Pitfalls of dry eye disease diagnosis
Listening to patients is key in diagnosing dry eye disease
Prof Marc Labetoulle
Dry eye disease assessment has many pitfalls, but most can be overcome with a 10-minute examination, said Prof Marc Labetoulle, South Paris University, France, at the ESCRS/EuCornea Cornea day in Marrakech, Morocco.
He noted that the first step in the examination is to listen to the patient’s description of their dry eye symptoms. That involves having the patient complete an OSDI questionnaire while still in the waiting room and then hearing the patient’s spontaneous complaints as well as information about risk factors.
The second step is examination of the eyes themselves, starting with slit-lamp examination, first without fluorescein to determine tear break-up time. Lid evaluation should follow, to determine the main mechanism of DED, whether it is aqueous deficiency or meibomian gland dysfunction. One should also be careful not to miss signs of other ocular surface diseases such as limbal keratitis, he pointed out.
It is also essential to get an idea about the level of tear secretion. Research shows Schirmer test and phenol red thread tests are reliable, and assistants can be trained to perform them effectively. Tear meniscus measurement can be a practical alternative, although there are precisely validated normal values for the parameter.
Once these tests and examinations are complete the prescription may be formulated that specifically addresses both the patient’s symptoms and the underlying disease, Prof Labetoulle said.