Diagnosis and classification of dry eye disease

Current recommendations from the Tear Film Ocular Surface Society’s 2017 DEWS workshop report may seem to require a very thorough examination is necessary for the accurate diagnosis and classification of dry eye disease (DED). However, most ophthalmic clinicians already have the tools they need at their disposal, Carina Koppen MD, PhD, University of Antwerp, told the 25th ESCRS Winter Meeting Virtual 2021. The Ocular Surface Disease Index (OSDI) questionnaire is very useful for determining the patient’s symptoms and the questionnaire can be completed in the waiting room. Also crucial is systematic slit lamp examination of the ocular surface, including the eye lids, lashes and margins and the lower and upper conjunctiva, said Dr Koppen. “As clinicians, we should not forget to systematically examine the eye lid margins and the orifices of the meibomian gland and to squeeze the glands to test their functionality,” she added. The next step, said Dr Koppen, is to determine tear break up time (TBUT) . A TBUT of of less than 10 seconds is suggestive of tear film instability , a TBUT of less than five seconds is the definitive signature of DED. Staining of the ocular surface will help determine the integrity of superficial cell layers. “If you want to improve your diagnostics systematically, screen for signs and symptoms. Listen to the patient’s symptoms of discomfort and fluctuating vision, look at the slit lamp and don’t forget to use a drop of fluorescein for BUT and staining which can tell you so much. And don’t forget to inspect and squeeze the meibomian glands,” Dr Koppen concluded.

Tags: dry eye disease, ESCRS Winter Virtual 2021