Diagnosing Dry Eye

Dry eye is a clinical diagnosis that combines information obtained from both the history and the examination, and from performing 1 or more tests to lend some objectivity to the diagnosis. Some of these tests include:

Tear break-up test (TBUT)

Measure the time lapse between instillation of fluorescein and appearance of the first dry spots on the cornea

Staining to evaluate epitheliopathy

  • Rose bengal staining
  • Fluorescein staining
  • Lissamine green staining

Schirmer test

  • Tests aqueous tear production
  • Schirmer I test - Measures both basic and reflex tearing
  • Schirmer II test - Measures reflex tearing

Tests to quantify individual tear components


Analyze collected meibum via high pressure liquid chromatography (HPLC) or gas chromatography with mass spectroscopy (GC-MS).


Measure tear film osmolarity, tear lysozyme, tear lactoferrin, EGF, aquaporin 5, lipocalin, and IgA concentration with ELISA.


Measure by using impression cytology or brush cytology techniques.

Symptom questionnaires can also be used to help establish a diagnosis of dry eye. Give your patients the Dry Eye Quiz to help determine if they might have dry eye.