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
  
  
• Care management
  
  
• Patient Education

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 [B:III]
    
    
  • Corneal history (prior keratoplasty, LASIK, PRK) [A:III]
    
    
  • Punctal surgery [A:III]
    
    
  • Eyelid surgery (e.g., prior ptosis repair, blepharoplasty, entropion/ectropion repair) [A:III]
    
    
  • Bell's palsy [A:III]
    
    
  • Chronic ocular surface inflammation (e.g, ocular cicatricial pemphigoid, Stevens-Johnson syndrome) [A:III]
    
    
• Systemic history, including
  
  
  • Smoking [A:III]
    
    
  • Dermatological diseases (e.g., rosacea) [A:III]
    
    
  • Atopy [A:III]
    
    
  • Menopause [A:III]
    
    
  • Systemic inflammatory diseases (e.g., Sjogren’s syndrome, graft vs host disease, rheumatoid arthritis, systemic lupus erythematosus, scleroderma) [A:III]
    
    
  • Systemic medications (e.g., antihistamines, diuretics, hormones and hormonal antagonists, antidepressants, cardiac antiarrhythmic drugs, isotretinoin, diphenoxylate/atropine, beta blockers, chemotherapy agents, any other drug  with anticholinergic effects) [A:III]
    
    
  • Trauma (e.g., chemical) [A:III]
    
    
  • Chronic viral infections (e.g., chronic hepatitis C, human immunodeficiency virus) [B:III]
    
    
  • Surgery (e.g., bone marrow transplant, head and neck surgery) [B:III]
    
    
  • Radiation of orbit [B:III]
    
    
  • Neurological conditions (e.g., Parkinson’s disease, Bell’s palsy, Riley-Day syndrome) [B:III]
    
    
  • Dry mouth, dental cavities, oral ulcers [B:III]

Initial Physical Exam

• Visual acuity [A:III]
  
  
• External examination
  
  
  • Skin [A:III]
    
    
  • Eyelids [A:I]
    
    
  • 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]

Care Management

• For patients with aqueous tear deficiency, the following measures are appropriate:
  
  
  • Elimination of exacerbating medications where feasible [A:III]
    
    
  • Ocular environmental interventions [A:III]
    
    
  • Humidification of ambient air [A:III]
    
    
  • Computer work site intervention [A:III]
    
    
  • Aqueous tear enhancement [A:III]
    
    
• For patients with aqueous tear deficiency, the following surgical therapies are used when medical treatment has not been adequate or appropriate:
  
  
  • Correction of lid abnormality resulting from blepharitis, trichiasis or lid malposition (e.g., lagophthalmos, entropion/ectropion) [A:III]
    
    
  • Punctal occlusion [A:III]
    
    
  • Tarsorrhaphy for severe cases [A:III]

Patient Education

• Counsel patients about the chronic nature of dry eye and its natural history. [A:III]
  
  
• Provide specific instructions for therapeutic regimens. [A:III]
  
  
• Reassess periodically the patient's compliance and understanding of the disease, risks for associated structural changes and realistic expectations for effective management, and reinforce education. [A:III]
  
  
• Refer patients with manifestation of a systemic disease to an appropriate medical specialist. [A:III]
  
  
• Caution patients with pre-existing dry eye that LASIK or PRK may worsen their dry eye condition. [A:III]

* Adapted from the American Academy of Ophthalmology Summary Benchmarks, November 2006 (www.aao.org)

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

Next: Diabetic Retinopathy (Initial and follow-up evaluation)

Also see:

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