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Dry eye disease

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  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 11 Dec 2025
Last updated: 19 Jun 2025

Summary

Definition

History and exam

Key diagnostic factors

  • known underlying medical cause
  • use of known causative medications
  • corneal filaments
Full details

Other diagnostic factors

  • ocular irritation/foreign body sensation
  • ocular burning
  • transient blurred vision
  • tearing
  • blepharitis/meibomianitis
  • punctate epithelial erosions
  • conjunctival punctate erosions
  • conjunctival injection
  • lagophthalmos
  • proptosis
  • presence of mites
Full details

Risk factors

  • female sex
  • older age
  • blepharitis/meibomianitis
  • connective tissue disorders
  • vitamin A deficiency
  • hepatitis C
  • HIV
  • hematopoietic stem cell transplantation
  • lens and eyelid surgery
  • contact lens use
  • diabetes mellitus
  • systemic medications
  • preserved topical ophthalmic medications
  • sarcoidosis
  • Parkinson disease
  • environmental factors
  • occupational factors
  • headache
Full details

Diagnostic investigations

1st investigations to order

  • tear film meniscus height (meniscometry)
  • tear film/fluorescein breakup time (TFBUT)
  • Schirmer test
Full details

Emerging tests

  • tear film osmometry
  • metalloproteinase-9 (MMP-9) detection
  • corneal topography
  • ocular surface interferometry
  • infrared thermography
  • in-vivo confocal microscopy
  • ocular surface immune markers (OSIM)

Treatment algorithm

ACUTE

dry eye at initial presentation

ONGOING

chronic dry eye

Contributors

Authors

Jonathan Smith, FRCOphth, MRCP

Consultant Ophthalmologist

Sunderland Eye Infirmary

Sunderland

UK

Disclosures

JS declares that he has no competing interests.

Philip Severn, FRCOphth, MRCP

Consultant Ophthalmologist

James Cook University Hospital

Middlesbrough

UK

Disclosures

PS declares that he has served on the advisory boards of and received travel grants from Bayer and Novartis. He has also received travel grants from Allergan.

Darren Shu Jeng Ting, FRCOphth, PhD

Honorary Associate Professor of Ophthalmology

School of Medicine

University of Nottingham

Consultant Ophthalmologist

Birmingham and Midland Eye Centre

UK

Declarações

DSJT declares that he has no competing interests.

Saurabh Ghosh, FRCOphth

Consultant Ophthalmologist

Sunderland Eye Infirmary

Sunderland

UK

Declarações

SG declares that he has no competing interests.

Revisores

I-Hui Wu, MD

Ophthalmology Resident

Wilmer Eye Institute

Baltimore

MD

Declarações

IW declares that she has no competing interests.

Gus Gazzard, MA, MBBChir, MD, FRCOphth

Consultant Ophthalmic Surgeon

King's College Hospital

Honorary Research Fellow

Institute of Ophthalmology

London

UK

Declarações

GG declares that he has no competing interests.

Bob Avery, MD, PhD

Assistant Professor

Ophthalmology

University of New Mexico Medical School

Albuquerque

NM

Declarações

BA declares that he has no competing interests.

Vatinee Y. Bunya, MD

Co-Director

Penn Dry Eye and Ocular Surface Center

Assistant Professor

Cornea and External Disease

Scheie Eye Institute

Philadelphia

PA

Declarações

VYB declares that she has no competing interests.

Créditos aos pareceristas

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Referências

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Principais artigos

Hakim FE, Farooq AV. Dry eye disease: an update in 2022. JAMA. 2022 Feb 1;327(5):478-9. Resumo

Amescua G, Ahmad S, Cheung AY, et al. Dry eye syndrome preferred practice pattern®. Ophthalmology. 2024 Apr;131(4):P1-49.Texto completo  Resumo

Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017 Jul;15(3):276-83.Texto completo  Resumo

Shtein RM, Shen JF, Kuo AN, et al. Autologous serum-based eye drops for treatment of ocular surface disease: a report by the American Academy of Ophthalmology. Ophthalmology. 2020 Jan;127(1):128-33.Texto completo  Resumo

Artigos de referência

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