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Defining and Diagnosing Dry Eye

Dry eye, or keratoconjunctivitis sicca, is a multifactorial tear film disorder characterized by tear deficiency or excessive tear film evaporation, which results in damage to the ocular surface, eye discomfort, and / or visual disturbances, according to the National Eye Institute / Industry Workshop on Clinical Trials in Dry Eye and the International Dry Eye Workshop. Each year, the eye doctor at Eye Fashion Optical handles many cases of Waco, TX dry eye.
Common symptoms of dry eye include burning, itching, excessive tearing (or lack of tearing), photophobia, granular sensation, and scratchiness or foreign-body sensation due to crusted debris or dryness. Decreased vision or changes in visual clarity may occur due to poor tear film, eyelids stuck together and/or eyes being red or crusty upon waking. A patient should come into the practice for an examination when upon noticing one or more of these symptoms to reestablish the tear film before the condition deteriorates, which could potentially prolong the longer treatment regimen. 
One of the most common misconceptions that people have about dry eye is when patients present with watery eye and they are surprised to learn the condition is actually caused by a dry eye. This typically results from a lack of meibomian gland secretions, which prevent the watery middle tear layer, lacrimal fluid, from evaporating. The resulting irritation causes the eyes to produce more tears, but those tears are poor quality, so it is actually considered dry eye.
The severity of dry eye can vary from mild to severe, and is categorized based on patient experience, as well as the analysis of tear film stability, conjunctival inflammation, corneal punctate staining that indicates corneal damage, and even keratitis and scarring.
Why should a patient come into the office as opposed to treating themselves by purchasing over the counter artificial drops?
Typically over the counter artificial eye drops contain vasoconstrictors to whiten the eye or the ocular lubricants contain preservatives the patient may be allergic too. If the eyes are red or dry it is likely the result of an underlying issue that has to be resolved. Tests should be performed to find the underlying cause of the redness and proper treatment prescribed.
Dry eye exams at Eye Fashion Optical consist of the following tests:

- The optometrist will examine the lid margins for blepharitis/meibomitis. 

- A biomicroscopic examination will look at the tear meniscus height and tear film break-up time (TFBUT). Diagnostic fluorescein drops will be used to assess corneal damage, and the eye area will be observed for sebaceous secretions and debris.

- The Schirmer test measures tear production and the Phenol Red Thread test measures the fluid present in the conjunctival sac. Lissamine green staining of the bulbar conjunctiva is an indication of conjunctival dryness. 

- Collagen plugs may be used over a period of several days to test for subjective responses to increased tear volume over several days, which may indicate benefitting from long term punctal plugs.

The eye doctor will also take a general medical history and look for other conditions that are often associated with dry eyes, such as rosacea, arthritis or osteoarthritis. Medications, which can sometimes cause dry eyes as a side effect, will be taken into account as well.
Once we diagnose dry eye and figure out what causes may be affecting the eyes, we can treat the problem. Patients are excited about having eyes that are comfortable and moist throughout their waking hours. There are plenty of good stories but Dr. Gerdes’ favorites are the ones working on computers that can work all day in visual comfort and the contact lens patients that can now wear their contact lenses with clarity and comfortable eyes.