Dry Eye

Change Language German


  • Dry eye, itching, foreign body sensation, burning, feeling of pressure, stabbing pain
  • OSDI (Ocular Surface Disease Index) Questionnaire
  • Medical history according to OSDI:
    • Ocular symptoms:
      • Light sensitivity? Foreign body sensation? Painful, sensitive eyes?
    • Visual impression:
      • Blurred vision? Reduced visual acuity?
      • Problems with reading, driving at night, working on computers, watching television?
    • Environmental factors:
      • Difficulty in windy conditions, dry air, air-conditioned rooms?
  • Risk factors: Smoking? Medication? Contact lenses?


Classification of dry eye disease (DED); TFOS DEWS II Definition and Classification Report


Triaging Questions; TFOS DEWS II Diagnostic Methodology report


  • Detailed examination at the slit lamp:
    • Eyelids: Lid architecture intact, blepharitis? Collarettes on eyelashes, Demodex mites? Meibomian gland dysfunction? Tear meniscus?
    • Conjunctiva: inflamed? Symmetrical in both eyes? Punctate fluorescein staining?
    • Cornea: Tear break-up time <10 seconds? Punctate fluorescein staining?
  • Tear osmolarity: Pathological if >308 mOsm/L or difference between both eyes > 8 mOsm/L
  • Schirmer’s Test: Indicated with reduced tear meniscus, symptoms of Sjögren’s syndrome
    • Schirmer I: without oxybuprocaine, pathological if <10mm after 5 minutes, more standardised than Schirmer II
    • Schirmer II: with oxybuprocaine, pathological if <6mm after 5 minutes
    • Investigation for Sjögren’s Syndrome in case of pathological Schirmer’s Test:
      • Anti-SSA and Anti-SSB recommended

DED Diagnostic Test Battery; TFOS DEWS II Diagnostic Methodology report


  • TFOS DEWS II Dry Eye Treatment Algorithm
  • Stage 1
    • Education about the condition, possible environmental factors (e.g., air conditioning, humidifiers)
    • Eliminate potential causes (smoking, medication, contact lenses)
    • Lubricating eye drops several times a day
    • Eyelid hygiene and warm compresses for blepharitis, e.g., with Blephaclean compresses
  • Stage 2:
    • Switch to preservative-free drops (e.g., Lacrycon / Lacri-Vision gtt)
    • Additionally, use gels or ointments (e.g., Lacrinorm / Liposic Gel or Vitamin A / Bepanthen ointment at night)
    • Eyelid hygiene with tea tree oil compresses for suspected Demodex (e.g., Blephademodex Pads)
    • Antibiotic treatment for blepharitis, e.g., with Fucithalmic eye gel twice daily / Oxytetracycline ointment twice daily for 2-3 weeks
    • Insert Punctum Plugs
    • Systemic antibiotic therapy, e.g., with Oracea (Doxycycline) 40mg 1x/day or Minocin Acne 50mg 2x/day for 6 weeks for rosacea
    • Ciclosporin eye drops once daily, consider overlapping with a 4-week topical steroid therapy (e.g., Dexafree SDU 4x/3x/2x/1x daily for each week)
  • Stage 3:
    • Autologous serum eye drops
      • CAUTION: must always be refrigerated, cumbersome handling/production
    • Bandage contact lens (rigid mini-scleral lens or soft)
  • Stage 4:
    • Long-term topical steroid therapy
    • Amniotic membrane
    • Permanent surgical closure of the tear ducts
    • Always start with punctum plugs
    • Tarsorrhaphy