How Does an Eye Doctor Test For Dry Eye?

How Does an Eye Doctor Test For Dry Eye? in Bellflower

Amplify Eyecare of Greater Long Beach

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

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.

The Phenol Red Thread 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.

Slit Lamp Test

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.

Tear Break Up Time (TBUT)

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).

SPEED™ Questionnaire

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.

High-definition meibography

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.

Meibomian Gland Evaluator

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.

TearLab Osmolarity

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.

Epithelial Staining

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.

Common Questions

Typically first your eye doctor would take a thorough case history reviewing your symptoms and the severity of the symptoms. (Some symptoms of dry eyes include burning, itching, excessive tearing, gritty/foreign body sensation, eye discomfort, inflammation, or blurry vision.) Your eye doctor will also review your medical history, any medications you’re taking, your day to day activities, as these can all contribute to dry eyes as well. Then a thorough dry eye evaluation will be conducted. Your eye doctor will look at your eyes under a microscope where they will assess your meibomian glands on your upper and lower lid margin. To get a better image of the inside of your meibomian/oil glands your doctor may also take an image of them using a Lipiscan/Meibography. If any of your oil glands are capped, truncated or atrophied this may indicate you have dry eyes. Also your tear layer will be assessed, typically a sodium fluorescein dye would be used. Here we can examine your tear break up time (TBUT), tear meniscus height, and blink rate. Various other tests can be used to detect dry eyes such as Lissamine green and Rose Bengal dye, Schirmer test 1 and 2, and Phenol red thread test. For the Schirmer Test your eye doctor will place a strip of medical paper inside of your lower eyelids, and the paper will then absorb your tears, which will show us the amount of tears you have. For the phenol red test it’s the same concept as the Schirmer test but instead a thin red thread string is placed inside your lower eyelids to determine the volume of your tears. If any of these values are below normal this can also help us detect dry eyes.
Dry eyes can be detected by your eye doctor first reviewing your symptoms and the severity. Some symptoms of dry eyes include burning, itching, excessive tearing, gritty/foreign body sensation, eye discomfort, inflammation, or blurry vision. Then a thorough dry eye evaluation will be conducted. Your doctor will look at your eyes under a microscope where they will assess your meibomian glands on your upper and lower lid margin. To get a better image of the inside of your meibomian/oil glands your doctor may also take an image of them using a Lipiscan/Meibography. If any of your oil glands are capped, truncated or atrophied this may indicate you have dry eyes. Also your tear layer will be assessed, typically a sodium fluorescein dye would be used. Here we can examine your tear break up time (TBUT), tear meniscus height, and blink rate. Various other tests can be used to detect dry eyes such as Lissamine green and Rose Bengal dye, Schirmer test 1 and 2, and Phenol red test. For the Schirmer Test your eye doctor will place a strip of medical paper inside of your lower eyelids, and the paper will then absorb your tears, which will show us the amount of tears you have. For the phenol red test it’s the same concept as the Schirmer test but instead a thin red thread string is placed inside your lower eyelids to determine the volume of your tears. If any of these values are below normal this can also help us detect dry eyes.
You may have dry eyes if your eyes are feeling gritty, irritated, scratchy, foreign body sensation, burning, excessive watering/tearing, redness, or if you’re experiencing light sensitivity. Dry eyes can also cause blurred vision; you may notice you find yourself blinking more frequently in order for your vision to get cleared up after going in and out of focus due to an unstable ocular surface caused by dry eyes.
If you’re experiencing any symptoms of dry eyes you should see your optometrist to get a thorough dry eye evaluation to determine the severity of your dry eyes and then have the proper course of treatment. Some symptoms of dry eyes are if your eyes feel gritty, irritated, scratchy, foreign body sensation, burning, excessive watering/tearing, redness, or you may experience light sensitivity. Other symptoms may include blurry vision; you may notice you find yourself blinking more frequently in order for your vision to get cleared up, after going in and out of focus, due to an unstable ocular surface. Since symptoms of dry eyes can also be similar to symptoms caused by other eye conditions, it’s best to not just take care of the problem by yourself, and it’s important to visit your eye doctor so that you can get the proper diagnosis and treatment. Additionally, there are instances when sometimes signs of dry eyes can be detected by your eye doctor before you even experience any symptoms. So, in that case your eye doctor may also provide some sort of treatment to prevent you from starting to feel symptoms of dry eyes in the future. Thus, if you don’t experience any symptoms of dry eyes it is still important to get your eyes examined at least once per year.
Dr. Ikeda cartoon

The Right Test for the Job

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.

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