Usually gradual or subacute onset, commonest in postmenopausal women. Present with:

May be the underlying cause in patients with recurrent blepharitis, conjunctivitis or marginal keratitis. Dry eye is associated with rheumatoid arthritis and other connective tissue diseases ( Sjogrens syndrome ).

Differential diagnosis of the dry eye

Condition Symptoms Vision Description Management
Dry eye Subacute, dry, gritty. Normal Mild conjunctival injection; Rose Bengal stain of conj and cornea. Lubricants
Conjunctivitis Irritable, red, sticky. Normal Diffuse conjunctival injection, clear cornea, discharge. Antibiotic
Blepharitis Irritable, sore, matted lashes. Normal Red rimmed lids, lashes crusted, styes, cysts. Ophthalmic ointments
Lid malposition "Lashes going in" or watery eye. Normal Entropion or ectropion check cornea. Refer to clinic.
Corneal erosions Severe pain and sticking sensation on awakening; resolves during day. Normal Normal between attacks. Area of raised or lost corneal epithelium during acute episode. Lubricant ointment at night. Refer to eye clinic.
Corneal ulcer Acute onset pain, photophobia and discharge. Varies Red eye. Localised corneal opacity with fluorescein stain. Refer to eye casualty.
Iritis Acute or subacute; aching, bruised, watery. Varies Circumcorneal injection. Small or irregular pupil Refer to eye casualty.

Schirmer's test

Measure wetting from fold after 5 minutes:

Treatment

Using artificial tear preparations, the greater the viscoscity the more proloinged the retention time. However, the more viscous preparations may cause blurring or lid crusting.

Ointments have a more prolonged retention time but are greasy and may cause blurring.