A concise review of current knowledge in the stimulation and regulation of tear production and its relationship to the ocular surface is presented. A discussion of treatment modalities, their benefits and drawbacks, follows. An approach to developing a rational treatment plan in the management of dry eyes is suggested with specific strategies. The application of these principles and the use of specific treatment modalities to manage the discreet manifestations of dry eye syndrome can lead to successful management in the majority of cases, with the preservation of useful vision and the relief of symptoms.