Dry Eyes - UpToDate

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Dry eyes
Author: Roni M Shtein, MD

Section Editor: Jonathan Trobe, MD
Deputy Editor: Lee Park, MD, MPH
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Nov 2016. | This topic last updated: Dec 22, 2015.
INTRODUCTION — Dry eye disease is a multifactorial disease of the tears and ocular surface that can result
in ocular discomfort and visual impairment [1]. Dry eye is also known as keratoconjunctivitis sicca, dry eye
syndrome, and dysfunctional tear syndrome.
The epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment options for dry eye will be
reviewed here. Various conditions associated with dry eye are discussed separately. (See "Diagnosis and
classification of Sjögren's syndrome" and "Allergic conjunctivitis: Clinical manifestations and diagnosis" and
"Blepharitis".)
EPIDEMIOLOGY
Prevalence — The exact prevalence of dry eye disease is unknown due to the difficulty in defining the
disease and the lack of a single diagnostic test to confirm its presence. Based on self-report of dry eyes in the
Beaver Dam Offspring cohort, prevalence of dry eye was reported as 14.5 percent (17.9 percent in women
and 10.5 percent in men) [2]. Other studies have estimated prevalence at 5 to 30 percent of the population
age 50 years and over [3-5]. This prevalence is expected to increase as the population in developed
countries continues to age.
Risk factors — Risk factors for dry eye disease include [6-9]:
● Age
● Female gender
● Hormonal changes (primarily due to decreased androgens)
● Systemic diseases (eg, diabetes mellitus, Parkinson disease)
● Contact lens wear
● Systemic medications (antihistamines, anticholinergics, estrogens, isotretinoin, selective serotonin
receptor antagonists, amiodarone, nicotinic acid)
● Ocular medications (especially those containing preservatives)
● Nutritional deficiencies (eg, vitamin A deficiency)
● Decreased corneal sensation
● Ophthalmic surgery (especially corneal refractive surgery)
● Low humidity environments
Sjögren's syndrome (SS) is a chronic inflammatory disorder characterized by diminished lacrimal and salivary
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gland function. Risk factors specific for Sjögren's Syndrome include a genetic predisposition, low androgen
status, nutritional deficiencies, and exposure to environmental agents [10]. Dry eye related to Sjögren's
syndrome is reviewed separately. (See "Diagnosis and classification of Sjögren's syndrome".)
CLINICAL SIGNIFICANCE — Dry eye disease can have a significant impact on visual acuity, daily activities,
social and physical functioning, and workplace productivity [11].
Utility assessment is a formal method for quantifying the relative impact on patients by a variety of disease
states. Previous studies evaluating the impact of dry eyes on quality of life show that patients with moderate
to severe dry eye report utility scores similar to patients with moderate to severe angina or patients receiving
dialysis [12,13].
In addition, patients with dry eye incur direct medical costs through frequent visits to health care
professionals, as well as pharmacologic and non-pharmacologic therapies. Indirect costs include decreased
productivity and time lost from work [14]. A cost analysis study estimates an overall annual cost of $55.4
billion to the United States from a societal perspective [15].
PATHOPHYSIOLOGY — Dry eye has a complex and multifactorial etiology. The tear film of the eye consists
of aqueous, mucous, and lipid components (figure 1). A healthy tear film relies on a synergistic interaction of
the lacrimal glands, eyelids, and ocular surface, which together comprise the lacrimal functional unit [16].
Dysfunction of any component in the lacrimal functional unit can lead to dry eye disease.
Dry eye is classified into two general groups: decreased tear production and increased evaporative loss. In
both groups, tear film hyperosmolarity and subsequent ocular surface inflammation lead to the variety of
symptoms and signs associated with dry eye.
Decreased tear production — Impaired lacrimal tear production can be caused by any form of lacrimal
gland destruction or dysfunction. The reduced volume of aqueous fluid leads to hyperosmolarity of the tear
film and subsequently the ocular surface, which incites inflammation of the ocular surface cells [17].
Deficiency of aqueous tear production can further be subclassified into Sjögren and non-Sjögren syndrome.
Sjögren syndrome — Sjögren syndrome is a systemic autoimmune exocrinopathy in which there is

inflammatory infiltration of the lacrimal glands leading to cell death and tear hyposecretion. (See "Diagnosis
and classification of Sjögren's syndrome".)
Non-Sjögren syndrome — Non-Sjögren syndrome, aqueous tear-deficient dry eye involves lacrimal
dysfunction without associated systemic findings. The most common form is age-related dry eye in which it is
believed that there is lacrimal ductal obstruction over time, leading to decreased lacrimal gland function [18].
Lacrimal gland obstruction can also be due to conjunctival scarring conditions such as trachoma, mucous
membrane pemphigoid, and ocular burns [1]. (See "Overview of trachoma".)
Non-Sjögren syndrome, aqueous tear-deficient dry eye can also be caused by lacrimal gland infiltration.
Infiltrative etiologies include sarcoidosis, lymphoma, graft versus host disease, and episcleritis. In addition,
contact lens use is associated with reduced corneal sensitivity and subsequently reduced reflex sensory tear
secretion [19]. Diabetes mellitus is also associated with non-Sjögren aqueous deficient dry eye [20]. (See
"Complications of contact lenses" and "Episcleritis".)
Increased evaporative loss — Excessive water loss from the ocular surface without any lacrimal
dysfunction leads to tear film instability and a similar cycle of tear hyperosmolarity and lacrimal functional unit
inflammation that is seen with decreased tear production. Increased tear evaporation is most commonly
caused by meibomian gland dysfunction, also known as posterior blepharitis, in which the accessory lacrimal
glands responsible for the lipid component of the tear film are dysfunctional [1]. The amphiphilic nature of the
lipid layer allows even spreading of the tear film to form a membrane and provides a barrier to minimize
evaporation of tears [21]. Abnormalities of the lipid layer are associated with a higher rate of tear film
evaporation [22].
Structural abnormalities of eyelid position or decreased blink function also increase evaporation of the tear
film by increasing the area or the time of tear film exposure [1,23]. Lastly, topical medicated or preserved eye
drop use, chronic contact lens wear, and ocular allergy syndromes can cause ocular surface irritation and
increased tear film evaporation [1,23].
SYMPTOMS — Symptoms in dry eye disease result from activation of sensory nerves of the ocular surface,
either due to tear hyperosmolarity, the presence of inflammatory mediators, or hypersensitivity of the sensory
nerves [24]. Most patients will present with symptoms of chronic eye irritation. However, there is considerable
variability in patient-reported symptoms and clinically measurable signs over time, as well as a recognized
lack of correlation between these symptoms and signs [23,25-27].
A good patient history may elicit many of the complaints below, as well as inciting or exacerbating causes
(including medications, windy conditions, cold weather, low humidity environment, time of day).
Common eye complaints include:
● Dryness
● Red eyes
● General irritation
● Gritty sensation
● Burning sensation
● Foreign body sensation
● Excessive tearing
● Light sensitivity
● Blurred vision
The blurred vision associated with dry eyes tends to be quite variable. Since the tear film is the first layer
encountered by light rays as they enter the eye, an irregular tear film can degrade the quality of the image
that is received by the retina. The visual impairment associated with dry eyes is usually temporary and often
improves with treatment of the condition [28,29]. Rarely, in severe dry eye conditions, permanent damage to
visual acuity can occur from corneal scarring.
If ocular complaints are accompanied by mouth dryness and other systemic complaints, an evaluation for
Sjögren's syndrome should be performed. (See "Diagnosis and classification of Sjögren's syndrome".)
DIAGNOSIS — There is no single definitive test or consensus of criteria to diagnose dry eye [30]. A variety of
symptom questionnaires and diagnostic tests described in this section are often used in an attempt to
standardize the identification and classification of dry eye disease.
Primary care evaluation — Given the known lack of correlation between patient-reported symptoms,
clinically measurable signs, and available diagnostic testing, dry eye is diagnosed primarily on the basis of
patient symptoms and supporting findings on the physical examination. The diagnosis can often be made at
the office of the primary care clinician. The physical examination may also give clues to other associated
conditions.
Dry eye disease can vary considerably in its intensity over time and under different environmental conditions
(picture 1 and picture 2 and picture 3). A complete clinical examination by the primary care clinician should
include observation for the following findings:
● Conjunctival injection, usually symmetric in both eyes (picture 4)

● Excessive tearing, which can paradoxically be a sign of dry eye
● Blepharitis, often visible as erythematous or irritated eyelid edges (picture 5 and picture 6)
● Malposition of the eyelids (inward or outward turning, also called entropion and ectropion, respectively)
(picture 7 and picture 8)
● Reduced blink rate
● Visual impairment, with visual acuity assessed in each eye separately. This should include evaluation as
to whether acuity improves with increased blink rate or use of lubricating eye drops.
Ophthalmology evaluation — The ophthalmologist will perform a thorough slit lamp evaluation along with
other testing to assess the status of the patient's lacrimal functional unit to determine the severity of dry eye
disease and possible etiologies. The following may be noted:
● Extent and pattern of conjunctival injection
● Eyelid health — Any eyelid or punctal malpositions are noted, as they can lead to dry eye, and often can
be surgically repaired. Careful evaluation for meibomian gland dysfunction (posterior blepharitis) is
performed. (See "Blepharitis", section on 'External examination'.)
● Ocular surface staining — Fluorescein is used to stain for areas of discontinuity in the epithelial surface
of the cornea. Lissamine green and Rose Bengal are used to stain areas of devitalized epithelium in the
cornea and conjunctiva.
● Tear break-up time — Measured with fluorescein stain in the eye to determine tear film stability. The
patient is instructed not to blink and the tear film is observed through the slit lamp. If the smooth, stained
green tear film layer begins to develop blue gaps in less than 10 seconds, the patient's tear film is
considered abnormal.
● Schirmer's test — Assessed by quantifying the number of tears produced by each eye. Small strips of
filter paper are placed in the lower eyelids of each eye, either with or without prior instillation of
anesthetic eye drops. Results are measured in millimeters of tears collected over a five minute time
period. This test is often used in the clinical setting, but has been shown to provide extremely variable
results [25].
● Corneal sensation — Objectively measured by the ophthalmologist with a variety of techniques to

provide information about ocular surface and possibly systemic associations of dry eye.
● Tear hyperosmolarity — Tear osmolarity testing is a potentially useful measure and is commercially
available for use in the clinical setting [31,32]. Further investigation is needed to determine how best to
use for guiding patient care.
● Questionnaires — Due to the variability of findings on clinical evaluation of dry eye, some clinicians base
their assessment of dry eye on the results of validated questionnaires [3]. Some of the more widely-
available questionnaires that are used specifically for the evaluation of dry eye symptoms include:
• Ocular Surface Disease Index (OSDI) — 12-item questionnaire validated in patients with dry eye
disease [33]
• Impact of Dry Eye on Everyday Life (IDEEL) — 57 questions in three modules validated in patients
with dry eye disease [34]
• Salisbury Eye Evaluation Questionnaire (SEE) — six-item questionnaire used in self-reported,

population-based prevalence surveys to determine visual impairment among older adult subjects
[35]
DIFFERENTIAL DIAGNOSIS — Other conditions that can cause similar symptoms to dry eyes include:
● Blepharitis — Posterior blepharitis often coexists with dry eye and may require several specific
treatments, including warm compresses and patient education on eyelid hygiene. (See "Blepharitis".)
● Ocular allergies — Allergic conjunctivitis can also coexist with dry eye. Symptoms of itching will often be
the primary complaint. The allergen should be promptly identified and avoided. (See "Allergic
conjunctivitis: Clinical manifestations and diagnosis".)
● Viral Conjunctivitis — Dry eye can be confused with "pink eye." A careful patient history to elicit course of
symptoms, any recent illnesses or sick contacts, and presence of lymphadenopathy can help to
distinguish the diagnosis. (See "Conjunctivitis".)
● Other microbial infections — Some ocular infections can begin with an indolent course of symptoms
similar to dry eye. Referral to an ophthalmologist should be considered for any patients at high risk for
ocular infections (eg, contact lens wearer, history of diabetes mellitus), particularly those with signs of an
infectious process on physical examination (eg, unilateral conjunctival injection, purulent drainage).
TREATMENT — Current treatment for dry eye disease is aimed at increasing or supplementing tear
production, slowing tear evaporation, and reducing tear resorption. The patient should discontinue
unnecessary systemic or ocular medications that can contribute to dryness. (See 'Risk factors' above.)
The first line of treatment in patients complaining of dry eye includes tear supplementation and environmental
coping strategies. Although several therapies discussed below have been studied in randomized trials, these
studies have been limited by small sample size, lack of placebo control, and non-standardized clinical
endpoints. Clinical trials of dry eye are also limited by the lack of clear diagnostic criteria for the condition.
Thus, assessment of treatment efficacy is difficult.
Artificial tears — Artificial tears generally include cellulose to maintain viscosity, a spreading agent such as
polyethylene glycol or polyvinyl alcohol to prevent evaporation, and a preservative to prevent contamination.
Available without a prescription, "artificial tears" come in liquid, gel, and ointment forms. Preservative-free
forms of these supplements are often recommended as some individuals with dry eye will have inflammatory
reactions to the preservatives [36]. However, these are often expensive, single-use formulations.
Artificial tears are considered first-line treatment for dry eye and have been shown to improve irritative
symptoms in patients with dry eye [8,37]. Artificial tears can also improve visual acuity in patients with dry eye
symptoms [38].
Artificial tears have shown some efficacy in randomized trials, but these trials are mostly limited due to
sample size, lack of an adequate control group, and non-standardized outcomes [39-42]. As laser-assisted in
situ kertomileusis (LASIK) is a refractive procedure that causes dry eyes, in part due to decreased
postoperative corneal sensation, LASIK serves as a model for assessing treatment of dry eye. Artificial tears
given to postoperative LASIK patients appear to improve dry eye symptoms compared to placebo [43]. Issues
related to dry eye and LASIK are discussed separately. (See "Laser refractive surgery".)
A reasonable starting dose for artificial tear administration is one drop in each eye, four times per day.
Patients often begin to notice improvement within a few days of initiating treatment, but may take up to three
to four weeks to note a significant change in their symptoms. If individuals remain symptomatic, the frequency
of artificial tear use can be increased to the level of symptoms, even as frequently as every hour. If used
more often than four to six times per day, it is recommended that a preservative free formulation be used to
minimize the potential for toxicity [44]. Higher viscosity artificial tear gels and ointments are also commercially
available and can be used if patients feel that the eye drops are not providing enough symptomatic relief.
Patients should be warned that the gels, and especially ointments, can blur vision temporarily and are often
best used at bedtime.
Unless there is a specific inciting factor that can be eliminated, dry eyes are most often a chronic condition
and require chronic treatment. Patients should be advised that they will need to use artificial tears for relief of
dry eye symptoms indefinitely.
Environmental strategies — Environmental coping strategies address the importance of environmental

causes that could be contributing to or even causing dry eye symptoms. One important strategy includes
frequent blinking, especially during visually attentive tasks such as reading or computer use. The patient
should also be urged to minimize exposure to air conditioning or heating. Humidifiers are useful in the
bedroom, office, or any space where the patient spends a significant amount of time.
Swim goggles or other "moisture chambers" are recommended to protect the humidity of the local
environment around the eyes. Moisture chambers can be purchased and fitted to current glasses in select
optical shops by trained opticians (picture 9 and picture 10).
Topical cyclosporine — Topical cyclosporine is an immunosuppressive agent that has been found to be
relatively safe, well-tolerated, and to improve signs and symptoms of dry eyes significantly in some
populations [45-48].
A 2013 systematic review of 18 randomized trials concluded that topical cyclosporine was a safe treatment
for dry eyes [48]. While meta-analysis was not possible because of lack of standardized criteria and outcome
measures, 9 of 9 trials that evaluated symptoms and 13 of 18 trials that evaluated tear function found
improvement. No improvements were found in patients with dry eyes from surgical procedures, contact lens
use, or thyroid orbitopathy. In a prospective cohort study of 158 patients with persistent dry eye symptoms
despite artificial tears, patients in all three severity groups (mild, moderate, severe) receiving cyclosporine
showed improvement in symptoms, Schirmer scores, and mean tear breakup times compared to baseline
[45].
Despite the available evidence, we have not seen such a degree of beneficial results in our practice. There
appears to be a subset of patients who do respond favorably to this treatment, but there are no good
predictive models available to guide clinical decision-making at this time. In the author’s anecdotal
experience, patients with evidence of local mild inflammation on the ocular surface or a systemic condition
associated with inflammation tend to have the highest likelihood of response to cyclosporine drops.
A 0.05% emulsion of cyclosporin (Restasis) is available for treatment of dry eye disease. It may take up to six
weeks or longer to achieve noticeable improvement of dryness. In some patients, cyclosporine can result in
long term resolution of dry eye symptoms [49]. Serum cyclosporine concentrations have been undetectable
or negligible with topical use, and no systemic toxicity has been reported. Cyclosporine can cause an
occasional, temporary burning sensation in the eye. Another important limiting factor of cyclosporine use is
high cost [37].
As patients may have other concurrent problems such as infection leading to eye irritation, they should have
a complete ophthalmological examination prior to receiving cyclosporine.
Other — Although several other treatments are available for dry eye, they are not in common use and should
only be used as an adjunctive treatment by eye specialists.
● Sodium hyaluronate — In a placebo-controlled trial of topical sodium hyaluronate solution versus

vehicle control in 444 subjects with dry eye, those randomly assigned to sodium hyaluronate had
improved symptoms and ocular staining scores compared to the control group [50].
● Topical glucocorticoids — Low-dose topical glucocorticoid eye drops can help to relieve symptoms
and signs of dry eye [51,52] and are useful on a short-term basis. As these drops can have significant
side effects with continued use, including cataracts and glaucoma, glucocorticoid eye drops should be
used with caution.
● Autologous serum tears — The serum of a patient's blood can be formulated into eye drops.
Autologous serum tears may improve dry eye symptoms [53,54], but there is not strong evidence for
long-term or significant benefit over artificial tears [55].
● Tear stimulation — Systemic pilocarpine (a cholinergic agonist) has been found to improve dry eye
symptoms in patients with Sjögren syndrome, but is associated with systemic side effects in a significant
portion of patients [56]. Other tear stimulation agents, including those for topical use, are being explored
as potential treatments for dry eye [57].
● Omega-3 and omega-6 fatty acids — Oral omega-3 and omega-6 fatty acids may improve symptoms
of dry eye [58-61]. Animal studies have found that the topical use of omega-3 and omega-6 fatty acids
may also be beneficial for the treatment of dry eyes [62].
● Oral antioxidants — Small randomized trials have shown some efficacy of oral antioxidants in the
treatment of dry eye [63,64]. As an example, in a blinded, placebo-controlled cross-over trial of 24 dry
eye patients, those randomly assigned an antioxidant combination compared to placebo had improved
tear break up times, Schirmer scores, and clinical symptoms, including burning, itching, and redness
[63].
● Vitamin A — Systemic vitamin A deficiency is associated with severe ocular surface dryness with
keratinization of the conjunctiva (Bitot spots) and night blindness. In dry eye patients without known
deficiency, topical vitamin A eye drops can improve dry eye symptoms [65].
● Punctal occlusion — Either temporary or permanent occlusion of the openings of the tear drainage
system can be performed to delay tear clearance and improve dry eye symptoms [66].
● Scleral contact lenses — In patients with severe dry eye, large diameter contact lenses can be used to
help retain a tear reservoir over the ocular surface [67]. These types of contact lenses require a
specialized fitting by an experienced contact lens practitioner.
● Acupuncture — Small studies have shown some improvement in dry eye signs and symptoms following
acupuncture therapy [68,69]. Acupuncture is discussed in detail separately. (See "Acupuncture".)
● Surgery — Eyelid abnormalities should be surgically corrected to realign and maintain normal lid
architecture. Surgery can also be performed on structurally normal eyelids to reduce the ocular surface
area and thus reduce tear evaporation.
● Investigational — Phase III randomized trials of an integrin antagonist (Lifitegrast ophthalmic solution)
that decreases inflammation by blocking lymphocyte-endothelial adhesion have found that it improves
the symptoms of dry eyes compared with placebo [70,71].
REFERRAL TO OPHTHALMOLOGY — We suggest referral to an ophthalmologist if the etiology of the

patient's symptoms is not clear, if a patient does not get adequate relief from tear supplementation and
environmental strategies, if patients have severe pain, or have associated visual loss [72]. The
ophthalmologist can reevaluate the patient and provide the other treatment options described above. (See
'Treatment' above.)
INFORMATION FOR PATIENTS — UpToDate offers two types of patient education materials, “The Basics”
and “Beyond the Basics.” The Basics patient education pieces are written in plain language, at the 5th to 6th
grade reading level, and they answer the four or five key questions a patient might have about a given
condition. These articles are best for patients who want a general overview and who prefer short, easy-to-
read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more
detailed. These articles are written at the 10th to 12th grade reading level and are best for patients who want
in-depth information and are comfortable with some medical jargon.
Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail
these topics to your patients. (You can also locate patient education articles on a variety of subjects by
searching on “patient info” and the keyword(s) of interest.)
● Basics topic (see "Patient education: Dry eye (The Basics)")
SUMMARY AND RECOMMENDATIONS
● Dry eye disease is a multifactorial disease of the tears and ocular surface that can result in ocular
discomfort and visual impairment. Dry eye is generally due to decreased tear production and/or
excessive evaporative loss. (See 'Pathophysiology' above.)
● Most patients present with symptoms of chronic eye irritation, such as eye dryness, red eyes, and
burning. However, there is considerable variability in patient-reported symptoms over time. (See 'Clinical
significance' above.)
● There is no single definitive diagnostic test to identify or classify the severity of dry eye disease. The
diagnosis is based primarily on patient symptoms and supportive findings of dry eye from examination.
(See 'Primary care evaluation' above.)
● We recommend artificial tears for the initial treatment of all patients with dry eye disease (Grade 1B).
When appropriate, environmental strategies should be undertaken, including discussing the importance
of frequent blinking and minimizing exposure to air conditioning or heating. (See 'Treatment' above.)
● Other treatment options include topical cyclosporin, other topical medications, oral medications, scleral
contact lenses, punctal occlusion, and surgery. (See 'Other' above.)
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Topic 6894 Version 28.0
GRAPHICS
Precorneal tear film
Adapted from: Pflugfelder, SC, Solomon, A, Stern, ME. The Diagnosis and Management of
Dry Eye: A Twenty-Five Year Review. Cornea 2000; 19:644.
Graphic 64230 Version 1.0
Dry eye disease with conjunctival injection, associated

neovascularization of the cornea, and a central corneal
opacity/scarring
Dry eye disease with loss of luster of the conjunctival and

corneal surface associated with breakdown of the normal
ocular epithelial surfaces
Dry eye disease with punctate epithelial erosions
Dry eye disease with prominent conjunctival vessels indicating

irritation of ocular surface
Anterior blepharitis
Lower lid with inflammation with characteristic scales on the eyelashes.
Posterior blepharitis
Lower eyelid with characteristic posterior lid inflammation and oily white
plugs visible at the meibomian gland openings.
Entropion
Inward turning of the lower eyelid with eyelashes rubbing against the ocular
surface.
Ectropion
Outward turning of the lower eyelid with increased exposure of the ocular
surface and sensitive mucous membrane of the inner lid, as well as
disruption of normal tear drainage patterns.
Moisture chamber
Moisture chamber in use
Contributor Disclosures
Roni M Shtein, MD Nothing to disclose Jonathan Trobe, MD Nothing to disclose Lee Park, MD,
MPH Nothing to disclose
Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are
addressed by vetting through a multi-level review process, and through requirements for references to be
provided to support the content. Appropriately referenced content is required of all authors and must
conform to UpToDate standards of evidence.
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Dry eyes - UpToDate 12/14/2559 BE, 11+32 AM

Official reprint from UpToDate®

Author: Roni M Shtein, MD

Sjögren syndrome — Sjögren syndrome is a systemic autoimmune exocrinopathy in which there is

Common eye complaints include:

● Conjunctival injection, usually symmetric in both eyes (picture 4)

● Extent and pattern of conjunctival injection

● Corneal sensation — Objectively measured by the ophthalmologist with a variety of techniques to

• Salisbury Eye Evaluation Questionnaire (SEE) — six-item questionnaire used in self-reported,

Environmental strategies — Environmental coping strategies address the importance of environmental

● Sodium hyaluronate — In a placebo-controlled trial of topical sodium hyaluronate solution versus

REFERRAL TO OPHTHALMOLOGY — We suggest referral to an ophthalmologist if the etiology of the

● Basics topic (see "Patient education: Dry eye (The Basics)")

SUMMARY AND RECOMMENDATIONS

(See 'Primary care evaluation' above.)

Use of UpToDate is subject to the Subscription and License Agreement.

surface and lacrimal glands. Cornea 1998; 17:584.

Topic 6894 Version 28.0

Precorneal tear film

Graphic 64230 Version 1.0

Dry eye disease with conjunctival injection, associated

Graphic 62824 Version 1.0

Dry eye disease with loss of luster of the conjunctival and

Graphic 75685 Version 1.0

Dry eye disease with punctate epithelial erosions

Graphic 75497 Version 1.0

Dry eye disease with prominent conjunctival vessels indicating

Graphic 72833 Version 2.0

Lower lid with inflammation with characteristic scales on the eyelashes.

Graphic 64540 Version 4.0

Graphic 61924 Version 1.0

Graphic 63579 Version 1.0

Graphic 72737 Version 1.0

Graphic 75764 Version 1.0

Moisture chamber in use

Graphic 52738 Version 1.0

Conflict of interest policy

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