Inflammation a target for dry eye

Article

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.

Related Videos
ARVO 2024: Andrew D. Pucker, OD, PhD on measuring meibomian gland morphology with increased accuracy
 Allen Ho, MD, presented a paper on the 12 month results of a mutation agnostic optogenetic programme for patients with severe vision loss from retinitis pigmentosa
Noel Brennan, MScOptom, PhD, a clinical research fellow at Johnson and Johnson
ARVO 2024: President-elect SriniVas Sadda, MD, speaks with David Hutton of Ophthalmology Times
Elias Kahan, MD, a clinical research fellow and incoming PGY1 resident at NYU
Neda Gioia, OD, sat down to discuss a poster from this year's ARVO meeting held in Seattle, Washington
Eric Donnenfeld, MD, a corneal, cataract and refractive surgeon at Ophthalmic Consultants of Connecticut, discusses his ARVO presentation with Ophthalmology Times
John D Sheppard, MD, MSc, FACs, speaks with David Hutton of Ophthalmology Times
Paul Kayne, PhD, on assessing melanocortin receptors in the ocular space
Osamah Saeedi, MD, MS, at ARVO 2024
© 2024 MJH Life Sciences

All rights reserved.