Dry eye syndrome is rising fast because of screen time, inflammation, autoimmune issues, and meibomian gland dysfunction and younger people are feeling it more than ever. In this episode of the Dr. Eye Health Podcast, Dr. Joseph Allen and Dr. Cecelia Koetting unpack the real reasons behind dry eye, why it’s not “just dryness,” and the simple lifestyle and clinical treatments that actually work.

Dry eyes isn’t one thing. It’s a syndrome with multiple layers- oil, aqueous, mucin and when even one system breaks down, your tear film can’t stabilize. Dr. Allen and Dr. Koetting break down the science in an easily understandable way, from “dirty windshield” corneal staining to how blinking drops by two-thirds when you’re scrolling your phone.

They also dive into inflammation cycles, autoimmune triggers, diabetes-related nerve damage, incomplete blinking, eyelid position, preservatives like BAK, lash serums, Accutane, Botox complications, sleep apnea, thyroid issues, and more.

This one is packed with real answers and real-life strategies you can use to protect your vision long-term.

✅ The top causes of dry eye syndrome most people never hear about

✅ Why meibomian gland dysfunction is behind 60 percent of cases

✅ How hormones, autoimmune issues, meds, and screen time make symptoms worse

✅ Simple steps you can take today to reduce dryness and protect your ocular surface

• (00:00) Intro: Why dry eye is misunderstood
• (00:20) How screen time lowers blink rate from 20 BPM to as low as 7 BPM
• (01:00) What tear film layers actually do
• (02:40) Dry eye vs dry eye disease vs syndrome
• (05:00) Keratoconjunctivitis sicca explained
• (07:30) “Dirty windshield” analogy for corneal staining
• (09:00) How fluorescein + lissamine green dyes show damage
• (11:20) Is dry eye becoming more common or just diagnosed more?
• (12:40) Autoimmune issues + inflammation
• (15:00) Diabetes, neuropathy + ocular surface nerve damage
• (17:45) How chemo + Accutane affect meibomian glands
• (18:30) Eyelid position, incomplete blink, Botox, and TMJ
• (22:00) Floppy eyelid syndrome + sleep apnea
• (24:10) BAK preservatives and long-term surface damage
• (26:01) Tear production issues: Sjogren’s, dehydration, meds
• (30:00) Hormones, menopause, HRT + dry eye
• (32:00) Thyroid disorders + ocular surface changes
• (34:00) MGD causes: bacteria, rosacea, demodex, lash products
• (40:36) Inflammation cycle + why symptoms get worse
• (44:00) Three lifestyle steps every patient should start today
• (46:58) Lid hygiene: tea tree, okra, manuka, hypochlorous acid

Key Takeaways

🔹 Dry eye is a multi-layered syndrome, not a single issue

🔹 Meibomian glands drive most cases- oil imbalance leads to evaporation

🔹 Inflammation is both a symptom and an accelerator of dry eye

🔹 Lifestyle habits (blinking, hygiene, hydration) truly change outcomes

Dr. Cecelia Koetting is an assistant professor at the University of Colorado School of Medicine specializing in anterior segment disease, ocular surface disease, neuro-optometry, and perioperative care. She is active in clinical research and widely known for her expertise in dry eye, meibomian gland dysfunction, and complex ocular surface conditions.

• Dr Cecelia Koetting