Cornea
Dry Eye Disease
Also known as: DED, dry eye, keratoconjunctivitis sicca, KCS, aqueous deficient dry eye, evaporative dry eye, tear film insufficiency, burning eye
Filed as: Routine
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
A multifactorial, chronic disease of the tears and ocular surface characterised by a loss of tear film homeostasis. Symptoms include dryness, burning, and visual disturbance. Evaporative dry eye from Meibomian gland dysfunction is the most common subtype.
Recognition
Symptoms: what patients report
- Dryness, burning, or stinging — often bilateral.
- Foreign body or gritty sensation.
- Variable or fluctuating vision, especially during sustained tasks (reading, screen use, driving).
- Paradoxical watering (reflex tearing in response to surface irritation).
- Symptoms worse later in the day, in air-conditioned environments, or in low humidity.
- Discomfort with contact lens wear.
- Photophobia in more advanced cases.
Signs: what the examination shows
- Reduced tear film break-up time (TFBUT) < 10 seconds (non-invasive NIBUT preferred).
- Corneal and conjunctival staining with sodium fluorescein (inferior > central) and lissamine green (nasal and temporal conjunctiva).
- Reduced Schirmer's test (< 10 mm/5 min in aqueous deficient DED).
- Reduced tear meniscus height.
- Lid margin telangiectasia and meibomian gland capping (evaporative/MGD subtype).
- Conjunctival hyperaemia.
- Corneal filaments in severe cases (filamentary keratitis).
What OptoGuide™ covers for dry eye disease
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Dry eye (keratoconjunctivitis sicca, KCS) — College of Optometrists CMG
- Anterior Eye Disease and Therapeutics A-Z (Bruce & Loughnan) — standard reference text
- Dry Eye Disease: An Update in 2022. Hakim FE, Farooq AV. JAMA. 2022;327(5):478-479.
- Incidence, prevalence, and outcome of moderate to severe neurotrophic keratopathy in a German tertiary referral center from 2013 to 2017. Roth M, Dierse S, Alder J, Holtmann C, Geerling G. Graefe's Archive for Clinical a
- The Differential Diagnosis of Dry Eyes, Dry Mouth, and Parotidomegaly: A Comprehensive Review. Cornec D, Saraux A, Jousse-Joulin S, et al. Clinical Reviews in Allergy & Immunology. 2015;49(3):278-87.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.