ICO International Clinical Guidelines:

Dry Eye Syndrome (Initial Evaluation)

(Download this Guideline as a PDF file - 103 KB)

On this page:

• Initial exam history
  
  
• Initial physical exam

Initial Exam History

• Ocular symptoms and signs [A:III]
  
  
• Exacerbating conditions [B:III]
  
  
• Duration of symptoms [A:III]
  
  
• Topical medications used and their effect on symptoms [A:III]
  
  
• Ocular history, including
  
  
  • Contact lens wear, schedule and care [A:III]
    
    
  • Allergic conjunctivitis [A:III]
    
    
  • Ocular surgical history [A:III] (prior keratoplasty, cataract surgery, keratorefractive surgery)
    
    
  • Ocular surface disease [A:III] (e.g., herpes simplex virus, varicella zoster virus, ocular mucous membrance pemphigoid, Stevens-Johnson syndrome, aniridia, graft-versus-host disease)
    
    
  • Punctal surgery [A:III]
    
    
  • Eyelid surgery [A:III] (e.g., prior ptosis repair, blepharoplasty, entropion/ectropion repair)
    
    
  • Bell palsy [A:III]
    
    
• Systemic history, including
  
  
  • Smoking or exposure to second-hand smoke [A:III]
    
    
  • Dermatological diseases [A:III] (e.g., rosacea)
    
    
  • Technique and frequency of facial washing including eyelid and eyelash hygiene [A:III]
    
    
  • Atopy [A:III]
    
    
  • Menopause [A:III]
    
    
  • Systemic inflammatory diseases [A:III] (e.g., Sjogren’s syndrome, graft -versus-host disease, rheumatoid arthritis, systemic lupus erythematosus, scleroderma)
    
    
  • Other systemic conditions [A:III] (e.g., lymphoma, sarcoidosis)
    
    
  • Systemic medications [A:III] (e.g., antihistamines, diuretics, hormones and hormonal antagonists, antidepressants, cardiac antiarrhythmic drugs, isotretinoin, diphenoxylate/atropine, beta-adrenergic antagonists, chemotherapy agents, any other drug  with anticholinergic effects)
    
    
  • Trauma [B:III] (e.g., chemical)
    
    
  • Chronic viral infections [B:III] (e.g., hepatitis C, human immunodeficiency virus)
    
    
  • Nonocular surgery [B:III] (e.g., bone marrow transplant, head and neck surgery, trigeminal neuralgia surgery)
    
    
  • Radiation of orbit [B:III]
    
    
  • Neurological conditions [B:III] (e.g., Parkinson’s disease, Bell palsy, Riley-Day syndrome, trigeminal neuralgia)
    
    
  • Dry mouth, dental cavities, oral ulcers [B:III]

Initial Physical Exam

• Visual acuity [A:III]
  
  
• External examination
  
  
  • Skin [A:III]
    
    
  • Eyelids [A:III]
    
    
  • Adnexae [A:III]
    
    
  • Proptosis [B:III]
    
    
  • Cranial nerve function [A:III]
    
    
  • Hands [B:III]
    
    
• Slit-lamp biomicroscopy
  
  
  • Tear film [A:III]
    
    
  • Eyelashes [A:III]
    
    
  • Anterior and posterior eyelid margins [A:III]
    
    
  • Puncta [A:III]
    
    
  • Inferior fornix and tarsal conjunctiva [A:III]
    
    
  • Bulbar conjunctiva [A:III]
    
    
  • Cornea [A:III]

* Adapted from the American Academy of Ophthalmology Summary Benchmarks, November 2008 (www.aao.org)

(Download this Guideline as a PDF file - 103 KB)

Next: Dry Eye Syndrome (Management Recommendations)

Also see:

• International Clinical Guidelines (Preface)
  
  
• Introduction to the Guidelines
  
  
• List of Guidelines