Dry eye disease

Last reviewed: 3 Sep 2022
Last updated: 22 Oct 2019

Summary

Definition

History and exam

Key diagnostic factors

  • known underlying medical cause
  • use of known causative medications
  • corneal filaments
More key diagnostic factors

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
Other diagnostic factors

Risk factors

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

Diagnostic investigations

1st investigations to order

  • tear film meniscus height (meniscometry)
  • tear film/fluorescein breakup time (TFBUT)
  • Schirmer test
More 1st investigations to order

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 received travel and meeting costs from Novartis, Bayer, and DORC.

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

Ophthalmology Specialist Registrar (ST7)

Sunderland Eye Infirmary

Sunderland

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.

Use of this content is subject to our disclaimer