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How is dry eye diagnosed?

How is dry eye diagnosed?

Based on the results of the anamnesis, the examinations and the tests indicated, the severity of the condition22 and the worker’s work aptitude for the position he occupies is determined, which can be: suitable without restrictions, suitable under observation (pending worker qualification), suitable with restrictions or limitations and not suitable.

When the appearance of multiple cases of SOS is detected in workers who perform similar tasks, the alert symptoms are considered to take preventive actions to determine whether there are labor factors related to this increase in incidence and act accordingly.

Although the use of PVD has been the most studied in the symptoms of SOS, the growing importance in the workplace of SBS in hermetic buildings built for the maximum use of air conditioning and heating stands out. Poor ventilation determines an increase in the concentration of various pollutants, main gases from air conditioning (carbon dioxide, nitrous oxide, carbon monoxide, ozone, and polynuclear aromatic hydrocarbons), which have an irritant effect on the mucous membranes, 23 o toxic inorganic particles such as arsenic, cadmium, chromium, copper, iron, lead, mercury or nickel, 24 and allergens such as pollen and dust mites, with a predominance of Dermatophagoides farinae, 25 and that, added to the elevated temperatures due to heating, it is an excellent breeding ground for pathogens. Artificial lighting predominates in these buildings, often inadequate, and the use of cleaning and disinfectant agents, which can be highly irritating and even toxic in high concentrations, such as formaldehyde, also seems to be involved in the disease. Although the most studied symptoms in SBS are respiratory symptoms, a notable increase in ocular symptoms has been observed. Symptoms of eye discomfort are an indicator of poor ambient air quality in these airtight constructions.26

When the occupational doctor detects or has knowledge of a worker with dry eye, he must confront this diagnosis with the requirements of the job and determine if he can continue to carry it out, provisionally or definitively depending on the cause of SOS, considering whether he should restricting the performance of any of the tasks or if a change of position is necessary.

Together with the preventive work of VSE, the occupational physician should diagnose the disease, if possible, in the initial stages, which will allow the application of early treatments that stop the natural evolution of the disease, and with this, achieve effective secondary prevention. The etiological treatment of dry eyes will be specific to the causal disease when it is known, 27 but the most frequent treatment for SOS is the replacement of tears by adding compounds such as artificial tears, gels, or ointments should be used all the time. Life and whose frequency of installation will depend on your discomfort.

Sodium hyaluronate tears are more effective than other types of commercially available tear substitutes.28 Sodium hyaluronidase, like mucopolysaccharides, 29 can retain large amounts of water on the ocular surface and increase corneal humidification, 30 lo which appears to have a protective effect on the corneal epithelium. Comparative studies between sodium hyaluronate and polyvinyl alcohol coincide with the superiority of the former.31,32 In recent years, the use of carboxymethylcellulose (carmellose) has been imposed for the relief of dry eye symptoms supported by various studies that confirm favorable clinical results and a good cost/benefit ratio.33

As the most effective preventive measures at work, the control actions of the ventilation and air conditioning systems stand out, which seem to reduce the prevalence of symptoms by 40 or 50%.34 Along with this, the application of general measures aimed at the sanitation of the building (table 2) and individual prevention measures

Dry eye or dryness of the ocular surface is a frequent ophthalmological problem that can be favored or caused by various factors (autoimmune, environmental, hormonal, toxic, etc.)

Due to the multifactorial origin of this disease, it is very important to try to identify in each case the factors that are most influencing the patient’s symptoms to be able to carry out the most individualized treatment possible.

In many cases, it is a long-term disease, and it is often not possible to completely make the symptoms caused by this disease disappear, so the objective of its treatment is to reduce the intensity of the symptoms of our patients as much as possible.

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What are the symptoms of dry eye?

Among the most common symptoms that can appear in this disease are the following:

  • The sensation of a foreign body or grit in the eyes
  • Itching and stinging of the eyes, “eye pricks,” heaviness of the eyelids.”
  • Visual fatigue”
  • Photophobia or vision fluctuating blur

In some cases, there may even be the need to keep your eyes closed.

There may also be a paradoxical increase in lacrimation, which is usually because, as the ocular surface does not enjoy the constant hydration it needs, in an attempt to compensate for this deficiency, which on the other hand does not achieve its objective, reflex hyperlacrimation occurs.

Most common symptoms:

    Foreign body sensation.


    It was fluctuating blurred vision.

    The heaviness of the eyelids.

Do you have any of these symptoms?

You may have a dry eye problem

What are the causes of dry eye?

There are many causes and risk factors for dry eye.

Some of them are:

    Advanced age.


    Environmental factors.

    Bad nutrition.

    Autoimmune diseases.

    Side effects of medications.

    Eye trauma.

    Use of contact lenses.

How is dry eye diagnosed?

We have the appropriate technology that allows us to try to make an individualized diagnosis in each patient.

We used the Keratograph 5M® for diagnosis, a Placido disc topographer with white and infrared illumination. It evaluates 22,000 points of the surface with what has obtained very precise and detailed information of the state of the ocular surface and the tear film.

In all cases, the “dry eye syndrome” entails inadequate moisturization and lubrication of the ocular surface, which causes the appearance of symptoms that can sometimes be very intense, annoying, even limiting the normal activity of the person who does it. You suffer from, and that affects your quality of life. For this reason, it will be necessary to supplement the natural hydration that our tears provide with the contribution of artificial tears and other gels or ointments that keep the ocular surface adequately lubricated day and night. The tear supplements used shouldn’t contain preservatives.

Likewise, the instability of the tear film and inflammation of the ocular surface play an important etiological role in the development of this disease. The dysfunction of the meibomian glands of the eyelids is at the base of most of the cases in which we find a “fragility of the tear,” and therefore, excessively rapid evaporation of the same.

For this reason, in many patients, it is necessary to indicate various physical treatments that improve the “quality” of our tears or allow the tear to remain, both natural and artificial, in contact with the ocular surface. And, of course, establish anti-inflammatory, immunomodulatory, or blood-derived treatments (autologous serum, PRP, PRGF) to control this inflammatory component present in many eyes affected by dryness. There are also modulators of sensitivity that do not fully anesthetize the eye.

Finally, in some patients, the chronicity of the symptoms caused by this disease can cause the appearance of so-called “neuropathic pain,” which is a pain produced by the chronic stimulation of the sensory endings of the ocular surface and that can remain even when the signs of dryness of the ocular surface have significantly diminished thanks to the treatment. Being precise, in some exceptional cases, the establishment of treatment on the part of the specialists of the Area of ​​the Pain.

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