As with most things, the first step to getting treated for dry eye (the colloquial term for Dry Eye Disease or Dry Eye Syndrome) is for the doctor to confirm that you are indeed suffering from dry eye.
Due to the fact that dry eye can be caused by a number of underlying causes, your doctor will require a complete health history and comprehensive eye exam, as well as any number of specialized tests to determine the cause and severity of your dry eye.
The Schirmer Test is a common test for determining whether a patient has dry eye. This test, also known as a basal secretion test, measures aqueous tear production in the eyes. The test involves the doctor placing blotting strips (small strips of paper with measurement lines) just inside each eye’s lower eyelid, then have the patient close their eyes slowly. The moisture moving down the strip determines the level of tear production. This test usually takes around 5 minutes.
The test is not painful, though the patient may receive numbing drops to reduce discomfort during the test.
In this test, which is similar to the Schirmer Test, a special red thread is used to measure tear production. In comparison to the Schirmer test, the Phenol Red Thread Test causes less reflex tearing, and, taking just 15 seconds, is much easier to administer to children. However, the test may need to be performed more than once to completely assess the severity of a patient’s dry eye.
In the slit lamp test, the doctor uses a microscope called a slit lamp to check if the patient’s eyes are producing enough tears. After a drop is put in the eye which makes tears easier to see, a thin, bright light will be shined into the eye as the doctor looks at it with a microscope.
This test checks how long a patient’s tear film (the layer of tears which covers the eyes) lasts after the eye blink. For the test, a small amount of dye will be placed in the eye, and the patient will be asked to blink so it fully covers the eye. Then, as the patient looks forward without moving or blinking their eyes, the doctor will observe how long the dyed tear film remains covering the eyes. The less time it lasts, the more likely the patient has dry eye (a tear breakup time of less than 10 seconds is considered abnormal).
This is a patient response questionnaire, which allows the patient to describe their experiences, and uses the answers to the questions to determine if dry eye symptoms are detected. If they are, both imaging of the meibomian glands and a gland evaluation are recommended.
Advanced dry eye practices have invested in technology that takes high resolution images of the Meibomian Glands. This is used to take images of the meibomian glands which helps the eye doctor understand the underlying cause of the patient's symptoms. It is estimated that over 80% of dry eye sufferers have blockage in the meibomian glands; this test allows for a more effective treatment of the root cause.
This is a specialized diagnostic instrument which provides a standardized, repeatable examination of meibomian gland function. It functions by applying the same pressure of a deliberate blink as it observes the gland function through a slit lamp. This lets the doctor assess gland function, as well as track progression of any condition and treatment.
This type of testing allows the doctor to precisely measure the stability and health of the tear film. In the test, a small micro fluid sample of tears is collected and analyzed by a device, which displays a number score based on the analysis. A score below 300 along with a difference of less than 8 mOsms/L (Osmolarity) is an indication that the tear film is stable. Higher scores indicate an unstable tear film, at which point treatment options can be discussed.
This test is another involving specialized dye. A quick acting, temporary dye is placed into the eyes, and the doctor then examines the surface of the eyes, searching for staining patterns on the cornea and the conjunctiva. There are three main types of dyes: rose bengal, lissamine green and fluorescein, and they each stain the eyes differently to allow the doctor to check for different things.
When you come in for an appointment, our eye doctor will determine, based on the symptoms you report, which test is most likely to provide the right information so we can determine the exact nature of your dry eye problem, and start working on treatment plans.