Skip to main content
Log in

Diagnostik des Trockenen Auges

Diagnostics of dry eye disease

  • review
  • Published:
Spektrum der Augenheilkunde Aims and scope Submit manuscript

Zusammenfassung

Die Diagnostik des Trockenen Auges umfasst ein breites Feld an unterschiedlichen Untersuchungsmodalitäten, wie beispielsweise die Beurteilung des Tränenfilms, der Augenoberfläche und der Augenlider. Das folgende Review beinhaltet eine strukturierte Übersicht der genannten Untersuchungen sowie Empfehlungen zur Durchführung dieser. Eine möglichst exakte Diagnose ist eine Grundvoraussetzung, um eine entsprechende Therapie einzuleiten und die Beschwerden der PatientInnen zu behandeln.

Summary

The diagnosis of dry eye syndrome encompasses a wide range of different examination modalities, which include the examination of the tear film, the ocular surface and the eyelids. This review contains a structured overview of the mentioned examinations as well as recommendations for the execution. An accurate diagnosis is a prerequisite to initiate an appropriate therapy and to treat the complaints of patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. Nichols KK, Nichols JJ, Mitchell GL. The lack of association between signs and symptoms in patients with dry eye disease. Cornea. 2004; https://doi.org/10.1097/01.ico.0000133997.07144.9e.

    Article  PubMed  Google Scholar 

  2. Sullivan BD, Crews LA, Messmer EM, et al. Correlations between commonly used objective signs and symptoms for the diagnosis of dry eye disease: clinical implications. Acta Ophthalmol. 2014; https://doi.org/10.1111/aos.12012.

    Article  PubMed  Google Scholar 

  3. Begley CG, Chalmers RL, Abetz L, et al. The relationship between habitual patient-reported symptoms and clinical signs among patients with dry eye of varying severity. Invest Ophthalmol Vis Sci. 2003; https://doi.org/10.1167/iovs.03-0270.

    Article  PubMed  Google Scholar 

  4. Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017; https://doi.org/10.1016/j.jtos.2017.05.008.

    Article  PubMed  Google Scholar 

  5. Wolffsohn JS, Arita R, Chalmers R, et al. TFOS DEWS II diagnostic methodology report. Ocul Surf. 2017; https://doi.org/10.1016/j.jtos.2017.05.001.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Foulks GN. Challenges and pitfalls in clinical trials of treatments for dry eye. Ocul Surf. 2003; https://doi.org/10.1016/S1542-0124(12)70004-6.

    Article  PubMed  Google Scholar 

  7. Begley CG, Chalmers RL, Mitchell GL, et al. Characterization of ocular surface symptoms from optometric practices in North America. Cornea. 2001; https://doi.org/10.1097/00003226-200108000-00011.

    Article  PubMed  Google Scholar 

  8. Schiffman RM, Christianson MD, Jacobsen G, Hirsch JD, Reis BL. Reliability and validity of the ocular surface disease index. Arch Ophthalmol. 2000; https://doi.org/10.1001/archopht.118.5.615.

    Article  PubMed  Google Scholar 

  9. Finis D, Pischel N, König C, et al. Comparison of the OSDI and SPEED questionnaires for the evaluation of dry eye disease in clinical routine. Ophthalmologe. 2014; https://doi.org/10.1007/s00347-014-3042-z.

    Article  PubMed  Google Scholar 

  10. Solomon JD, Greiner JV, Korb DR. Correlation and comparison of two dry eye questionnaires: standard patient evaluation of eye dryness (SPEED) vs. ocular surface disease index (OSDI). Invest Ophthalmol Vis Sci. 2008;49:5324.

    Google Scholar 

  11. Blackie CA, Solomon JD, Scaffidi RC, Greiner JV, Lemp MA, Korb DR. The relationship between dry eye symptoms and lipid layer thickness. Cornea. 2009; https://doi.org/10.1097/ico.0b013e318191b870.

    Article  PubMed  Google Scholar 

  12. Schaumberg DA, Gulati A, Mathers WD, et al. Development and validation of a short global dry eye symptom index. Ocul Surf. 2007; https://doi.org/10.1016/S1542-0124(12)70053-8.

    Article  PubMed  Google Scholar 

  13. Cher I. A new look at lubrication of the ocular surface: fluid mechanics behind the blinking eyelids. Ocul Surf. 2008; https://doi.org/10.1016/S1542-0124(12)70271-9.

    Article  PubMed  Google Scholar 

  14. Willcox MDP, Argüeso P, Georgiev GA, et al. TFOS DEWS II tear film report. Ocul Surf. 2017; https://doi.org/10.1016/j.jtos.2017.03.006.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Mooi JK, Wang MTM, Lim J, Müller A, Craig JP. Minimising instilled volume reduces the impact of fluorescein on clinical measurements of tear film stability. Contact Lens Anterior Eye. 2017; https://doi.org/10.1016/j.clae.2017.01.004.

    Article  PubMed  Google Scholar 

  16. Wang MTM, Murphy PJ, Blades KJ, Craig JP. Comparison of non-invasive tear film stability measurement techniques. Clin Exp Optom. 2018; https://doi.org/10.1111/cxo.12546.

    Article  PubMed  Google Scholar 

  17. Downie LE. Automated tear film surface quality breakup time as a novel clinical marker for tear hyperosmolarity in dry eye disease. Invest Ophthalmol Vis Sci. 2015; https://doi.org/10.1167/iovs.15-17772.

    Article  PubMed  Google Scholar 

  18. Nichols KK, Mitchell GL, Zadnik K. The repeatability of clinical measurements of dry eye. Cornea. 2004; https://doi.org/10.1097/00003226-200404000-00010.

    Article  PubMed  Google Scholar 

  19. Yokoi N, Bron AJ, Tiffany JM, Kinoshita S. Reflective meniscometry: a new field of dry eye assessment. Cornea. 2000; https://doi.org/10.1097/00003226-200005001-00008.

    Article  PubMed  Google Scholar 

  20. Mishima S, Gasset A, Klyce SD, Baum JL. Determination of tear volume and tear flow. Invest Ophthalmol. 1966;5(3):264–76.

    CAS  PubMed  Google Scholar 

  21. Werkmeister RM, Alex A, Kaya S, et al. Measurement of tear film thickness using ultrahigh-resolution optical coherence tomography. Invest Ophthalmol Vis Sci. 2013; https://doi.org/10.1167/iovs.13-11920.

    Article  PubMed  Google Scholar 

  22. Schmidl D, Witkowska KJ, Kaya S, et al. The association between subjective and objective parameters for the assessment of dry-eye syndrome. Invest Ophthalmol Vis Sci. 2015; https://doi.org/10.1167/iovs.14-15814.

    Article  PubMed  Google Scholar 

  23. Garhöfer G, Dos Santos VA, Stegmann H, et al. The association between tear film thickness as measured with OCT and symptoms and signs of dry eye disease: a pooled analysis of 6 clinical trials. J Clin Med. 2020; https://doi.org/10.3390/jcm9113791.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ang M, Baskaran M, Werkmeister RM, et al. Anterior segment optical coherence tomography. Prog Retin Eye Res. 2018; https://doi.org/10.1016/j.preteyeres.2018.04.002.

    Article  PubMed  Google Scholar 

  25. Nguyen P, Huang D, Li Y, et al. Correlation between optical coherence tomography-derived assessments of lower tear meniscus parameters and clinical features of dry eye disease. Cornea. 2012; https://doi.org/10.1097/ICO.0b013e3182261577.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Li L, Braun RJ, Driscoll TA, Henshaw WD, Banks JW, King-Smith PE. Computed tear film and osmolarity dynamics on an eye-shaped domain. Math Med Biol. 2016; https://doi.org/10.1093/imammb/dqv013.

    Article  PubMed  Google Scholar 

  27. Braun RJ, King-Smith PE, Begley CG, Li L, Gewecke NR. Dynamics and function of the tear film in relation to the blink cycle. Prog Retin Eye Res. 2015; https://doi.org/10.1016/j.preteyeres.2014.11.001.

    Article  PubMed  Google Scholar 

  28. Potvin R, Makari S, Rapuano CJ. Tear film osmolarity and dry eye disease: a review of the literature. Clin Ophthalmol. 2015; https://doi.org/10.2147/OPTH.S95242.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Jackson DC, Zeng W, Wong CY, et al. Tear interferon-gamma as a biomarker for evaporative dry eye disease. Invest Ophthalmol Vis Sci. 2016; https://doi.org/10.1167/iovs.16-19757.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Tomlinson A, Khanal S, Ramaesh K, Diaper C, McFadyen A. Tear film osmolarity: determination of a referent for dry eye diagnosis. Invest Ophthalmol Vis Sci. 2006; https://doi.org/10.1167/iovs.05-1504.

    Article  PubMed  Google Scholar 

  31. Bron AJ, Tomlinson A, Foulks GN, et al. Rethinking dry eye disease: a perspective on clinical implications. Ocul Surf. 2014; https://doi.org/10.1016/j.jtos.2014.02.002.

    Article  PubMed  Google Scholar 

  32. Rolando M, Baldi F, Zingirian M. The effect of hyperosmolarity on tear mucus ferning. Fortschr Ophthalmol. 1986;83(6):644–6.

    CAS  PubMed  Google Scholar 

  33. Maragou M, Vaikousis E, Ntre A, et al. Tear and saliva ferning tests in sjögren’s syndrome (SS). Clin Rheumatol. 1996; https://doi.org/10.1007/BF02230328.

    Article  PubMed  Google Scholar 

  34. Horwath J, Ettinger K, Bachernegg M, Bodner E, Schmut O. Ocular ferning test—effect of temperature and humidity on tear ferning patterns. Ophthalmologica. 2001; https://doi.org/10.1159/000050838.

    Article  PubMed  Google Scholar 

  35. Bron AJ, Argüeso P, Irkec M, Bright FV. Clinical staining of the ocular surface: mechanisms and interpretations. Prog Retin Eye Res. 2015; https://doi.org/10.1016/j.preteyeres.2014.10.001.

    Article  PubMed  Google Scholar 

  36. Argüeso P, Tisdale A, Spurr-Michaud S, Sumiyoshi M, Gipson IK. Mucin characteristics of human corneal-limbal epithelial cells that exclude the rose bengal anionic dye. Invest Ophthalmol Vis Sci. 2006; https://doi.org/10.1167/iovs.05-0735.

    Article  PubMed  Google Scholar 

  37. Dundas M, Walker A, Woods RL. Clinical grading of corneal staining of non-contact lens wearers. Ophthalmic Physiol Opt. 2001; https://doi.org/10.1016/S0275-5408(00)00011-9.

    Article  PubMed  Google Scholar 

  38. Bron AJ, de Paiva CS, Chauhan SK, et al. TFOS DEWS II pathophysiology report. Ocul Surf. 2017; https://doi.org/10.1016/j.jtos.2017.05.011.

    Article  PubMed  Google Scholar 

  39. Whitcher JP, Shiboski CH, Shiboski SC, et al. A simplified quantitative method for assessing Keratoconjunctivitis sicca from the Sjögren’s syndrome international registry. Am J Ophthalmol. 2010; https://doi.org/10.1016/j.ajo.2009.09.013.

    Article  PubMed  Google Scholar 

  40. Höh H. Lidkantenparallele Konjunktivale Falten. Trockenes Auge: Anatomie, Physiologie, Pathophysiologie, Diagnostik Und Therapie Des Sicca-Syndroms. : Kaden Verlag; 2001.

    Google Scholar 

  41. Calonge M, Diebold Y, Sáez V, et al. Impression cytology of the ocular surface: a review. Exp Eye Res. 2004; https://doi.org/10.1016/j.exer.2003.09.009.

    Article  PubMed  Google Scholar 

  42. Haller-Schober EM, Schwantzer G, Berghold A, Fischl M, Theisl A, Horwath-Winter J. Evaluating an impression cytology grading system (IC score) in patients with dry eye syndrome. Eye (Lond). 2006; https://doi.org/10.1038/sj.eye.6702058.

    Article  Google Scholar 

  43. Messmer EM, von Lindenfels V, Garbe A, Kampik A. Matrix metalloproteinase 9 testing in dry eye disease using a commercially available point-of-care Immunoassay. Ophthalmology. 2016; https://doi.org/10.1016/j.ophtha.2016.07.028.

    Article  PubMed  Google Scholar 

  44. Kaufman HE. The practical detection of MMP‑9 diagnoses ocular surface disease and may help prevent its complications. Cornea. 2013; https://doi.org/10.1097/ICO.0b013e3182541e9a.

    Article  PubMed  Google Scholar 

  45. Chan TCY, Chow SSW, Wan KHN, Yuen HKL. Update on the association between dry eye disease and meibomian gland dysfunction. Hong Kong Med J. 2019; https://doi.org/10.12809/hkmj187331.

    Article  PubMed  Google Scholar 

  46. Geerling G, Tauber J, Baudouin C, et al. The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction. Invest Ophthalmol Vis Sci. 2011; https://doi.org/10.1167/iovs.10-6997g.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Goto E, Tseng SCG. Differentiation of lipid tear deficiency dry eye by kinetic analysis of tear interference images. Arch Ophthalmol. 2003; https://doi.org/10.1001/archopht.121.2.173.

    Article  PubMed  Google Scholar 

  48. Li J, Ma J, Hu M, Yu J, Zhao Y. Assessment of tear film lipid layer thickness in patients with Meibomian gland dysfunction at different ages. BMC Ophthalmol. 2020; https://doi.org/10.1186/s12886-020-01667-8.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Eom Y, Lee JS, Kang SY, Kim HM, Song JS. Correlation between quantitative measurements of tear film lipid layer thickness and meibomian gland loss in patients with obstructive meibomian gland dysfunction and normal controls. Am J Ophthalmol. 2013; https://doi.org/10.1016/j.ajo.2013.01.008.

    Article  PubMed  Google Scholar 

  50. Hwang JH, Lee JH, Chung SH. Comparison of Meibomian gland imaging findings and lipid layer thickness between primary Sjögren syndrome and non-Sjögren syndrome dry eyes. Ocul Immunol Inflamm. 2020; https://doi.org/10.1080/09273948.2018.1562557.

    Article  PubMed  Google Scholar 

  51. Yamaguchi M, Kutsuna M, Uno T, Zheng X, Kodama T, Ohashi Y. Marx line: fluorescein staining line on the inner lid as indicator of meibomian gland function. Am J Ophthalmol. 2006; https://doi.org/10.1016/j.ajo.2005.11.004.

    Article  PubMed  Google Scholar 

  52. Jansen ME, Begley CG, Himebaugh NH, Port NL. Effect of contact lens wear and a near task on tear film break-up. Optom Vis Sci. 2010; https://doi.org/10.1097/OPX.0b013e3181d951df.

    Article  PubMed  Google Scholar 

Download references

Danksagung

Ganz besonderer Dank an Dr. Cornelia Hirn und Dr. Andreas Schlatter für die Durchsicht und Diskussion des vorliegenden Reviews.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Stefan Palkovits PhD.

Ethics declarations

Interessenkonflikt

S. Palkovits gibt an, dass kein Interessenkonflikt besteht.

Additional information

Hinweis des Verlags

Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Palkovits, S. Diagnostik des Trockenen Auges. Spektrum Augenheilkd. 35, 159–168 (2021). https://doi.org/10.1007/s00717-021-00495-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00717-021-00495-5

Schlüsselwörter

Keywords

Navigation