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Dry eyes can usually be diagnosed by the symptoms alone. Tests can determine both the quantity and the quality of the tears. A slit lamp examination can be performed to diagnose dry eyes and to document any damage to the eye.

A Schirmer’s test can measure the amount of moisture bathing the eye. This test is useful for determining the severity of the condition. A five-minute Schirmer’s test with and without anesthesia using a Whatman filter paper 5 mm wide by 35 mm long is performed. For this test, wetting under 5 mm with or without anesthesia is considered diagnostic for dry eyes.

If the results for the Schirmer’s test are abnormal, a Schirmer II test can be performed to measure reflex secretion. In this test, the nasal mucosa is irritated with a cotton-tipped applicator, after which tear production is measured with a Whatman filter paper. For this test, wetting under 15 mm after five minutes is considered abnormal.

A tear breakup time (TBUT) test measures the time it takes for tears to break up in the eye. The tear breakup time can be determined after placing a drop of fluorescein in the cul-de-sac.

A tear protein analysis test measures the lysozyme contained within tears. In tears, lysozyme accounts for approximately 20 to 40 percent of total protein content.A lactoferrin analysis test provides good correlation with other tests.

The presence of the recently described molecule Ap4A, naturally occurring in tears, is abnormally high in different states of ocular dryness. This molecule can be quantified biochemically simply by taking a tear sample with a plain Schirmer test. Utilizing this technique it is possible to determine the concentrations of Ap4A in the tears of patients and in such way diagnose objectively if the samples are indicative of dry eye.

Eye doctors use a combination of routine clinical exams and other specific tests for dry eyes. For example, the Schirmer test uses a tiny strip of paper placed on the edge of the lower eyelids. This measures how much moisture is in the eye, and it’s also useful for determining the severity of the problem. Doctors may also use dye, such as fluorescein or rose bengal, which is placed on the eye to stain the surface. This is to see how much the surface of the eye has been affected by dryness.

Diagnosis and Tests

Determining the quality of your tears. Other tests use special dyes in eyedrops to determine the surface condition of your eyes. Your doctor looks for staining patterns on the cornea and measures how long it takes before your tears evaporate.

Measuring the volume of your tears. Your doctor may measure your tear production using the Schirmer tear test. In this test, blotting strips of paper are placed under your lower eyelids. After five minutes your doctor measures the amount of strip soaked by your tears.

Dye Testing:Sometimes chronic dry eye syndrome is not caused by a lack of tears, but by faulty tear film that evaporates and breaks up instead of holding together to lubricate the eye, as healthy tears do. This kind of dry eye is measured with dye testing. Fluorescein and Rose Bengal are two types of dye commonly used. In fluorescein dry eye testing, a strip of fluorescein is applied to the lower eyelid and removed. The doctor will ask you to blink so that the fluorescein disperses, coloring the tear film on the outside of your eye blue. A cobalt blue filtered light enables the doctor to see how quickly the tear film breaks up. From this data, the doctor will discern whether your dry eye symptoms are mild or severe. Rose Bengal is another safe dye doctors typically use to diagnose dry eye disease. Rose Bengal temporarily stains cells on the eye that are inadequately covered by tear film. This test reveals the degree of dry eye and is especially useful for testing mild dry eyes.

Schirmer Test:One way a dry eye diagnosis can be made is by measuring the amount of tears the eyes produce. For a Schirmer test, your doctor uses a paper filter to measure the quantity of your tears to determine if your tear production is abnormally low. A tiny strip of paper is placed beneath your eye for five minutes while you look forward and blink normally. If few tears are produced, you may have severe dry eyes. If enough tears are produced, yet you still feel your eyes are uncomfortable and dry, it is likely you have a mild case of dry eyes. The Schirmer method of dry eye testing is more effective in the diagnosis of severe dry eyes rather than mild or moderate dry eyes.