Clinical Features and Investigation of Dry Eye.

Symptoms of Dry Eye:

  • Feelings of dryness, grittiness and burning sensation that characteristically worsen over the course of the day.
  • Stringy discharge, transient blurring of vision, redness and crusting of the lids are also common.
  • Sensitivity to light, Difficulty with nighttime driving.
  • Foreign Body (FB) sensation
  • Watery eyes, which is the body’s response to the irritation of dry eyes.
  • Lack of emotional or reflex tearing is unusual.

Signs of Dry Eye:

1. In Eyelid:

  • Posterior (seborrhoeic) blepharitis.
  • Meibomian gland dysfunction.

2. In Conjunctiva:

  • Redness.
  • Staining with fluorescein and rose Bengal.
  • Keratinization.
  • Conjunctivochalasis.

3. Tear film:

  • In the normal eye, When the tear film breaks down the mucin layer becomes contaminated with lipid but is washed away.
  • In the dry eye, The lipid-contaminated mucin accumulates in the tear film as particles and debris that move with each blink
  • The marginal tear meniscus (strip), In the normal eye the meniscus is 0.20.4 mm in height but in dry eye becomes thin or absent.

4. In Cornea:

  • Punctate epithelial erosions, that stain well with fluorescein
  • Filaments, stain well with rose Bengal but less with fluorescein.
  • Mucous plaques, occur in severe dry eye.

Investigation to diagnose Dry Eye:

  • The aim of investigation is to quantify and confirm a clinical diagnosis of dry eye.
  • The tests measure the following parameters:

1. Stability of the tear film:

  • Tear break-up time (BUT).

2. Tear production:

  • Schirmer Test.
  • Fluorescein clearance.
  • Tear osmolarity.

3. Ocular surface disease:

  • Corneal stains
  • Impression cytology
  • There is no clinical test to confirm the diagnosis of evaporative dry eye.
  • Diagnosis is based on the presence of associated clinical findings.

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