Questions to ask before you agree to dry eye treatment

You are being offered a treatment and you want to get it right

Somebody has mentioned LipiFlow or IPL, the price is not small, and you have already spent a year on drops. You want relief, but you also do not want to pay for a device aimed at a problem you do not have. The way to protect yourself is to ask a short list of questions before you book, and to notice how they are answered.

This page is the checklist. The background sits in our guides to what dry eye is and eye drops versus in-clinic treatment, and the three main devices are compared in our post IPL vs LipiFlow vs Rexon-Eye. Our post on whether LipiFlow is right for your dry eyes covers that device's suitability in more detail.

What the evaluation should establish before anything is recommended

The Tear Film and Ocular Surface Society's 2025 DEWS III diagnostic report describes dry eye as a diagnosis made from symptoms plus signs, and it recommends matching treatment to the underlying driver: a tear film problem, an eyelid problem, a surface problem, or a mix. That means the evaluation comes first and the device second. The Medsafe data sheet for one prescription dry eye drop says the same thing in its own way: a comprehensive eye examination should be performed to determine the cause of symptoms, and any reversible condition treated first.

At NVISION, dry eye care starts with a comprehensive dry eye evaluation that works out whether the problem is too few tears, a poor oil layer, or both, before any treatment is matched to it. Our dry eye questionnaire scores your symptoms beforehand. Whoever you see, by the end of the evaluation you should be able to answer these:

• Which type of dry eye do I have: aqueous-deficient, evaporative, or mixed? If the answer is vague, the treatment choice will be too.
• What did you see in my eyelid oil glands, and are they blocked, inflamed, or already lost? Gland treatments work on glands that are still there.
• Is my blinking complete? Clinicians quoted by the American Academy of Ophthalmology note that clearing the glands may not help if a patient is not blinking fully.
• Is anything else driving this: a medicine I take, blepharitis, rosacea, an immune condition, contact lenses, or my screen set-up?
• Have I done the home routine properly, for long enough? Healthify NZ describes warm compresses and lid massage twice a day over the long term, and a preservative-free drop if you use drops more than four times a day.

Questions about the treatment itself

Once the type is clear, the questions move to the proposed treatment. Ask why this one for your type, and what the evidence shows. For intense pulsed light, a 2020 Cochrane review found three small trials and was unclear about the effect on symptoms, with uncertain safety. For punctal plugs, a 2017 Cochrane review found it unclear whether they are effective and noted they may cause watery eyes. Clinicians quoted by the AAO say LipiFlow tends to help when the glands are not yet scarred, that benefits need retreatment every three to twelve months, and that it does not work for everyone. None of this means the treatments are wrong for you. It means the honest answer to "will it work" is "it may, for your type, and here is how we will know".

Ask what is included and what is not. In-clinic dry eye treatments at NVISION are listed on our consultation fees page, including the number of sessions in a course and whether the evaluation is separate; read that page before your appointment rather than relying on a figure quoted from memory. Ask what a follow-up costs, and whether a repeat course would be needed later.

Ask what result you should expect, by when, and how it will be measured. A fair answer names the symptom or test score you will compare, and gives a review date. Ask about side effects: the practice's LipiFlow page lists burning, stinging, redness, discharge, blurred vision and light sensitivity as possible effects, and the Cochrane IPL review reports mild pain, burning and eyelash loss from device error. Ask who should not have the treatment. The practice's LipiFlow page names recent eye surgery, an eye injury, ocular herpes and chronic eye inflammation; prescription ciclosporin drops are not started during an active eye infection, according to their Medsafe data sheets.

Finally, ask what happens if it does not help. Healthify NZ's advice is to go back to the optometrist to review the diagnosis and to review any prescription medicines that may be contributing. The TFOS DEWS III management report notes that dry eye often has more than one cause and that combinations of treatment are common, so "we try the next thing on the list" is a reasonable answer; "it always works" is not.

Conditions that need a GP or an ophthalmologist first

Some dry eye is a symptom of something else, and treating the eyelids alone will miss it. Healthify NZ links dry eye with Sjögren's disease, rheumatoid arthritis, rosacea, thyroid disease and diabetes, and with medicines such as antihistamines, some antidepressants, some blood pressure medicines and isotretinoin. If you have a dry mouth as well as dry eyes, joint pain, or a recent medicine change, tell your GP before you spend money on a gland treatment, because the plan may need both.

An optometrist can prescribe some eye medicines in New Zealand if they are authorised to do so, which you can check on the ODOB public register. Severe dry eye that does not respond, or dry eye with damage to the surface of the eye, can be referred to a hospital eye clinic or a private ophthalmologist by your optometrist or GP. Ask whether your case is one of those before you start a course of anything.

When an optometry appointment is the wrong place

Dry eye does not need an emergency department. These things do. Call 111 or go to the nearest hospital emergency department for sudden loss of vision, a shadow or curtain across part of your vision, flashes of light with a sudden shower of new floaters, a chemical splash (Healthify NZ says 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.

Healthify NZ and the NHS also advise prompt care, rather than waiting for a planned dry eye appointment, for a painful red eye, a red eye in a contact lens wearer, light that hurts the eye, a sudden change in vision, or coloured discharge with lids stuck shut on waking. Those suggest infection or inflammation, not dryness, and no gland treatment is given until they are sorted out. For advice at any hour, Healthline is free on 0800 611 116.

What to bring and what happens next

Bring every drop you currently use, including the empty boxes, a list of your medicines, and a note of when the dryness is worst and what makes it better. If you wear contact lenses, bring the packaging. A dry eye evaluation at NVISION takes longer than a routine eye exam; the fee is on our consultation fees page. No referral is needed, and you can call us on 09-475 5548 or book online. Take this list with you, and judge the clinic by how it answers.