Array of clinical findings also key to diagnosis
Despite recent advances in understanding of dry eye disease, diagnosis of this common disorder still depends on a multipronged evaluation combining findings from patient history and clinical examination.
"Relieving bothersome symptoms associated with dry eye disease and improving patient quality of life depends on accurate diagnosis and appropriate treatment," added Dr Rapuano, director of the Cornea Service and codirector of the Refractive Surgery Department, Wills Eye Institute, and professor of ophthalmology, Thomas Jefferson University, Pennsylvania, USA. "There is no single test [to diagnose] dry eye, and the focus of the evaluation is to identify signs and symptoms that differentiate dry eye disease from other conditions that can mimic it or coexist and contribute to the problem."
Look for clues
In his evaluation of patients with suspected dry eye disease, Dr Rapuano probes for historical clues that he believes provide some of the most valuable information in differentiating it from blepharitis, which may be comorbid, and ocular allergy, another common mimicker.
Primary complaints of dryness, grittiness, or a sandy feeling that are worse later in the day and during sustained visual activities associated with a reduced blink rate, such as reading, working at the computer, or watching TV, are consistent with dry eye disease. Reports of crusting, irritation, itching, and foreign body sensation in the morning suggest blepharitis, and if itching is the patient's main complaint, especially if it can be related to a particular environmental exposure, then allergic conjunctivitis appears likely.
Dr Rapuano also asks about the many systemic medications that can decrease tear production and bring on or exacerbate dry eye symptoms. Additionally, he considers that numerous topical medications can cause surface toxicity and ocular surface discomfort symptoms.
The history also elicits information about treatments tried for relieving symptoms. Benefit of up to 2 hours duration from using artificial tears supports a diagnosis of dry eye disease. Relief with use of hot compresses is consistent with blepharitis, and alleviation of symptoms from instillation of an over-the-counter or prescription anti-allergy drop indicates the problem may be allergy.