Dry Eye Evaluation

We begin by asking detailed questions about your symptoms, when they occur, and what makes them better or worse. We also use a validated symptom questionnaire, such as OSDI or SPEED, to quantify how dry eye affects you. Then we perform a series of non-invasive tests that measure tear quantity, quality, and stability, as well as the condition of your eye surface and glands. The entire process is gentle and typically causes little to no discomfort.

You may experience slight irritation from certain dyes we use to highlight areas of damage, but any stinging fades within moments.

On the day of your evaluation, avoid wearing eye makeup because it can interfere with some tests and imaging. Try to arrive well-rested, as fatigue can affect your tear production. If possible, schedule your visit during a time when your symptoms are most typical so we get an accurate picture of your usual eye health.

• Skip eye makeup on the day of your appointment
• Get a good night's sleep the night before
• Choose a time that reflects your normal symptom pattern
• Avoid using artificial tears, redness relievers, or ointments for at least two hours before your visit unless you need them for comfort
• Bring your contact lens case and solution in case we ask you to remove lenses
• Write down any questions you want to ask during the visit

We need to know about all the medications you take, including prescription drugs, over-the-counter pills, vitamins, and supplements. Certain antihistamines, antidepressants, blood pressure medications, and hormone therapies can reduce tear production. Be sure to mention any eye drops you use, even if they are just artificial tears, because some contain preservatives that can worsen dry eye over time.

Please tell us if you use glaucoma drops, isotretinoin, or CPAP, and whether you have conditions like rheumatoid arthritis, thyroid disease, or Sjogren's syndrome. Bring a list or the actual bottles if you are unsure of the names or doses.

Contact lenses can alter your tear film and temporarily change the appearance of your eye surface. If you wear contacts, we may recommend leaving them out for at least 24 hours before your evaluation so we can see your eyes in their natural state. This gives us the most accurate baseline measurements and helps us determine whether your lenses are contributing to your symptoms.

Bring your glasses to wear on the day of the appointment if you need vision correction.

Schirmer test results below five millimeters after five minutes usually indicate severe aqueous deficiency, while values between five and ten millimeters suggest mild to moderate deficiency. Phenol red thread measurements below ten millimeters in 15 seconds also point to low tear volume. These cutoffs assume testing without anesthetic. With anesthetic, baseline values are lower and thresholds differ. These numbers help us decide whether treatments that stimulate tear production or conserve existing tears will benefit you most.

We also consider your symptoms and other test findings to get the full picture.

We use standardized grading systems to score the amount and location of staining on your eye surface. We grade staining with standardized scales so we can track change over time. Central corneal staining often signals severe dry eye or exposure problems, while staining on the nasal or temporal conjunctiva can indicate specific eyelid or blink issues. Higher grades mean more extensive damage and usually require more aggressive treatment.

Tracking staining over multiple visits shows us whether your eye surface is healing or if we need to adjust your therapy.

We combine all your test results, along with your symptoms and how much they affect your daily life, to classify your dry eye as mild, moderate, or severe. We use a composite of symptoms and signs to stage severity and guide stepwise treatment. Mild cases might respond to simple measures like preservative-free artificial tears and lifestyle changes. Moderate dry eye often needs prescription medications or in-office procedures. Severe dry eye may require a combination of therapies and close monitoring to prevent vision loss.

This classification guides our initial treatment plan and helps set realistic expectations for improvement.

If your tests show low tear production, we may recommend treatments that increase secretion or prevent tear drainage from your eyes. If evaporative dry eye is the main problem, we focus on restoring your oil glands and improving lid hygiene. Patients with high osmolarity or significant inflammation might benefit from anti-inflammatory therapies or therapies that address the root cause of the imbalance.

• Low tear volume: punctal plugs or punctal cautery, tear stimulation with varenicline nasal spray, oral secretagogues when appropriate
• Gland dysfunction: daily warm compresses and lid hygiene, in-office thermal pulsation, intense pulsed light, or radiofrequency treatments
• Inflammation and surface damage: short steroid pulses when indicated, prescription anti-inflammatories such as cyclosporine or lifitegrast
• Tear conservation and protection: preservative-free artificial tears and gels, moisture chamber glasses, environmental modifications
• Severe disease: autologous serum tears or scleral lenses for surface protection
• Supplements: discuss options with us, since evidence for omega-3 is mixed

Dry eye is often a chronic condition, so we use follow-up testing to see how well your treatment is working. If your symptoms improve but tests still show significant surface damage, we may intensify therapy. If both symptoms and test results are better, we might simplify your regimen. Repeat testing also alerts us to new problems, such as gland dropout or worsening osmolarity, that require a change in strategy.

We typically recheck your eyes every few months until your condition stabilizes, then less often for maintenance. Follow-up intervals vary by severity and treatment changes.