Vol. 2, #13   •   Thursday, June 17, 2021


Review's Chief Clinical Editor
Paul M. Karpecki, OD, FAAO

Provides you with cutting-edge clinical strategies for optimal management of ocular surface disease and beyond.


Dry Eye Symptoms Without Signs: Consider a Different Diagnosis

One particular case emphasizes why dry eye signs must accompany symptoms for accurate dry eye diagnosis.

A patient presented to the office after having been treated for dry eyes for almost four years. He complained of dry, gritty eyes and foreign body sensation. The symptoms were present upon wakening and seemed to worsen as the day went on. The patient had been treated with every conceivable dry eye drop, oral medication, in-office treatment, and OTC product. Nothing seemed to work.

Osmolarity measurements were 297 mOsmol/L OD and 296 mOsmoL/L OS. Meibomian gland expression showed clear, easy oil expression, and ample tear meniscus was present. The key to diagnosis in this case was NaFl staining, as it revealed superior foreign body tracking in one eye. The patient was informed that he probably didn’t have dry eye, and everting the upper eyelid revealed concretions in both eyes.

This case underscores why dry eye signs must accompany symptoms: There are simply far too many conditions exhibiting symptoms consistent with dry eye that may lead to misdiagnosis. They include the following:

Allergic conjunctivitis
Epithelial Basement Membrane Dystrophy/ Map Dot Fingerprint Dystrophy
Pinguecula or Pterygia
Mucin fishing syndrome
Limbal stem cell deficiency
Demodex blepharitis
Giant papillary conjunctivitis (GPC)
Asthenopia (e.g., Convergence insufficiency)
Trigeminal dysphoria
Salzmann’s Nodular Degeneration
Conjunctivochalasis (CCH)
Conjunctival concretions
Superior limbic keratoconjunctivitis (SLK)
Graves ophthalmopathy
Exposure keratitis
Corneal neuralgia/neuropathic corneal pain

This long list reinforces why signs (indicated by osmolarity findings, TFBUT, MG expression, tear meniscus status, ocular surface staining, etc.) are essential to making a dry eye disease diagnosis.

KEY TAKEAWAY: Don’t rely on symptoms alone to make a diagnosis of dry eye. The lack of signs likely indicates one of many differential diagnoses.

Supported by an independent medical grant from Kala Pharmaceuticals

Review of Optometry® is published by the Review Group, a Division of Jobson Medical Information LLC (JMI), 19 Campus Boulevard, Newtown Square, PA 19073.

To subscribe to other JMI newsletters or to manage your subscription, click here.

To change your email address, reply to this email. Write "change of address" in the subject line. Make sure to provide us with your old and new address.

To ensure delivery, please be sure to add revoptom@lists.jobsonmail.com to your address book or safe senders list.

Click here if you do not want to receive future emails from Review of Optometry.