Dry Eye Experts Rely on Patient Symptoms, Clinical Signs for Diagnosis

Dry eye experts frequently identify dry eye disease using subjective questionnaires and evaluating ocular surface damage, according to research published in Heliyon. However, clinicians do not appear to follow any strict criteria when making the diagnosis, the report suggests.

Researchers included responses from 77 dry eye experts through an anonymous online survey administered between June and July 2021. The respondents compared their diagnostic methods with those outlined in the Tear Film & Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) and evaluated the importance of using tear breakup time (TBUT), Schirmer testing, tear meniscus height, tear osmolarity, noncontact meibography, and other assessments for diagnosing dry eye disease using a 5-point Likert scale (1, never; 5, always).

A majority of the dry eye experts (98.6%) reported using subjective questionnaires as a tool for diagnosing dry eye disease — 71.4% stated they used them always or frequently. All survey respondents reported performing meibomian gland and blepharitis assessments and evaluating ocular surface damage. A majority assessed ocular surface damage through fluorescein staining (92%). Tear film composition was the least evaluated feature, with a total of 69.8% of participants reporting performing this assessment. Among the clinicians who did perform this assessment, most performed it using tear osmolarity testing (66.2%).

Clinicians from Europe reported a greater importance for using TBUT (P =.002) and Schirmer assessment (P =.021) compared with dry eye experts in North America, according to the report. 

“The results highlight the importance of considering symptoms and clinical signs, especially those related to epithelial damage, tear film instability, and tear volume, without necessarily following strict criteria,” according to the study authors.  

Survey limitations include an underrepresentation of dry eye experts from certain regions, the use of a subjective approach to locate experts, and a high proportion of experts working in academia.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.