How to Know When You Have Dry Eye and Getting It Diagnosed Properly

Health Line

7 hours ago

Key takeaways
Diagnosing dry eye involves a comprehensive eye exam, including a detailed medical history and specific tests to measure tear production and quality. Common diagnostic tests include the Schirmer test, tear breakup time, and ocular surface staining.
Identifying the underlying cause of dry eye is crucial for developing an effective treatment plan. Accurate diagnosis helps your doctor tailor treatment strategies to your individual needs.
Once you receive a diagnosis, follow-up appointments are important to monitor treatment effectiveness and make necessary adjustments. Learning how to manage your symptoms and make any lifestyle changes is also essential.
There are many things that can make your eyes dry. Simple environmental conditions can cause dry eyes, but you could also have conditions that change the way your eyes make or use tears.
This article will explore some of the causes of dry eye, as well as what you might want to know about dry eye disease and how it can be treated.
What is dry eye?
Eye dryness can develop for all kinds of reasons, and it's a problem that affects millions of people every year. Weather conditions, wearing contact lenses, certain medical conditions, or changes in the way your eye makes or uses tears can all lead to dry eyes.
In many cases, dry eye isn't a serious condition and is at most a discomfort or inconvenience. In severe cases, though, dry eyes can impact your vision and cause severe pain.
There are many ways to manage dry eyes, ranging from over-the-counter (OTC) medications, to prescription treatments and even surgery.
The first step in managing dry eye is to find out the precise cause and scope of the problem.
What tests can help diagnose dry eye?
If you're experiencing dry eye, an eye doctor and healthcare team will want to know when the problem started and what kinds of things might make it worse.
Two questionnaires that an eye doctor can use to gather information that may help diagnose dry eye include:
Ocular Surface Disease Index (OSDI): OSDI is a 12-question survey that can quickly determine the symptoms you might have showing irritated eyes and how they have impacted your vision during the past week. It uses a 0 to 4 scale, ranging from 'none of the time' to 'all of the time.'
Symptom Assessment in Dry Eye (SANDE): SANDE is is very brief, made up of only two questions, and uses a visual scale that helps determine both severity and frequency of dry eye symptoms, ranging from 'rarely' to 'all of the time.'
Below are some other eye examinations that can help provide clues:
Slit lamp test
This test uses a microscope and a thin, bright light that will help a doctor or healthcare professional examine the surface of your eye. With this test, a doctor will be able to see if your eyes are producing enough tears.
Schirmer's test
This is another test that can help a doctor check for adequate tear production. For this test, numbing eye drops will be placed in your eye, and a small piece of paper will be placed on the edge of your eyelid.
You'll be asked to close your eyes for 5 minutes, and at the end of that time, a doctor will observe how much moisture has collected on the paper.
Tear break-up time
This test checks how long your natural tears stay on the surface of your eye.
A small amount of dye is placed into your eye during this test, and you'll be asked to blink so that the dye covers the entire surface of your eye. You'll then be asked to look ahead without blinking or moving your eye.
The amount of time the dye covers your eye will help indicate how well your eye retains moisture. Dye that dissipates quickly could indicate a dry eye problem.
What causes dry eye?
Some common factors that cause dry eye may include:
age
biological sex
environmental conditions
inefficient tear production, or a decrease in the quality of the tears your eye is producing
tears evalopating too quickly
In a basic eye exam, a doctor will also review your medical history and any medications you're taking. There are several medications and conditions that can cause your eyes to dry out, including:
Sjögren's disease
lupus
rheumatoid arthritis
menopause
stroke
Bell's palsy
diabetes
some blood pressure medications
beta-blockers
diuretics
antidepressants
anti-anxiety medications
antipsychotics
decongestants
antihistamines
certain contraceptives
Can you have dry eye and not know it?
Eye dryness is a condition that's difficult to miss, but it's also possible that you could notice eye pain or vision changes more than dryness.
If you're having problems seeing, or you feel like there's something floating in your eye, dryness might be the real problem.
Regular eye examinations can help a doctor monitor the health of your eyes and how well tears are being produced and used.
Finding the best eye doctor and insurance coverage
Although you might first discuss eye dryness or irritation with a primary care physician, you'll likely be sent to an optometrist or ophthalmologist to pinpoint the underlying cause of your problem and guide treatment.
An optometrist is a doctor that specializes in the diagnosis and management of both internal and external eye diseases, and an ophthalmologist usually specializes in surgical procedures on the eye. There are several reasons why you might be sent to either of these specialists, and you should check with your health insurance plan about coverage before your appointment.
Not every medical insurance plan includes coverage for eye issues. However, medical insurance coverage may at times be used for eye problems related to other conditions such as diabetes-related retinopathy. Eye problems that are typically covered under vision insurance may be denied by a medical insurance plan. Vision care is usually covered under a separate vision insurance plan.
Even with a medical reason to see an optometrist or a vision plan that covers eye care, you may want to check with your insurance plan on your share of the cost responsibility before your appointment. Different types of plans and different levels of specialists might require high copayments or fees.
How do you treat dry eye once it's diagnosed?
How your dry eye is treated will depend a lot on what's causing the problem.
Dry eye caused by wearing contacts, wind, or other environmental factors may be able to be treated simply with OTC lubricating drops or warm compresses.
More severe cases of dry might be treated with special artificial tears, other lubricating drops or ointments, or prescription eye drops that target excessive tear evaporation like Miebo (perfluorohexyloctane) or inflammation like Vevye (cyclosporine).
In some cases, surgery may even be required to help clear blocked tear ducts or repair other abnormalities that might be harming tear production and quality.
In addition to these treatments, a healthcare team may recommend a number of things that can help reduce eye dryness and irritation. Examples include things such as:
using air filters in your home
adding humidification to your air
protecting your eyes from the wind
avoiding cigarette smoke and other irritants
giving your eyes a break from computer screens or other sources of eye strain
considering adding omega-3 fatty acids to your diet or taking them each day as supplements
practicing good eyelid hygiene by washing gently with mild soaps and water and rinsing well
There a number of other ways to treat chronic dry eye, so consider consulting your eye care team for more options that might be helpful.
Takeaway
There are several medical conditions and particular eye diseases that can cause you to have pain from dry eyes, but the culprit can also be as simple as wind, contact lenses, or even cold medications.
If you experience pain regularly from dry eyes, have repeated eye irritation, or notice changes in your vision, talk with a healthcare professional or eye care specialist about finding the underlying cause of your problem and identifying the best course of treatment.