6
Diagnosis
Î A high degree of suspicion is appropriate for patients who have
clinically significant dry eye and dry mouth symptoms. (III, G, S)
Î Patients who might have thyroid eye disease should be tested for anti-
thyroid peroxidase antibody and anti-thyroglobulin antibody. (III, In, D)
Î A B-scan sonogram or other imaging study should be ordered to assess
extraocular muscle thickness in patients who have suspected thyroid
eye disease. (III, G, S)
Î Conjunctival biopsy is appropriate for any patients who have significant
chronic conjunctivitis with a nodular appearance or cicatrization.
(III, In, D)
Î Several studies have failed to correlate tear osmolarity levels with
clinical signs or patient symptoms, and it is not clear that the test has
utility in the diagnosis of dry eye syndromes. (II-, M, D)
Î For patients with moderate to severe aqueous tear deficiency, the
diagnosis can be made by using one or more of the following tests: tear
break-up time test, ocular surface dye staining, and the Schirmer test.
(III, In, D)
Î These tests should be performed in this sequence because the
Schirmer test can disrupt tear film stability and cause false-positive
ocular surface dye staining. (III, In, D)
Î Several minutes should be allowed between the dye testing and the
Schirmer test. (III, In, D)
Î Corneal sensation should be assessed when trigeminal nerve
dysfunction is suspected. (III, M, D)
Î A laboratory and clinical evaluation for autoimmune disorders should
be considered for patients with significant dry eye, other signs and
symptoms of an autoimmune disorder, or a family history of an
autoimmune disorder. (III, G, S)
Î Because most dry eye conditions have a chronic course, repeated
observation and reporting of symptoms over time will allow clinical
diagnosis of dry eye in most cases. (III, G, S)
