J Korean Med Assoc.  2018 Jun;61(6):352-364. 10.5124/jkma.2018.61.6.352.

Diagnosis and treatment of dry eye syndrome

• Kim EC

• KMID: 2414144
• DOI: http://doi.org/10.5124/jkma.2018.61.6.352

Abstract

Dry eye syndrome is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms. Tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles. Symptom screening with the Five-item Dry Eye Questionnaire or Ocular Surface Disease Index can be used to identify the possibility that a patient might have DED dry eye syndrome and triggers. The results of these screening tools can lead to performing diagnostic tests of (ideally non-invasive) breakup time, osmolarity and ocular surface staining with fluorescein and lissamine green (observing the cornea, conjunctiva and eyelid margin). Meibomian gland dysfunction, lipid thickness/dynamics and assessments of the volume and severity of tear allow the subclassification of dry eye syndrome as predominantly evaporative or aqueous deficient, which informs the management of dry eye syndrome. A staged management algorithm was derived that presents a stepwise approach to implementing the various management and therapeutic options according to disease severity.

Keyword

Dry eye syndromes; Tear film instability; Meibomian gland dysfunction

MeSH Terms

Conjunctiva
Cornea
Diagnosis*
Diagnostic Tests, Routine
Dry Eye Syndromes*
Eyelids
Fluorescein
Homeostasis
Humans
Inflammation
Mass Screening
Meibomian Glands
Osmolar Concentration
Tears
Fluorescein

Figure

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  Figure 1. Aqueous lacrimal secretion in upper fornix conjunctiva with slit lamp biomicroscopic exam.

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  Figure 2. Noncontact infrared meibography (grade 1, 2, 3, 4, respectively).

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  Figure 3. Lipid tear film interferometer with lipid thickness.

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  Figure 4. Noninvasive tear breakup time with keratometer.

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  Figure 5. Fluorescein stain (×16) of cornea in patient of dry eye syndrome.

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  Figure 6. Rose Bengal stain (×16) of conjunctiva in patient of dry eye syndrome.

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