Dry eye is a common condition in which the eye does not make enough tears or the tears evaporate too fast, leaving the surface irritated and inflamed. It is more common with age, in women, with screen use, contact lenses, some medicines and autoimmune diseases such as Sjogren syndrome.
Key symptoms
- Gritty, sandy or burning feeling
- Redness that worsens through the day
- Blurred vision that clears with blinking
- Paradoxical watering of the eyes
- Discomfort with screens, wind or air conditioning
What you find on exam
- Visual acuity
- Eyelid margins for blepharitis and blocked oil glands
- Low tear film; fluorescein shows dots of staining and fast tear breakup
- Eyelid closure and blinking
- Dry mouth and joint signs (Sjogren syndrome)
Tests
- Tear breakup time with fluorescein
- Schirmer test for tear volume
- Anti-Ro (SSA) and anti-La (SSB) if Sjogren syndrome is suspected
Treatment basics
- Artificial tears, preservative-free if used more than 4 times a day; gel or ointment at night
- Warm compresses and lid hygiene for oil gland dysfunction
- Reduce triggers: screen breaks, humidifier, review drying medicines such as antihistamines
- Anti-inflammatory drops such as cyclosporine or lifitegrast for moderate disease
- Punctal plugs in selected cases
Red flags
- Vision loss or severe pain
- Corneal ulcer or thinning on exam
- Dry eye with inability to close the eye (exposure, facial palsy)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.