Diagnosing Dry Eye

Diagnosing Dry Eye – Tools that help uncover the signs and symptoms of this common condition.

Ocular surface disease

Nowadays, ophthalmologists and optomotrists have to deal regularly with dry eye patients and ocular surface diseases. For better diagnosis and identify patients who need dry eye treatment, a variety of tests and tools are available to your doctor.

Education about Dry Eyes

Prior visiting your doctor office, make sure you read about the subject and better understand what dry eye is. This will allow you to have a better dialogue with your doctor. Your doctor will certainly ask you several questions to better understand your type of dry eye and the treatment best suited for you. Make sure to tell to your doctor if you experience dry, watery, burning eyes or any other symptoms. Do not forget to talk about your environmental and lifestyles. A myriad of factors could contributes to your dry eye problem. Your doctor will probably ask you some questions about your home and work environments that may contribute to your symptoms.

As explained in our article : DRY EYES AT NIGHT, by just turning off the ceiling fan, you may get considerable improvement of your dry eye symptoms. Make a list of the medications you are taking. Some medications are known to dry out the eyes. Bring this list during your visit to the doctor and show it to him.

Clinical Examination

When the doctor will examine your eyes  he will look, among other things, at these points:

• Adnexa (dermatological infllammation, dermatochalasis, rosacea)
• Eyelids and eyelid margins (infectious, inflammatory, allergic, lagophthalmos, blepharitis, meibomian gland dysfunction, lid-wiper epitheliopathy, giant papillary conjunctivitis)
• Conjunctiva (staining, chemosis, conjuctivochalasis)
• Cornea (topographical, hypoxia, secondary infectious / inflammatory dystrophy).

It seems that MGD is the most frequent cause of dry eye. It is possible to be in presence of MGD even if the eyelids looks normal at the first glance.

Clinical Testing

Schirmer test

Schirmer test is to evaluate aqueous tear production. This test is more often used in patients referred by a rheumatologist. Normally, if you get a result of 10 mm or more of moisture on the filter after 5 minutes, your aqueous tear secretion is considered normal.

Corneal and conjunctival staining

For this test, the doctor will use a staining dye. This is why you have to remove your contact lenses prior to the doctor visit. The dye is Fluorescein and it will help to reveal defects in the corneal and conjunctival epithelium. On the other hand, Rose Bengal will stain dead conjunctival cells or cells that are not adequately protected by a normal mucin layer.

Lissamine green works by the same mechanism as rose bengal but tends to be less irritating for the patient.

Usually, the degree of staining is directly proportional with the degree of aqueous tear deficiency, tear break-up time and reduced mucus production by conjunctival goblet cell and epithelial cells.

If the doctor sees staining on the ocular surface, the ocular surface must be treated before thinking to wear contact lenses.

Tear breakup time

Tear breakup time TBUT will help to evaluate the evaporative tear deficiency. It is fast and easy for the doctor to evaluate your tear breakup time. Usually, a TBUT of less than 10 seconds is considered to be abnormal indicating tear film instability. Under 5 seconds you will probably start to feel dry eye symptoms.

InflammaDry

This test is used to measure ocular inflammation. The purpose of this test is to measure the amount of matrix metallproteinase-0 (MMP-9) in your tears. MM-9 is a marker for inflammation. Results are obtained in 10 minutes and are easy to interpret. A red mark is positive while a blue line is negative.

TearLab Osmolarity

The Tearlab Osmolarity test is also quick and easy to use. The doctor will collect a very small amount of your tears to obtain a result. Usually, osmolarity values above 308 mOsms/L are an indication of a dry eye.

Anterior segment imaging

Your doctor might want to use newer technologies such as Oculus or Lipiview to evaluate your tear film regularity. These machines help to evaluate more precisely lipid layer thickness, blink rates. The lipiview will also permit the doctor to visualize your meibomian glands structure and have a better idea of the severity of your MGD.

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