How Is Chronic Dry Eye Diagnosed?

Dry eye disease is a complex and distressing disease of the eye. Many conditions, drugs, and other factors may lead to chronic dry eye. Because of the complex nature of the disease, there is not a single gold standard for diagnosis. Follow-up management for symptoms may also vary depending on the type and severity of dry eye.1

Dry eye symptoms may be dismissed by a doctor when first reported. This is often because dry eye is common. It is important to know that experiencing occasional dry eyes is different from chronic dry eye and the damage caused by the disease. A correct diagnosis is key to make sure you get the treatment you need.

Medical history and physical exam

Because chronic dry eye may be linked to various conditions, it is important to provide a detailed medical history. Bring a list of medicines you take. Make sure to also tell your doctor about any nutritional supplements you may be taking.1,2

Describe your symptoms in detail:

  • What time of day are your symptoms worse?
  • What activities or situations make them better or worse?

One tool your eye doctor may use is called the ocular surface disease index (OSDI). The OSDI is a 12-question survey that is used to help diagnose dry eye disease. The survey focuses on physical symptoms. The impact of dry eye symptoms on activities of daily living – such as reading, driving at night, looking at a computer screen or TV – are assessed in the survey.2

Your doctor will look at your eyelids, which play a major role in dry eye symptoms. Many times, dry eyes may happen because of problems with your eyelids. Glands that help with tear production are found in your eyelids, along with nerves. If your eyelids do not properly close, dry eye symptoms may also develop.3

Eye tests or exams

Eye tests and exams are important to help diagnose dry eyes. When you visit your eye doctor, some of the following tests or exams may be needed.

Slit lamp examination

A slit lamp is a microscope with a bright light. Your doctor uses this to see the parts of your eye up close. This device is a key to finding eye disease and assessing the overall health of your eye.4

Schirmer test

This is a test used to measure the amount of your tears. Blotting strips of paper are placed under your lower eyelids. Your doctor then checks the amount of strip soaked by your tears after 5 minutes. A strip with less than 5 milliliters of wetting suggests decreased tear production.5

Fluorescein, lissamine green, and rose bengal staining

Diagnostic dyes are used to see if there is damaged tissue on the surface of your eye. Your doctor places eye drops containing the dye or paints the surface of your eye with test strips containing the dye. Your doctor will then use the slit lamp to see areas of damage on the surface of your eyes.5-8

Phenol red thread test

A thread that is filled with a dye is placed over your lower eyelid for 15 seconds. Your tears change the color of the dye, which measures the volume of your tears. If the volume of your tears are less than normal, this may be the reason for your dry eyes.5

Managing underlying conditions

The term comorbidity is used to describe a condition or illness that occurs at the same time as another condition or illness. There are many different comorbid conditions for chronic dry eye. Your doctor will focus on treating any condition that may be contributing to or causing your dry eye symptoms.9

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Written by: Katie Murphy│Last reviewed: June 2021