When Is It Time to Switch Dry Eye Treatments?
- Lynn Valley Optometry
- 2 days ago
- 4 min read
Updated: 21 hours ago
This article is adapted from a professional discussion between Dr. Damon Dierker, OD, FAAO and Dr. Mahnia Madan, OD, FAAO, originally published in Eyes On Eyecare, Ocular Surface (October 24, 2024), When to Switch DED Therapies. Dr. Madan is a valued part of the dry eye team at Lynn Valley Optometry in North Vancouver.
Dry eye disease is rarely simple. And it is almost never one-size-fits-all.
At Lynn Valley Optometry, we often meet patients who have already tried artificial tears, warm compresses, omega supplements, or even prescription drops, yet still feel frustrated by ongoing redness, irritation, or fluctuating vision.
So how do we know when a dry eye treatment needs to change?
Dr. Mahnia Madan recently shared her clinical perspective on this topic in a professional discussion focused on optimizing outcomes in dry eye disease (DED). Here is what patients should understand about treatment “failure,” treatment limitations, and when it is time to pivot.
Dry Eye Treatment Is Rarely Linear
Dry eye disease is multifactorial. That means several different contributors may be active at the same time, including:
Inflammation
Meibomian gland dysfunction
Tear film instability
Environmental exposure
Hormonal influences
Screen use
Systemic health
Hydration and lifestyle habits
Because of this complexity, improving just one part of the problem may not fully resolve symptoms.
As Dr. Madan explains:
“In dry eye, when it’s multifactorial and there are multiple things that we need to address, sometimes addressing one part is only going to give you an incomplete response.”
That does not mean treatment has failed. It often means we need to expand or refine the strategy.
Treatment Failure vs. Treatment Limitation
One of the most important distinctions we make in advanced dry eye care is the difference between true treatment failure and treatment limitation.
After reassessing a patient who felt her redness had not improved, Dr. Madan reflected:
“I don’t think this is a case of treatment failure, but perhaps treatment limitation and maybe patient expectations — what they’re expecting right away from that therapy.”
This distinction matters.
If clinical signs are improving — even if symptoms lag behind — the treatment may be working, just not completely.
Dr. Dierker offered a helpful analogy:
“You can make the parallel to glaucoma. If someone’s pressure gets better but it’s not at goal, does that mean the treatment failed? No. It means they need more treatment.”
Dry eye works the same way. Addressing one layer of inflammation or tear instability may move things in the right direction, but additional therapies are often required to fully stabilize the ocular surface.
The Importance of Honest Conversations in Eye Care
A powerful part of dry eye management is communication.
When patients feel discouraged, the solution is not always a new prescription. It is clarity.
Dr. Madan emphasizes:
“It’s such an honest conversation to have with the patient. It’s the way we connect with them — that you’re both part of the same team.”
At Lynn Valley Optometry, this partnership is central to Dr. Madan’s Dry Eye Discovery process. She evaluates not only symptoms, but also measurable signs such as tear break-up time, tear meniscus height, gland function, and ocular surface integrity.
Sometimes the eyes are objectively improving before patients feel dramatic relief. Understanding that progression helps reduce frustration and builds trust.
If you feel stuck in your current dry eye care, a fresh, advanced evaluation can provide clarity.
Dry Eye Is Also a Lifestyle Condition
In one clinical case discussed, a patient with chronic redness was diligently following her treatment plan but still felt no improvement.
Further discussion revealed that prolonged mask use at work had led to chronic dehydration.
As Dr. Madan explains:
“Dry eye is very much a lifestyle condition. Are there things in your lifestyle that we could be improving that could help us with this?”
Hydration, screen habits, environment, cosmetics, and over-the-counter drops can all influence outcomes.
Dry eye management is rarely just about eye drops. It is about the whole picture.
When It’s Time to “Reset” the Ocular Surface
If progress stalls, it may be necessary to step back and reassess. Are preservative-containing drops irritating the surface? Is gland obstruction still present? Is inflammation fully controlled?
Sometimes, as Dr. Madan puts it:
“Sometimes you just have to hit reset on the ocular surface.”
This may involve in-office treatments, lid therapy, advanced imaging, or escalating anti-inflammatory care to create a healthier foundation before continuing long-term management.
Dr. Madan provides advanced dry eye therapies at Lynn Valley Optometry, including IPL, radiofrequency, and various treatments designed for more complex cases.
When to Elevate Dry Eye Treatment
If foundational therapies are not enough, we may add or transition to advanced treatments such as:
The goal is not simply short-term symptom relief. It is long-term stabilization.
The Bigger Goal: Stabilization, Not Just Relief
The ultimate goal of dry eye management is not just symptom improvement.
It is:
Stabilizing the ocular surface
Preventing progression
Protecting long-term vision
Improving quality of life
Because dry eye disease is chronic and multifactorial, treatment plans often evolve over time. Adjusting therapy is not a setback. It is part of personalized care.
Book a Dry Eye Consultation with Dr. Mahnia Madan
If you are struggling with persistent dryness, redness, fluctuating vision, or irritation, it may be time for a more comprehensive approach.
Dr. Mahnia Madan provides advanced dry eye assessments at Lynn Valley Optometry, designed to identify every contributing factor and create a personalized treatment strategy.
📞 Call 604-987-9191 to schedule your comprehensive dry eye evaluation with Dr. Madan.
Or request an appointment online and select Dry Eye Consult with Dr. Madan.
Your eyes deserve more than temporary relief. Let’s stabilize them properly — together.