Before the oculoplastic surgeon decides on whether the patient has dry eyes, they will take a thorough history, measure the vision and then examine the eyes. The oculoplastic surgeon will ask about eye symptoms and onset, general health, previous eye infections and conditions, contact lens wear, previous laser eye surgery, environmental factors and whether eyedrops used. Medical conditions, drugs taken, allergies. They will specifically look for blepharitis and meibomian gland dysfunction as dry eyes and blepharitis often co-exist.
A thorough eye examination is performed. The Schirmers test using a small strip of filter paper and measuring the extent of moisture absorption or Tear Osmolarity is measured before the eyelids are examined.
We examine the skin around the eyes, the eyelid position, blink rate, exclude plaque like debris on the eyelid margins and look at the under surface of the eyelids. Special dyes are instilled into the eyes to observe the tear film and cornea surface.
The lid margin and health of the meibomian glands are especially examined in order to determine if there is anterior blepharitis or meibomian gland dysfunction with an oily meibum deficiency. Possible Dermadex infection is looked for.
The degree of lid margin inflammation, granular deposits of meibum and skin cells, are assessed and whether there are posterior lid margin telangiectasia present indicative of ocular rosacea.
The cornea is examined with the bright light and magnification from the slit lamp. A blue light is used after administration of fluorescein drops to help see any dry spots on the eye and examine the tear break up time.