Clinical studies have failed to correlate symptoms with clinical findings.[26][27] This means some patients are hugely troubled by symptoms but have minimal defects on examination and, more worryingly, some patients are relatively free of symptoms but have significant defects. Diagnosing dry eye requires detailed history taking, clear documentation, ophthalmologist-led examination, and various diagnostic tests.[28]

Consider undiagnosed Sjögren syndrome in patients presenting with dry eye. If histories suggest underlying systemic causes, it is important to document systemic signs and refer to appropriate specialities.

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