Dry Eye Disease Diagnostic Methods Are Inconsistent Between Eye Care Practitioners

Woman usind eyedropper...applying eye drops
Woman usind eyedropper…applying eye drops
Researchers investigate the attitudes of eye care professionals toward treating and diagnosing patients with dry eye symptoms to determine a need for uniform consensus.

Opinions on the utility of different dry eye diagnostic tests vary among eye care practitioners (ECPs), according to research published in Contact Lens and Anterior Eye. Researchers argue that clinicians must come to a uniform consensus and create consistency in diagnosing patients with dry eye disease. 

Researchers distributed an electronic questionnaire to 144 ECPs (7.6% ophthalmologists, 92.4% optometrists) between December 2020 and March 2021. The questionnaire presented various hypothetical symptoms and asked participants which symptoms and signs were associated with dry eye. The survey also assessed ECPs’ attitudes toward the utility of diagnostic tests and test characteristics, and their satisfaction with dry eye diagnostics. A total of 55.6% of ECPs reported having a special interest in treating dry eye.

The questionnaire demonstrated that clinicians still prefer traditional methods over new diagnostic tests. Clinical history (11.24±1.31 on a scale from 1-12) was the preferred method of dry eye diagnosis among ECPs. Optical coherence tomography (OCT) was viewed as the least useful diagnostic method (5.01±2.56). With the exceptions of fluorescein staining and fluorescein break-up time (FBUT) ECPs rated all other tests as significantly less useful than clinical history (P <.01 for all).  

ECPs associated posterior blepharitis with dry eye more than any other indicator listed on the survey including anterior blepharitis, skin signs of rosacea, contact lens wear, causative medications, and previous LASIK surgery (P <.01). 

When choosing a diagnostic test, ECPs indicated that test validity was significantly more important than patient comfort (P <.01), ease of use (P =.04), time to perform the test (P =.02), and the cost of the test (P <.01). 

Although ECPs’ attitudes toward patients with dry eyes were primarily positive (42.2%), their views towards diagnostic tests were primarily negative (41.9%). Many expressed empathy, confidence, and comfort in treating these patients, but stated that diagnostic tests were complicated, expensive, imprecise, and inconsistent, according to the report.

“Clinicians often struggle to provide satisfactory management for patients with dry eye, which is a common yet complex condition, especially as patient symptoms do not always match with clinical signs,” according to the researchers. “Despite the armamentarium of traditional and novel tests available for dry eye, to date, clinicians have not agreed upon a gold standard.”

Study limitations include a low participation rate by ophthalmologists, failure to screen participants for current work status, failure to screen IP addresses for repeat participants, and potential geographic bias. 


Li Y, Smith RG, Steel JC, Layton CJ. Attitudes of eye health practitioners towards diagnostic tests and therapies for dry eye disease in Australasia. Cont Lens Anterior Eye. Published online June 23, 2022. doi:10.1016/j.clae.2022.101724