For Doctors - Diagnosis of Dry Eye

Dry Eye Syndrome (DES)

DES is a symptomatic description that may also be noted as Keratoconjunctivitis sicca / keratitis / conjunctivitis / xerophthalmia / epiphora (wasted tear production).

The issues relate to the tear film quality, balanced between the three main component secreting systems:

Lachrymal (USA: lacrimal) Glands become dysfunctional with ageing, hormonal variations such as the menopause or HRT, auto-immune diseases such as rheumatoid arthritis, Sjögren's syndrome and Lupus. Parkinson's and Thyroid Eye disease also disable natural lacrimal function.

Meibomian Gland Dysfunction is due to problems causing the Meibum secretions to become waxy and block the glands. Chalazions (UK: Styes, USA: Stys) follow with staphylococcus aureus being a common cause of blepharitis infection and inflammation.

Conjunctiva Goblet Cells dysfunction is rare but is now becoming more common as a result of corneal surface damage caused during LASIK refractive surgery.

Dry Eye Syndrome leads to a poor quality tear film where the concentrations of proteins, antibodies and essential corneal nourishment are low. Unbalanced osmolality and pH stress the surface cells.

Epidemiology

The Beaver Dam USA study of almost 6,000 adults over 5 years showed that dry eye is equally common in both men and women over 45 years of age.

Assessing Severity of Dry Eye conditions

Various measurement systems have been tried:

Schirmer's paper strip tear volume indicator
Rose Bengal staining
Slit lamp cellular examination
...but one of the simplest ways to determine dry eye severity is to use a scorecard of easy questions about the patient's recent history.

Each question scores 0 for "none", 1 for "a little", 2 for "a lot"

photophobia (oversensitivity to bright light)
foreign body sensation
blurring of vision
sensation of eye burning or soreness

Results:
      0 = no dry eye
      1-2 = mild dry eye
      3-5 = moderate
      6-8 = severe dry eye

next: Part 3 - Dry Eyes Care & Treatment