The Diagnosis and Management of Dry Eyes

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Anatomy and physiology of the tear film

The anatomy of the tear film really begins with the ocular surface, because a healthy tear film depends upon a healthy ocular surface, and a healthy ocular surface depends upon a healthy tear film. The tear film, therefore, can be considered to have four layers: the ocular surface, the mucous layer, the aqueous layer, and the lipid layer. Together they lubricate, nourish, and protect the ocular surface.

The pathogenesis of dry eye disorders

The pathogenesis of dry eye involves several processes. First, in dry eye, the tear film loses water, and tear film osmolarity increases. This increase in tear film osmolarity causes an osmotic dehydration of the eye surface and the symptoms of dry eye. Validated symptom questionnaires have shown that in dry eye symptoms get worse as the day goes on [17], and Farris and co-workers [14] have shown that tear film osmolarity increases as the day goes on. Second, the ocular surface pathology shows

Pathways to dry eye

In approaching the patient with dry eye, it is important to know how patients can develop dry eye (Fig. 1).

The history

Although much emphasis has been placed on the use of diagnostic tests to diagnose dry eye, the most helpful diagnostic tool available today in diagnosing dry eye is the history. A classic dry eye history has high sensitivity and specificity and is helpful in separating dry eye from other causes of chronic eye irritation. The following seven questions will extract the information needed:

  • 1.

    Character: What does the irritation feel like? Is it a sand/-gritty feeling, burning, foreign body sensation,

Treating dry eye

The most important goal in treating dry eye, whether the condition results from decreased tear production or increased tear film evaporation, is to lower elevated tear film osmolarity while addressing any concomitant inflammatory lid disease.

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