The most important first step in treating Dry Eye Syndrome and the numerous related co-morbidities is an accurate diagnosis. In some cases a doctor may be able to diagnose Dry Eye simply by looking at the tear film and evaluating the volume of the tear pools. If the eyes are not glossy and the tear pool is minimal, the diagnosis may be aqueous tear deficiency. Some doctors may rely on relatively simple tests, like variations of the Schirmer test, in which a type of litmus paper is placed inside the lower lids to measure the amount of tears produced. One study found that TBUT (tear break-up time) and fluorescein stain were the most frequently used clinical tests.
However, the reliance on common tests belies the need for more comprehensive diagnostic techniques that provide accurate and actionable results to inform effective treatment protocols. For example, examination of the meibomian glands is usually warranted when there is aqueous deficiency, because the two conditions, aqueous tear deficiency and meibomian gland dysfunction (MGD), frequently co-exist. Having an accurate picture of the state of the meibomian glands allows for the development of a more effective overall treatment plan. But, merely examining the meibomian glands may not be enough because of the numerous other co-morbidities that frequently can co-exist with aqueous deficiency and MGD.
Complicating matters, as patients we may not always be willing participants in the testing process. Sometimes we are afraid of what the diagnosis may be. Or, we may fear the potential pain or discomfort associated with the test itself. Some of us may find it hard to trust doctors who perform the tests, having seen many who promised hope for our debilitating condition but did little in the way of relieving symptoms. And others may balk at the possible out-of-pocket costs.
Regardless, in the hands of a capable ophthalmologist or optometrist, the tests are usually painless and although there may be some discomfort, they are usually easily tolerated. Most tests take only a few moments; a few, like the modified Schirmer, no more than 15 minutes. Pain is eliminated if numbing drops are well tolerated. For those who might be allergic to preservatives in numbing drops, a quick irrigation with a few squirts of .9% sterile saline solution should minimize any adverse reaction.
Consequently, we recommend that thorough testing for Dry Eye and related conditions be undertaken so that the diagnosis is both accurate and comprehensive.
Unfortunately, even with numerous tests and tools available, the specific causes of Dry Eye symptoms and discomfort are often missed or misdiagnosed. When this happens again and again, sufferers tend to lose hope and may even begin to think that no one can help them or even figure out what’s wrong.
If your doctor isn’t telling you very specifically what’s wrong and why you feel the way you do, it may be time to find another doctor who is specializes in cornea and external diseases with a subspecialty in Dry Eye Syndrome.
For information on commonly used diagnostic methodologies, see:
Diagnostic Tools and Techniques
For more information about the challenges of diagnosing Dry Eye see:
These reports published in 2007 and 2011 provide detailed information about diagnostic methodologies available at the time: