Eye drops versus in-clinic dry eye treatment

You have a drawer full of drops and the relief lasts twenty minutes

Most people start with whatever drop the pharmacy had. It helps for a while, then the grittiness comes back by the next meeting. That cycle is not a sign that drops are useless. It is a sign that the drop is treating the symptom while the cause, often blocked oil glands in the eyelids, carries on.

The American Academy of Ophthalmology describes artificial tears as drops that are like your own tears: they lubricate, they do not repair. Which steps actually fix something depends on the type of dry eye you have. If you have not read it yet, our what is dry eye guide explains the two types in a few minutes, and the rest of this page assumes that background.

What you can do at home, and how far it goes

Healthify NZ sets out the home options clearly. Thin drops suit mild symptoms and are used only when needed. Thicker drops and gels stay on the eye longer and suit moderate to severe symptoms, used regularly through the day. Ointments blur vision, so they are for bedtime. No single brand suits everyone; the AAO suggests trying a few.

Preservatives are the catch. Healthify warns that some preservatives, such as benzalkonium chloride, can irritate and damage the surface of the eye, and both Healthify and the AAO advise switching to a preservative-free product if you use drops more than four times a day, react to a preservative, or wear certain contact lenses. Avoid drops sold as redness relievers: the AAO notes they are decongestants that can worsen dry eye over time. For the options, see our page on which drops suit which type of dry eye, Healthify NZ for practical details on drops, gels and ointments, and our post on choosing the right eye drops.

For blocked oil glands, heat and cleaning do what drops cannot. Healthify's routine is a heated wheat bag or eye mask on closed lids for ten minutes (a hot flannel loses heat too fast), followed by a gentle massage of the lids towards the lash line, done twice a day over the long term, plus lid wipes if you have blepharitis. The TFOS DEWS III management report adds the habits that matter most: breaks from screens, deliberate full blinks and better indoor humidity.

• Drops are enough when: symptoms are mild, come and go with screens or weather, and settle with a drop or two a day.
• Step up when: you need drops more than four times a day, you have tried a preservative-free product and regular warm compresses, and symptoms persist for more than a week or two.
• Omega-3 supplements: a 2019 Cochrane review found they may have little to no effect on symptoms compared with placebo, with some improvement in clinical signs. A possible add-on, not a treatment on its own.

Prescription drops in New Zealand

When lubrication is not enough, the TFOS DEWS III management report lists anti-inflammatory drops as the long-term option, with ciclosporin (also spelt cyclosporine) as the usual choice, and short courses of steroid drops for flares under close monitoring. Two ciclosporin eye drops hold Medsafe approval in New Zealand. Cequa, approved in February 2023, is indicated to increase tear production in moderate to severe dry eye where artificial tears have not been sufficient. Vevye, approved in January 2025, is indicated for moderate to severe dry eye in adults that has not improved despite tear substitutes. Both are prescription medicines used twice a day, and the Cequa data sheet says the most common side effect in trials was stinging on instillation.

Funding is the sticking point. Neither ciclosporin drop appears as a funded item in the November 2026 Pharmaceutical Schedule, so a prescription is paid for privately; ask what that costs before you commit. Preservative-free lubricants are different: the Schedule funds two of them under a Special Authority for people with severe dry eye confirmed on examination who use drops more than four times a day or have had a confirmed allergic reaction to a preservative, and Pharmac removed the need to renew those approvals from February 2025. Optometrists authorised to prescribe medicines are shown as such on the ODOB public register; ask our optometrists whether a prescription drop is appropriate for your type and what the Special Authority criteria would mean for you.

When in-clinic treatment is considered, and for whom

Healthify NZ lists intense pulsed light (IPL), low-level light therapy (LLLT) and thermal pulsation (LipiFlow) as options to unblock eyelid glands when self-care has not worked. The TFOS DEWS III management report groups IPL and thermal devices under tear restoration, alongside warm compresses, and stresses that several treatments are often combined because dry eye usually has more than one cause. That is the honest framing: these are gland treatments for evaporative dry eye, not a replacement for every drop.

NVISION offers LipiFlow, IPL, Rexon-Eye, low-level light therapy and punctal plugs, each after a comprehensive dry eye evaluation. The differences between the three main devices are already set out in our post IPL vs LipiFlow vs Rexon-Eye, so this guide will not repeat them. What it will say is what the independent evidence looks like, because that shapes what to expect.

A 2020 Cochrane review of IPL for meibomian gland dysfunction found only three small trials and concluded the authors were unclear about the effect on symptoms, that IPL may improve some clinical signs, and that they were uncertain about safety, with reported side effects including mild pain, burning and eyelash loss from device error. Clinicians quoted by the AAO say LipiFlow tends to work better when the glands are not yet scarred, that the benefit needs retreatment every three to twelve months, and that it does not work on everyone. A 2017 Cochrane review found it unclear whether punctal plugs are effective, and noted they may cause watery eyes; the AAO points out they can be removed. For Rexon-Eye and LLLT the published evidence is thinner again, so ask what has been shown for your type. Fees for each are on our consultation fees page.

When an optometry appointment is the wrong place

Dry eye is not an emergency, but some things that feel like it are. Call 111 or go to the nearest hospital emergency department for sudden loss of vision, a shadow or curtain across your vision, flashes of light with a sudden shower of new floaters, a chemical splash (flush with clean running water for at least 15 minutes first), a red and painful eye with light sensitivity, or any injury to the eye. Do not drive yourself.

See your GP first if you think a medicine is causing the dryness, if you have symptoms of an immune condition such as Sjögren's disease or rheumatoid arthritis, or if you have rosacea or thyroid disease that is not yet under treatment. Healthify NZ also advises prompt care for a painful or red eye, coloured discharge or lids stuck shut on waking, which suggest infection rather than dryness. In-clinic gland treatments are not offered during an active eye infection, and the practice's LipiFlow page lists recent eye surgery, eye injury, ocular herpes and chronic eye inflammation as reasons it may not be suitable. Healthline is free on 0800 611 116 at any hour.

How to decide

Start with the evaluation, not the device. It tells you whether the problem is too few tears, poor oil, or both, and that decides whether drops, prescription drops, gland treatment or a combination makes sense. Then read our list of questions to ask before dry eye treatment so you go in knowing what a good answer sounds like.