Dry Eye Signs and Symptoms
All primary eye conditions considered, dry eye disease (DED) may have the greatest impact on your practice. More than 30 million people in the US alone likely have DED, making it the most common ocular condition we manage.1 But even outside of medical eye care—DED contributes to increased rates of contact lens drop out (consequently forcing spectacle remakes) and yields suboptimal postoperative refractive outcomes.2 The condition may even inhibit compliance with glaucoma medications. So, it's imperative we monitor for DED in every patient encounter.
Because signs and symptoms don’t always correlate, it's imperative that we conduct testing in all suspected cases.3
● Symptoms. Results from TFOS DEWS II recommend the use of a validated dry eye questionnaire. The researchers' recommendations were the DEQ-5 (which I use) or the OSDI. Other effective options include the SPEED questionnaire. If you want to rely on patient history, consider asking a few key questions:
Do your eyes ever feel dry or uncomfortable?
- Are you bothered by changes in your vision throughout the day?
- Are you ever bothered by red eyes?
- Do you ever use or feel the need to use drops?
● Signs. While it is important to consider corneal staining in a DED work-up in order to determine dry eye severity, staining alone is a poor early disease indicator.4 It almost goes without saying that DED is profoundly easier to manage if diagnosed early. For example, early diagnosis and intervention may potentially allow patients to remain in their contact lenses. Any two or more of the following could help identify DED patients, including those with early-stage disease:
- Osmolarity testing, which is considered the most accurate diagnostic approach for early disease detection.5
- Meibomian gland expression.
- Non-invasive tear film break-up time
- Conjunctival staining (e.g., lissamine).
Once you identify DED, initiate treatment by controlling inflammation via the use of topical prescription medications (e.g., lifitigrast), lubricating drops, warm compresses and omega-fatty acid supplementation.
1. Paulsen AJ, Cruickshanks KJ, Fischer ME, et al. Dry Eye in the Beaver Dam Offspring Study: Prevalence, Risk Factors, and Health-Related Quality of Life. Am J Ophthalmol. 2014 April;157(4):799-806.
2. Nelson D, Craig JP, Esen K, et all. TFOS DEWS II Introduction. The Ocular Surface 15 (2017) 269e275.
3. Nichols KK, Nichols JJ, Mitchell GL. The lack of association between signs and symptoms in patients with dry eye disease. Cornea. 2004 Nov;23(8):762-70.
4. Savini G, Prabhawasat P, Kojima T, et al. The challenge of dry eye diagnosis. Clin Ophthal-mol. 2008 Mar;2(1):31-55.
5. Masmali A, Alrabiah S, Alharbi A. Investigation of tear osmolarity using the TearLab Osmo-larity System in normal adults in Saudi Arabia. Eye Contact Lens. 2014;40(2):74-8.