Dry Eye Symptoms

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In aqueous-deficient dry eye, the worst time from the evening onwards, and in evaporative dry eye, the worst time is from getting up in the morning.

The main symptoms are:

Watch out for grit

Sensation of a foreign body or fine sand or eye dryness, with difficulty in keeping the eyes open.

Eye with a lightning bolt above it, symbolising pain


Eye with lightning and fire that represent a burning sensation.


Watch out for a tear

Watery eyes.

Blurred person, representing blurred vision

Sometimes blurred vision, particularly after working for a certain time with screens (computer, mobile telephone, tablets).

There is an important environmental component, as is it is very common for the discomfort to appear or is aggravated in certain environments (excessive heating, air conditioning, smoke-laden air, wind), or at determined times of the year depending on environmental humidity. If there is corneal involvement (stippled or punctate keratitis – an eye disorder associated with the death of small groups of cells on the surface of the cornea), there may also be a moderate or intense photophobia, even with weeping.

Signs of Dry Eye

The main signs are found in the cornea and conjunctiva. Different techniques are used to observe these lesions, such as special stains with fluorescein or lissamine green on the eye surface. The fluorescein stain evaluated with a slit lamp with cobalt light shows that superficial punctate keratitis (yellow spots that reveal de-epithelialised areas of the cornea), which can be classified according to the severity from 0 to 4 (0 = none, 4= many) using the Oxford scale. The lissamine green stain evaluated with the white light of the slit lamp reveals a green spots over the nasal or temporal area of the conjunctiva and over the cornea (areas without the mucin layer of the tear film), which can be evaluated according to the severity from 0 to 3 (0= none, 3= many) in the nasal area of the conjunctiva, corneal area, and conjunctival temporal area using the Van Bijsterveld scale (maximum score of 9).

In very advanced cases a whitish secretion is observed, which forms filaments that stick to the cornea (filamentary keratitis).

In evaporative dry eye, it is common to find signs of blepharitis or dysfunction of the Meibomian glands, with irregularities in the palpebral free edge with reddening, telangiectasia (swelling of the blood vessels), keratinisation, chalazion (swollen protuberance on the eyelid), collars, flakes, grooves, infiltrations, etc.

Substantiated information by:

Maria Teresa Sáinz de la Maza Sierra

Published: 23 May 2019
Updated: 23 May 2019

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