INTRODUCTION
Keratoconjunctivitis sicca commonly known as dry eye disease is defined as a multifactor disease that affect the tears and surface of the eye which yields to discomfort, disturbances in vision and unstable tear film that causes tremendous damage to the surface of the eye, followed by increment in the osmolarity of the tear film and inflammation on the ocular structures involved [1].
Physiologically the tear film is made up of a lipid, aqueous and mucin layer. The lipid layer is produced by meibomian and other glands; aqueous layer is secreted by lacrimal gland, accessory gland, conjunctival and corneal epithelium; and mucin layer is produced by the goblet cells of the conjunctiva. These structures are the main targets for dry-eye
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First ask the patient to dry their eyes in case there are excess tears. Fold filter paper 5mm on one end and place it in the middle of the outer end of the lower eyelid. The patient keeps their eyes closed for 5minutes. Thereafter, you remove the filter paper and measure from it the amount that is wet. If after 5min there is less than 5.5mm of wetting. Redo to confirm the test and if the results are the same then there is aqueous tear-deficiency dry eye. With evaporative dry eye the schirmer test is usually normal [6].
If there is aqueous tear-deficiency dry eye, suspect Sjogren syndrome especially if there is xerostomia. Further tests such as serologic and labial salivary gland biopsy can diagnose Sjogren syndrome. It is important to evaluate and monitor Sjogren syndrome because it increases the risk of serious diseases such as primary biliary cirrhosis [6].
Tear breakup time: This test is used to evaluate evaporative dry eye. You first wet a fluorescein strip with saline then apply it to the inferior cul-de-sac. Have patient blink a few times to spread the fluorescein on the surface of the eye then look with slitlamp under blue light while timing. You will check for the first appearance of dark spots on the cornea then stop timer. Tear breakup time of less than 10seconds is abnormal and indicates evaporative dry eye [5].
You can use either of the following stains when evaluating tear break up