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
- refractive surgery
- contact lens use
- diabetes mellitus
- systemic medications
- preserved topical ophthalmic medications
- sarcoidosis
- Parkinson disease
- environmental factors
- occupational factors
Diagnostic investigations
1st investigations 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 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.
Differentials
- Red eye
- Sjögren syndrome
- Meibomian gland dysfunction
More DifferentialsGuidelines
- Dry eye syndrome
- TFOS Dry Eye Workshop II (TFOS DEWS II) report
More Guidelines
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer