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The Dry Eye

This document discusses the clinical features, signs, tests, and grading of dry eye severity. Key signs of dry eye include irritation, foreign body sensation, dryness, itching, and sore eyes. Tear film tests like the tear breakup time test (BUT) and Schirmer test are used to evaluate the tear film. Staining of the ocular surface with dyes like Rose Bengal can also indicate dry eye. Severity is graded on a scale of 1 to 4 based on signs and test results.

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Mohit Boora
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171 views8 pages

The Dry Eye

This document discusses the clinical features, signs, tests, and grading of dry eye severity. Key signs of dry eye include irritation, foreign body sensation, dryness, itching, and sore eyes. Tear film tests like the tear breakup time test (BUT) and Schirmer test are used to evaluate the tear film. Staining of the ocular surface with dyes like Rose Bengal can also indicate dry eye. Severity is graded on a scale of 1 to 4 based on signs and test results.

Uploaded by

Mohit Boora
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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The Dry Eye

Clinical features
• Symptoms suggestive of dry eye include :-
-- irritation,
-- foreign body (sandy) sensation,
-- feeling of dryness,
-- itching,
-- nonspecific ocular discomfort and
-- chronically sore eyes not responding to
a variety of drops instilled earlier.
Signs of dry eye
• Tear film signs:- It may show presence of
stingy mucous and particulate matter.
Marginal tear strip is reduced or absent
(normal height is 1 mm). Froth in the tears
along the lid margin is a sign of meibomian
gland dysfunction.
• Conjunctival signs :- It becomes lustureless,
mildly congested, conjunctival xerosis and
keratinization may occur. Rose Bengal or
Lisamin green staining may be positive.
• Corneal signs:- It may show punctate
epithelial erosions, filaments and mucus
plaques. Cornea may loose lusture. Vital
stains, fluorescein, Rose Bengal or Lisamin
green may delineate the above lesions.
• Signs of causative disease such as posterior
blepharitis, conjunctival scarring diseases
(trachoma, Stevens-Johnson syndrome,
chemical burns, ocular pemphigoid) and
lagophthalmos may be depicted.
Tear film tests
• 1. Tear film break-up (BUT) :- It is the interval
between a complete blink and appearance of
first randomly distributed dry spot on the
cornea. It is noted after instilling a drop of
fluorescein and examining in a cobalt-blue
light of a slit-lamp. BUT is an indicator of
adequacy of mucin component of tears. Its
normal values range from 15 to 35 seconds.
Values less than 10 seconds imply an unstable
tear film.
• 2. Schirmer-I test:- It measures total tear secretions. It
is performed with the help of a 5 × 35 mm strip of
Whatman-41 filter paper which is folded 5 mm from
one end and kept in the lower fornix at the junction of
lateral one-third and medial two-thirds. The patient is
asked to look up and not to blink or close the eyes .
• After 5 minutes wetting of the filter paper strip from
the bent end is measured. Normal values of Schirmer-I
test are more than 15 mm. Values of 5–10 mm are
suggestive of moderate to mild keratoconjunctivitis
sicca (KCS) and less than 5 mm of severe KCS.
• 3. Rose Bengal staining :- It is a very useful
test for detecting even mild cases of KCS.
Depending upon the severity of KCS three
staining patterns A, B and C have been
described: ‘C’ pattern represents mild or early
cases with fine punctate stains in the
interpalpebral area; ‘B’ the moderate cases
with extensive staining; and ‘A’ the severe
cases with confluent staining of conjunctiva
and cornea.
Grading of dry eye
severity
• Various criteria have been proposed to grade
severity of dry eye. Recently accepted system
based on severity of signs and tear film tests
recommended by Dry Eye Workshop (DEWS)
Report (2007) grades the severity of dry eye into
4 levels:
- Level 1 (mild dry eye),
- Level 2 (moderate dry eye),
- Level 3 (severe dry eye), and
- Level 4 (very severe dry eye).

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