Burning, dryness, foreign body sensation, mildly to moderately decreased vision, and excess tearing. Often exacerbated by smoke, wind, heat, low humidity, or prolonged use of the eye (e.g., when working on a computer that results in decreased blink rate). Usually bilateral and chronic (although patients sometimes are seen with recent onset in one eye). Discomfort often out of proportion to clinical signs.
Critical
NOTE: |
Tear film defects must be randomly located, as isolated areas of repeated early tear break-up may indicate a focal corneal surface irregularity. |
Other
Punctate corneal or conjunctival fluorescein, rose bengal, or lissamine green staining; usually inferiorly or in the interpalpebral area. Excess mucus or debris in the tear film and filaments on the cornea may be found in severe cases.
Mild Dry Eye
Artificial tears q.i.d., preferably preservative-free.
Moderate Dry Eye
Severe Dry Eye
NOTE: |
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In days to months, depending on the severity of symptoms and degree of dryness. Anyone with severe dry eyes caused by an underlying chronic systemic disease (e.g., rheumatoid arthritis, Sjögren syndrome, sarcoidosis, ocular pemphigoid) may need to be monitored more closely.
NOTE: |
Patients with significant dry eye should be discouraged from contact lens wear and corneal refractive surgery such as PRK, LASIK, and SMILE. However, daily disposable soft contact lenses can be successful if fit loosely and combined with aggressive preservative-free lubrication and plugs, if needed. |
Patients with Sjögren syndrome have an increased incidence of lymphoma and mucous membrane problems and may require internal medicine, rheumatologic, dental, and gynecologic follow up.