How is Dry Eye Diagnosed?

Allow us to get to the bottom of your symptoms with our effective dry eye diagnostic testing and treatment plans.

How is Dry Eye Diagnosed? Optometrist
Specialty Vision

Dry eye occurs when the tears are inadequate and there can be a number of different reasons why that is. Determining the cause of your dry eye symptoms is as important as diagnosing the problem’s existence in the first place. At our dry eye center, we consider this our primary task when patients come in seeking help and wanting to alleviate the symptoms they are experiencing. There are various methods of testing available in order to determine the cause, and afterwards a proper treatment plan can be offered.

What To Expect at Your Dry Eye Appointment

What To Expect at Your Dry Eye Appointment

Your appointment will begin with our eye doctor speaking to you about your eye health, overall health and dry eye symptoms in order to start the diagnostic process. Our optometrist will ask you specific questions about your symptoms such as the severity and frequency. You may also be asked to fill out a questionnaire to provide additional information about the symptoms you are experiencing in order to help us better understand your situation and determine what course of treatment to pursue.
Certain things, such as the cause of your dry eye, require proper diagnostic techniques and equipment. There are several types of tests you can expect at your appointment:

Comprehensive Eye Exam

A comprehensive eye exam is far more than just reading a vision chart. It includes a full thorough examination of your eye health and vision which can provide insight and vital information about your eyes and your dry eye condition. 

Tear Volume Tests for Dry Eye

Tear Volume Tests for Dry Eye

Dry eye can occur if you are not producing a sufficient amount of tears, and there are a couple of different tests designed to check your tear production. One such test is the Schirmer test in which a strip of thin paper that has measurement markings like a ruler is placed under your eyelid to measure tear production. If you are sensitive to something touching your eye you can request a gentle numbing eyedrop. After 5 minutes, the amount of paper that has become wet is measured to check the tear volume and if only a small amount of paper has become wet, it is a sign of dry eyes.

Alternatively, there is the phenol red test, in which a thread with pH-sensitive dye, which will change to become red when exposed to tears, is placed over the lower eyelid. After 15 seconds, the length of the string that became wet with tears is measured and if only a small amount of the string turned red, it could be a sign of dry eyes.

Tear Quality Tests for Dry Eye

Tear Quality Tests for Dry Eye

Dry eye can also be caused by a problem with the quality of your tears. Is your tear film producing adequate tears to prevent you from having dry eyes? There are tests to check this, such as the osmolarity test, which measures the composition of your tears using advanced technology.

Tear Break Up Time (TBUT)

Our eye care professional may also perform a test using a flueorescein dye to check for damage to the surface of the eye, which can cause dry eye. The optometrist will gently place some fluorescein on your eye and you will be asked to blink for a few seconds in order to help the dye spread around your cornea. Afterwards you will stop blinking and our eye doctor will evaluate and measure the time it takes for you to blink again in order to determine if you have dry eye. 

Meibomian Gland Evaluation for Dry Eye

Meibomian gland dysfunction (MGD) is another common cause of dry eye, as it causes disruption in the production and secretion of oil that is a key component of the tear film. Our optometrist can physically check for signs of a problem using advanced imaging to scan the meibomian glands.

What To Expect at Your Dry Eye Appointment
Tear Volume Tests for Dry Eye

What Comes Next?

Following the diagnostic tests and discussion with you, our eye care professional will have a good idea of what the cause of your dry eye is, and will be able to recommend to you a treatment plan specifically tailored to your unique situation.

How can I find an eye doctor near me?

If you don’t already have a trusted optometrist, you could start your online search by typing in phrases such as "eye doctor near me," "optometrist near me," or "dry eye specialist near me."

Common Questions

Normally we have tear ducts located in the inner corners of our eyes that help to drain our tears out of the eye into the nose; but if your tear drainage system is blocked (lacrimal stenosis) and/or not functioning properly it may cause overly watery eyes (epiphora). Additionally, if you’re experiencing excessive tearing, this may sound counter-intuitive, but it may mean that your eyes are dry. When our eyes are dry, they feel irritated and uncomfortable, which stimulates the lacrimal gland to produce so many tears that this then overwhelms the eye’s natural drainage system, causing our tears to roll down our face instead of through our tear ducts. Allergies, and irritants can also cause excessive tearing. Infections can also cause overly watery eyes because part of your body’s response to an eye infection is to produce excess tears in order to keep the eye lubricated and wash away any germs or discharge.
There are ways to alter your environment in order to prevent dry eyes. For instance, avoid air blowing in your eyes such as a fan, air conditioner, hair dryers, or car heaters. Also consider adding a humidifier to add moisture to dry indoor air, which is especially useful when the heaters are on in the winter. Also, when you go outside the wind and dry air can cause your eyes to tear and be dry, so to prevent this and to protect your eyes it’s important to wear sunglasses or other protective eyewear when you go outside. Furthermore, if you are working with your digital device it’s important to take breaks and follow the 20/20/20 rule, which is every 20 minutes look 20 feet away for 20 seconds. Additionally, sometimes your eye doctor may notice early signs of dry eyes before you experience symptoms, so you can prophylactically treat dry eyes by applying warm compresses over your eyes and doing lid massage, as well as using artificial tears to keep the front surface of your eyes lubricated.
When you have dry eyes this sends out a signal to your lacrimal gland to produce more tears, but then this results in an overproduction of tears causing tearing/watery eyes. The overproduction of tears is called reflex tearing. Your body is trying to counteract your dry eyes, so it then starts to produce more tears, but then it ends up flooding your eyes with too much tears, resulting in a vicious cycle of dry and then teary eyes. That is why it’s important to deal with the root of the cause of the tearing, which is your dry eyes, to stop this sequence of events from happening. But it’s important to also note that watery eyes can be caused by other conditions as well, so be sure to get a thorough evaluation by your eye doctor to determine the proper diagnosis and treatment.
Typically first your eye doctor would take a thorough case history reviewing your symptoms and the severity of the symptoms. (Some symptoms of dry eyes include burning, itching, excessive tearing, gritty/foreign body sensation, eye discomfort, inflammation, or blurry vision.) Your eye doctor will also review your medical history, any medications you’re taking, your day to day activities, as these can all contribute to dry eyes as well. Then a thorough dry eye evaluation will be conducted. Your eye doctor will look at your eyes under a microscope where they will assess your meibomian glands on your upper and lower lid margin. To get a better image of the inside of your meibomian/oil glands your doctor may also take an image of them using a Lipiscan/Meibography. If any of your oil glands are capped, truncated or atrophied this may indicate you have dry eyes. Also your tear layer will be assessed, typically a sodium fluorescein dye would be used. Here we can examine your tear break up time (TBUT), tear meniscus height, and blink rate. Various other tests can be used to detect dry eyes such as Lissamine green and Rose Bengal dye, Schirmer test 1 and 2, and Phenol red thread test. For the Schirmer Test your eye doctor will place a strip of medical paper inside of your lower eyelids, and the paper will then absorb your tears, which will show us the amount of tears you have. For the phenol red test it’s the same concept as the Schirmer test but instead a thin red thread string is placed inside your lower eyelids to determine the volume of your tears. If any of these values are below normal this can also help us detect dry eyes.
Certain nutritional deficiencies can contribute to dry eyes. For instance, a deficiency in omega-3 fatty acids, which are crucial for healthy meibomian glands and tear production, can lead to dry eye symptoms. Similarly, deficiencies in vitamins A and D can negatively impact eye health, potentially leading to dry eyes. It's important to remember that dry eye can have multiple causes, and nutritional deficiencies are just one factor. A comprehensive eye exam with our eye care professional can help identify the specific cause of your dry eye symptoms.
Yes, our optometrists can diagnose dry eye. They are equipped with the knowledge and tools necessary to conduct a comprehensive eye examination and perform specific tests to measure tear production and quality. Based on the findings, they can accurately diagnose dry eye and suggest an appropriate treatment plan.
The approach to dry eye treatment is tailored to its root cause and the severity of the symptoms. At our clinic, the first line of treatment typically involves the application of heat and expression of the meibomian glands to enhance tear production and quality.
Two common tests used for diagnosing dry eye are the Schirmer test and the Tear Breakup Time (TBUT) test. The Schirmer test measures the volume of tears produced by placing a thin strip of paper under the lower eyelid. The Tear Breakup Time test, on the other hand, checks the quality of tears by assessing how long it takes for dry spots to appear on the eye after a blink. Both tests provide crucial insights to help your eye doctor establish the root cause of dry eye symptoms.
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