Dry Eye Diagnosis & Evaluation

Dry eye symptoms can have several different causes, so an evaluation is more than simply checking whether your eyes feel dry.

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Why Is a Dry Eye Evaluation Important?

Dry eye is a multifactorial condition. Two people may experience similar symptoms while having different underlying contributors.

For example, one person may have insufficient tear production, while another may have excessive tear evaporation associated with eyelid or meibomian gland problems. Environmental factors, medications, systemic conditions, and previous eye procedures may also contribute.

An eye-care professional may examine the surface of your eyes, evaluate your tear film, assess your eyelids and tear production, and consider your medical history and medications. The goal is to understand what may be contributing to your symptoms so that management can be appropriately tailored. Identifying these differences can help an eye-care professional determine which management approaches are most appropriate.

What Happens During a Dry Eye Evaluation?

The exact evaluation varies depending on your symptoms and medical history.

Your eye-care professional may begin by asking about:

  • How long you have experienced symptoms
  • Whether symptoms affect one or both eyes
  • Burning, itching, irritation, watering, or blurred vision
  • When symptoms are most noticeable
  • Screen use and other visually demanding activities
  • Contact lens use
  • Current medications
  • Previous eye procedures or surgeries
  • Relevant medical conditions

You may also be asked how your symptoms affect reading, computer use, driving, work, or other everyday activities.

A slit-lamp examination uses a specialized microscope to examine the eye’s surface and eyelids.

During this examination, your eye-care professional can look for changes involving the tear film, eyelids, and other structures of the eye. A dye may be used to make the tears easier to see and evaluate.

The examination is generally straightforward and helps provide information that cannot be obtained simply by asking about symptoms.

One test that may be used is called a Schirmer’s test.

For this test, the eye may be numbed with drops before a small strip of paper is placed along the edge of the lower eyelid. You close your eyes for several minutes, and the amount of moisture collected on the paper provides an indication of tear production.

This test is not necessarily required for every patient. Your eye-care professional determines which testing is appropriate based on the overall evaluation

Your tears need to remain distributed across the eye between blinks.

A tear break-up time, sometimes abbreviated as TBUT, evaluates how long the tear film remains stable after you blink.

A small amount of dye may be placed on the eye. After you blink, the examiner observes the tear film to determine how long it remains intact. A tear film that breaks up quickly can be a sign of tear-film instability.

The eyelids play an important role in maintaining a healthy tear film.

The meibomian glands within the eyelids produce oils that help reduce tear evaporation. Problems with these glands can contribute to evaporative dry eye.

An examination may therefore include looking closely at the eyelid margins and gland openings.

This can help determine whether eyelid or gland dysfunction may be contributing to symptoms.

Dry-eye symptoms are not specific to dry eye.

Eye redness, irritation, discomfort, or blurred vision can occur with several other eye conditions. A proper evaluation can help distinguish dry eye from other causes of ocular discomfort and determine whether additional evaluation is appropriate.

Medical conditions such as diabetes, thyroid disorders, and autoimmune diseases can also be associated with dry eye. Some medications may contribute as well.

For this reason, your medical history is an important part of the evaluation.

What Should You Tell Your Eye Doctor?

Before an appointment, it can be helpful to make a list of your:

  • Prescription medications
  • Over-the-counter medications
  • Eye drops
  • Contact lens use
  • Previous eye surgeries or procedures
  • Relevant medical conditions
  • Typical dry-eye symptoms
  • Situations that make symptoms better or worse

If you have been using over-the-counter eye drops, tell your eye-care professional which products you use and how often.

Eye drops should be handled carefully because ophthalmic products must remain sterile to reduce the risk of contamination and infection.

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What Happens After the Evaluation?

Once the evaluation is complete, your eye-care professional can discuss the findings with you.

Depending on what is contributing to your symptoms, management may involve simple environmental or behavioral changes, lubricating drops, prescription medication, treatment of eyelid or gland problems, tear-conservation measures, or other approaches.

Not every patient needs every available treatment.

The appropriate approach depends on factors such as the severity of symptoms, tear production, tear-film stability, eyelid health, medical history, medications, and other findings from the examination.

Frequently Asked Questions

There is no single follow-up schedule that applies to everyone with dry eye.

People with mild or occasional symptoms may need less frequent evaluation, while people with persistent symptoms or ongoing treatment may require monitoring to determine whether management is working.

Your eye-care professional can recommend follow-up based on your individual findings and treatment needs.

Dry eye usually causes irritation and discomfort rather than sudden severe symptoms.

However, significant or rapidly developing vision changes, severe eye pain, serious injury, or other unusual symptoms should not simply be assumed to be dry eye.

If symptoms change substantially or you develop concerning new symptoms, seek appropriate medical evaluation.

Most dry-eye evaluation procedures are straightforward. Some tests may involve drops, temporary mild discomfort, or a brief sensation associated with placing a test strip near the eyelid.

Usually, there is no complicated preparation. Bring information about your medications, eye drops, contact lenses, previous procedures, and symptoms.

Dilation is not necessarily required for every dry-eye assessment. Depending on your symptoms and overall eye examination, your doctor may recommend a broader examination that includes dilation.

Yes. Irritation from dry eye can cause reflex tearing, so watery eyes do not automatically rule out dry eye.

Some medications can contribute to dry-eye symptoms. Knowing what you take can help your eye-care professional consider possible contributing factors.

The eyelids and meibomian glands contribute to the stability of the tear film. Problems affecting these structures can contribute to evaporative dry eye.

Not necessarily. Dry eye is multifactorial, so clinicians may consider symptoms, examination findings, tear production, tear-film stability, eyelid health, and other factors together.

Continue Learning

What Is Dry Eye?
Learn about the causes, risk factors, symptoms, and effects of dry eye.

Dry Eye Treatment & Long-Term Management
Learn what treatments may be used after dry eye has been evaluated and its contributing factors considered.

Medical Disclaimer

The information on this page is provided for general educational purposes and is not a substitute for a professional eye examination, diagnosis, or individualized medical advice. Cataract treatment and surgical decisions depend on each patient’s eye health, medical history, visual needs, and other individual factors. If you have sudden or significant changes in vision, severe eye pain, or other concerning symptoms, seek prompt medical attention.

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