Diagnostic Protocol

Consider including osmolarity, inflammation and meibography assessment to aid in the diagnosis of dry eye disease in patients suspected of having dry eye disease.

DEWS II Dry Eye Disease Definition leads to a Simple Diagnostic Protocol

Validated Questionnaires

There are typically 4 different symptom surveys used to provide a score of how a patient self-assesses their symptoms.  These include:

*recognized in DEWSII as a validated survey

Validated Questionnaires

Osmolarity

Tear osmolarity has been demonstrated to have the highest correlation to disease severity of clinical DED tests and has been frequently reported as the single best metric to diagnose and classify DED.1,2,3,4

Tear osmolarity, an important biomarker of ocular surface, is a measure of the solute content of the tear film. Abnormal osmolarity indicates a breakdown of the homeostatic mechanism resulting in an unhealthy tear film, which can potentially damage the ocular surface and cornea.

  • Osmolarity > 300 mOsm/L and/or an inter-eye difference of greater than 8 mOsm/L indicates abnormal/elevated osmolarity and unstable tear film.
  • A scale is used to grade the disease severity:
    • 300-320 mOsm/L-Mild DE
    • 320-340 mOsm/L-Moderate DE
    • >340 mOsm/L-Severe DE
  • There is greater inter-eye variability of osmolarity in DED than in normal patients.
  • The inter-eye variability has been shown to substantially reduce over time with successful treatment of DED.

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Osmolarity

Inflammation

Inflammation is a recognized component of the pathophysiological mechanism of DED5 and has been proposed to offer a stable indicator of DED severity.  The matrix metalloproteinases (MMPs) are one of many classes of proteases secreted into the tears in DED.6,7,8,9  The levels of MMPs reflect the loss of ocular surface barrier function, since MMPs can destroy tight junctions in the ocular surface epithelium.  MMPs are not specific to the source of inflammation.

The lack of correlation between clinical signs and symptoms of dry eye disease makes diagnosing and treating patients a challenge. Often times, inflammation is present before the clinical signs of dry eye.10

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Inflammation

Meibography

Meibomian Gland Dysfunction is considered the main etiology of dry eye. It is more important now than ever that doctors utilize this technology for the management of ocular surface diseases.

Meibography allows for the observation of the silhouette of the meibomian gland morphological structure, such as the shortening, the distortion and/or the dropout of meibomian glands.

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Meibography

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