Here’s the thing many people don’t realise - dry eye is almost universally evaporative regardless of its cause. Even the rare aqueous deficient dry eye (eg. Sjögren's syndrome) has an evaporative component as well - unless patients have their eyes closed! Most often this hyper-evaporative component arises from co-existing meibomian gland dysfunction (MGD)1. With a functional lacrimal gland, most people with dry eye will thus have reactive epiphora from time to time and so the term, ‘tear film instability’, can often be intuitively better tolerated and understood by patients complaining of occasional watering.
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