Depending on your exact condition, standard treatments may be treating the wrong problem, or treating only one of the problems (and in either case quite possibly exacerbating another problem) or, sometimes, just not be great things to do anyway.

We’re guessing you are experiencing one of three things. If you’re not, you probably wouldn’t be reading this section.

1. You’re using lots and lots of unpreserved artificial tears, and doing nothing else. (Well, it could be worse, you could be using preserved ones.) If you are truly aqueous deficient, and aqueous deficient only, this might be okay depending on which tears you are using, but most of them are not very good and most of the really good ones are not available in the UK or Ireland, so even in this good case you’re probably over-diluting your good tears with bad ones. But if you are not aqueous deficient, or you are but you also have a significant problem with lipids, artificial tears alone either aren’t going to help, or they aren’t going to help enough. And if on top of that you have a mucin layer problem, you can drop as many tears on your eyes as you want and they are just going to keep evaporating and basically falling off your epithelium until you do something about the lipid and mucin problems.
2. You’ve taken it to the next step: Punctal plugs. Mind you, we’re not saying this is a bad thing — just that in many cases it’s not going to solve the problem and may not even help, for the same reason that artificial tears may not be helping: not enough lipids, and/or not enough mucins. Trapping your tears isn’t going to prevent them from evaporating and can’t force them to stick to your epithelium.
3. You’re using greasy ointments at night. Remember when we talked about mucins and how there seems to be some sort of rocket science aspect to how your eye does, and doesn’t, get and keep itself wet, whether or not there is wet stuff around? Well, we won’t pretend to understand all the technicalities of it all, but the really serious lacrimology scientist-type people all seem to say that petroleum based ointment is Not a Good Thing for wetting of your eyes, even if it is temporarily helpful to prevent corneal erosions/abrasions. We don’t mean to say you cannot use ointment, but regular use of it, as far as we understand, is going to make your dry eye condition worse, not better. There are many other things you can do to protect your eyes at night. Gels are safer than ointments. Night guards are good. Some people even manage to get used to wearing goggles. A humidifier in the bedroom will help, as will lowering the heat.

Now, before anybody (like a doctor prescribing these things) flies off the handle about this, remember that I’m not saying these treatments are bad things — just that they need to be the right thing for every patient. Almost all of you need artificial tears and many of you will benefit from plugs. All I’m saying is that depending on your real problem(s), this may or may not be right or enough — you may need to combine them with other treatments or switch to other treatments. You should try things out and see what works for you (under medical supervision, of course).