deep eyelid cleaning

• gland expression

• demodex-targeted approaches

8) Nutrition & supplements

Dry eye is affected by inflammation throughout the body.

DEWS III supports:

• Omega-3 supplements (EPA/DHA) where suitable

• ensuring key nutrients such as vitamin D and B12 are adequate

It also notes that the evidence is still evolving – so this is supportive, not a replacement for treatment.

Dry eye after eye surgery (cataract / laser)

Many people notice increased dry eye after cataract surgery or refractive surgery.

DEWS III encourages:
✅ treating existing dry eye before surgery
✅ using protective treatment plans after surgery
✅ managing inflammation early

This helps comfort and supports clearer vision results.

What should you take away from DEWS III?

The biggest message is this:

Dry eye is real, common, and treatable – but it needs a personalised plan

Dry eye is not “just older age” or “just too much screen time”.

It is usually:

• multi-factorial

• long-term

• manageable with the right approach

How we apply DEWS III in practice

At our clinic, we focus on:

• identifying what’s causing your symptoms

• testing the tear film, lids and eye surface properly

• creating a treatment plan based on your drivers

• combining treatments where needed

• reviewing progress and adjusting over time

This is the new gold-standard model supported by TFOS DEWS III.

If you’re struggling with dry eye symptoms

If your eyes regularly feel uncomfortable, gritty, watery or tired — please don’t ignore it.

Dry eye tends to worsen over time when the root cause isn’t addressed, but the earlier it’s treated, the better the outcome.