Summary
Definition
History and exam
Key diagnostic factors
- known underlying medical cause
- use of known causative medications
- corneal filaments
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
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
Diagnostic tests
1st tests to order
- tear film meniscus height (meniscometry)
- tear film/fluorescein breakup time (TFBUT)
- Schirmer test
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
dry eye at initial presentation
chronic dry eye
Contributors
Authors
Jonathan Smith, FRCOphth, MRCP
Consultant Ophthalmologist
Sunderland Eye Infirmary
Sunderland
UK
Disclosures
JS has been reimbursed by DORC for attending several conferences.
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
Disclosures
DSJT declares that he has no competing interests.
Saurabh Ghosh, FRCOphth
Consultant Ophthalmologist
Sunderland Eye Infirmary
Sunderland
UK
Disclosures
SG declares that he has no competing interests.
Peer reviewers
I-Hui Wu, MD
Ophthalmology Resident
Wilmer Eye Institute
Baltimore
MD
Disclosures
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
Disclosures
GG declares that he has no competing interests.
Bob Avery, MD, PhD
Assistant Professor
Ophthalmology
University of New Mexico Medical School
Albuquerque
NM
Disclosures
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
Disclosures
VYB declares that she has no competing interests.
References
Key articles
Hakim FE, Farooq AV. Dry eye disease: an update in 2022. JAMA. 2022 Feb 1;327(5):478-9. Abstract
Amescua G, Ahmad S, Cheung AY, et al. Dry eye syndrome preferred practice pattern®. Ophthalmology. 2024 Apr;131(4):P1-49.Full text Abstract
Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017 Jul;15(3):276-83.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Red eye
- Sjögren syndrome
- Meibomian gland dysfunction
More DifferentialsGuidelines
- Dry eye syndrome preferred pactice pattern
- Dry eye syndrome preferred practice pattern
More Guidelines
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