Diagnosis

diagnosis

Obtain a detailed history from the patient:

• make certain that the symptoms are consistent with dry eye
  • inquire about chronic burning, grittiness, and visual fluctuations
  • worsening of symptoms with prolonged visual tasks, exposure to wind, and air conditioning strongly suggest dry eye
• rule out a systemic condition
  • presence of dry mouth suggests Sjögren’s syndrome
  • inquire about common systemic illnesses
• assess for any risk factors e.g. - use of drugs that worsen dry eye, previous ocular procedures etc
• check for any red flag signs
  • the following may indicate a more serious condition
    • acute history
    • persistent or profound visual loss
    • associated diplopia
    • systemic ill health evidenced by loss of weight or fever.

Multiple tests are required to assess symptoms and clinical signs.

• tear film breakup time (TBUT) test
  • a fluorescein dye is placed in the eye and the patient is asked to blink to distribute the dye throughout the tear film. The time taken between the individual's last complete blink and the breakup of the tear film is recorded using slit-lamp examination.
    • normal time for tear film breakup is 15–20 sec
    • values <10 seconds are considered as abnormal
• epithelial staining
  • special dyes (e.g. - rose bengal, lissamine green, or fluorescein dye) is used to assess corneal and conjunctival epithelium integrity
• Schirmer test
  • measures the tear production by the lacrimal gland during fixed time period

In addition several questionnaires are available for the diagnosis of DES and to assess the effects of treatments or to grade disease severity e.g -

• Ocular Surface Disease Index (OSDI) – used to measure symptom severity, frequency and impact on functioning
• Canadian Dry Eye Epidemiology Study (CANDEES) questionnaire – for screening

Reference:

• (1) Drug and Therapeutics Bulletin. The management of dry eye. BMJ. 2016;353:i2333.
• (2) Perry HD. Dry eye disease: pathophysiology, classification, and diagnosis. Am J Manag Care. 2008;14(3 Suppl):S79-87
• (3) Phadatare SP et al. A Comprehensive Review on Dry Eye Disease: Diagnosis, Medical Management, Recent Developments, and Future Challenges.  Advances in Pharmaceutics 2015, Article ID 704946