Recognising dry eye earlier: a team approach

At Earlam and Christopher, dry eye awareness is very much a whole-practice responsibility. I think one of the biggest missed opportunities in practice is assuming that dry eye conversations only happen in the consulting room. In reality, patients often mention symptoms casually at reception, during pre-screening, while choosing spectacles, when ordering contact lenses, or when collecting and buying products.

Our reception and front-of-house team are often the first to hear comments such as “my eyes are tired,” “they water all the time,” “I can’t wear my lenses as long,” “my vision goes blurry on the computer,” or “I just feel gritty by the end of the day.” They are trained to recognise that these comments may be signs of ocular surface disease rather than simply something to dismiss as tiredness or age. Their role is not to diagnose, but to signpost appropriately and let patients know that dry eye is something we take seriously and that there is a specialist clinic for this and there are effective treatments.

Our clinical support team help by gathering information, completing questionnaires, performing imaging and objective tests where appropriate, and making the patient journey feel structured rather than ad hoc. That is important because many dry eye patients have already tried multiple over-the-counter drops and feel they have “failed treatment.” Showing them that we are looking at tear film stability, lid health, meibomian gland function and lifestyle factors helps them understand that dry eye is not one single problem.

Our dispensing team also play a key role. They see the link between ocular comfort, visual performance and lifestyle every day. They can reinforce messages about screen use, lens comfort, blinking, environmental triggers, contact lens replacement schedules, make-up removal, lid hygiene and the importance of follow-up care.

In our practice, we try to create a culture where every team member feels confident saying: “That could be dry eye related – we have a dedicated clinic and there are things we can do to help.” That simple sentence can be hugely powerful.

For us, bringing the team along with regular team meeting and training sessions often starts with explaining the “why” before the “what.” If we introduce a new product, device or service, we do not want the team to feel they are simply being asked to sell something new. They need to understand the clinical problem it addresses, the type of patient it may help, where it fits into our pathway, and what we can and cannot claim.

Dry eye patients are often complex. Some have evaporative dry eye, some aqueous deficiency, some inflammatory disease, some contact lens discomfort, some skin or lid-related disease, and many have several contributing factors. So when we introduce something new, we frame it within that bigger clinical picture.

Practically, this means we use team training sessions, short internal guides, shared language, and patient journey mapping. We talk through common patient questions: “Why do I need this?” “Why are drops not enough?” “How long will treatment take?” “Will I need ongoing maintenance?” “Is this a cure?” The whole team needs to feel comfortable answering these in a consistent, balanced way.

We also try to let the team see the technology and the patient experience for themselves. If staff understand what a treatment feels like, what the appointment involves, what the patient sees on the screen, and what follow-up looks like, they are much better able to talk about it naturally.

I also think it is important to create space for the team to challenge and ask questions and not to be afraid to admit when they are not sure. If the team have doubts, patients will sense that. Education should not just be a one-off product briefing; it should be an ongoing process where we review outcomes, discuss patient feedback, and refine how we communicate the service.

Yes, and I think this is where practice teams can make a real difference. The core message is the same – dry eye is common, multifactorial and manageable, but the way we explain it should be relevant to the person in front of us.

The most important message the team can reinforce is that dry eye management is a process, not a one-off event. Many patients arrive expecting a quick drop recommendation, but modern dry eye care is often about understanding triggers, identifying the subtype, improving the tear film environment and supporting the ocular surface over time.

The team can help by repeating simple, consistent messages at different points. For example: “Use the treatment regularly, not just when your eyes feel bad.” “Come back if symptoms change.” “Watery eyes can still be dry eyes.” “Contact lens discomfort is not something you simply have to put up with.” “Screen-related symptoms are common, but there are practical ways to manage them.”

Reception staff can reinforce follow-up appointments. Dispensing staff can discuss visual comfort and occupational needs. Contact lens support staff can identify early signs of dropout risk. Clinical assistants can explain why images or tear film measurements matter. Everyone can help normalise the idea that dry eye is common, treatable and worth addressing early.

At Earlam and Christopher, we also try to avoid making patients feel blamed. Lifestyle factors matter, but the language has to be supportive. Rather than saying, “You are on screens too much,” we might say, “Your work pattern is putting extra demand on your tear film, so let’s build a plan that fits your day.”

That kind of reinforcement outside the testing room is crucial. Patients often remember the repeated, simple explanations more than the detailed clinical discussion.

With screen users, I usually focus on performance and comfort rather than disease terminology alone. These patients may not think they have “dry eye”; they may describe tired eyes, fluctuating vision, frontal headaches, reduced concentration, or end-of-day blur.

The message might be: “When we concentrate on screens, we tend to blink much less often and less completely. That means the tear film is not being refreshed as effectively, so vision can fluctuate and the eyes can feel tired or gritty.”

The advice should be practical: blink awareness, screen positioning, regular breaks, managing airflow, checking spectacle correction, treating meibomian gland dysfunction if present, and using lubricants or other therapies where clinically indicated. TFOS Lifestyle specifically highlights digital device use, blink changes and environmental demands as important contributors to ocular surface symptoms. 

With contact lens wearers, I try to avoid presenting dry eye as a reason they must stop using lenses. Instead, I frame it as something we need to optimise to protect comfortable wearing time.

The message might be: “Contact lenses sit within the tear film, so if the tear film is unstable, lenses can become uncomfortable even if the lenses themselves are a good fit. We need to look at the ocular surface, the lids, the lens material, replacement schedule and wearing pattern.”

This is particularly important because discomfort is a major reason for contact lens dropout. BCLA CLEAR and TFOS contact lens-related reports emphasise that dryness, irritation, fluctuating vision and reduced wearing time are key issues in contact lens practice, and that management should include both the lens and the ocular surface environment. 

For these patients, the practice team can reinforce that they should not simply reduce wearing time silently or keep changing solutions without advice. Early intervention can make a big difference.

My biggest tip is to make dry eye part of the everyday language of the practice. Patients do not always present by saying, “I have dry eye.” They say, “My eyes water,” “my vision comes and goes,” “my lenses are uncomfortable,” “I’m tired by the end of the day,” or “I can’t cope with screens anymore.” If the whole team can recognise those clues and confidently signpost the patient, dry eye care becomes more proactive, more consistent and much more patient centred.

For menopausal or perimenopausal patients, the message needs to be validating. Many patients do not connect hormonal change with ocular symptoms, and they may feel frustrated that their eyes have suddenly become uncomfortable, watery, gritty or contact lens intolerant.

I might say: “Hormonal changes can affect the tear film, the ocular surface and the oil-producing glands in the lids. You are not imagining it, and it is not just ageing, there are ways we can assess what is happening and support the surface of the eye.”

This group often appreciates a more holistic discussion: skin, lid margin health, rosacea, sleep, systemic medication, autoimmune history, screen use and nutrition may all be relevant. It is also important not to trivialise symptoms, because dry eye can have a major impact on quality of life.