5
Î Identifying characteristics of the causative factors, such as adverse
environments, prolonged visual efforts, or ameliorating circumstances,
is helpful in diagnosing dry eye. (III, G, S)
Î Supporting clinical observations and tests are used to confirm the
diagnosis. (III, G, S)
Î Questions about patient symptoms and signs, exacerbating conditions,
duration of symptoms, and ocular history may elicit helpful information.
(III, G, S)
Î All patients should have a comprehensive adult medical eye evaluation
at the recommended intervals. (II++, G, S)
Î The initial evaluation of a patient who presents with symptoms
suggestive of dry eye should include those features of the
comprehensive adult medical eye evaluation relevant to dry eye.
(II++, G, S)
Î The external examination should pay particular attention to the skin,
eyelids, adnexa, proptosis, cranial nerve function, and hands. (III, G, S)
Î Evaluation of conjunctival staining is helpful but underutilized.
(III, In, D)
Î Patients with moderate punctate staining of the cornea and/or
conjunctiva should be considered for testing for an underlying Sjögren
syndrome, since these patients will require a multidisciplinary
approach. (III, In, D)
Î Lissamine green dye is NOT recommended for evaluating corneal
epithelial disease. (III, In, D)
Î The Schirmer test can be performed to evaluate aqueous tear
production, but it is well recognized that it gives variable results and
should not be used as the sole criterion for diagnosing dry eye.
(III, In, D)
Î The slit-lamp biomicroscopy evaluation should focus on the tear film,
eyelashes, anterior and posterior eyelid margins, puncta, conjunctiva,
and cornea. (III, G, S)
Î A detailed review of systems should be performed for any patient who
has clinically significant dry eye. (III, G, S)
Diagnosis
