Do dry eyes cause inflammation, or does inflammation lead to dry eyes?

Most would agree that dry eyes cause inflammation.

Another way to look at this is to ask, "What does inflammation feel like and what exactly is inflamed. I have seen patients complaining of dryness whose tear volume is fine, who exhibit no redness or obvious inflammation. Do they report dryness in response to inflammation that is not obvious during the exam? I think they do sometimes. Can we assume the eyes are minimally inflamed? Can we assume that some component of the tears is lacking in spite of the normal volume? If we treat that patient with anti-inflammatories and they say, "My eyes feel better now, not as dry.", do we presume they actually had inflammation causing the sensation of dryness? I really don't have an exact answer to the second part of your question.