Dry Eye Disease (Keratoconjunctivitis Sicca) Clinical Presentation

Updated: Dec 12, 2019
  • Author: C Stephen Foster, MD, FACS, FACR, FAAO, FARVO; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Depending on the severity of dry eye disease (DED), or keratoconjunctivitis sicca (KCS), the following are the most common patient complaints:

  • Foreign-body sensation
  • Grittiness
  • Redness
  • Mucoid discharge
  • Ocular irritation
  • Ocular dryness
  • Excessive tearing (secondary to reflex secretion)
  • Photophobia
  • Itching
  • Fluctuating or blurry vision

These symptoms are often exacerbated in smoky or dry environments, by indoor heating, by fans, or by excessive reading or computer use. These symptoms are quantified objectively in the Ocular Surface Disease Index (OSDI) questionnaire, which lists 12 symptoms and grades each on a scale of 1-4.

In dry eye disease, symptoms tend to be worse toward the end of the day, with prolonged use of the eyes, or with exposure to extreme environmental conditions. Smoking and other environmental irritants, including chronic smartphone, computer, or soft contact lens use, are important risk factors.

Patients with meibomian gland dysfunction (MGD) may complain of redness of the eyelids and conjunctiva, but in these patients, the symptoms are often worse upon awakening in the morning.

Paradoxically, some patients with dry eye disease complain of too much tearing. When evidence of dry eye disease exists, this symptom is often explained by excessive reflex tearing due to severe corneal surface disease from the dryness. Epiphora may also accompany conjunctivochalasis, which demands consideration of surgical intervention.

Certain systemic medications also decrease tear production, such as antihistamines, beta-blockers, anticholinergics, and oral contraceptives.

Many topical medications also decrease tear production, including antihistamines, beta blockers, and many other glaucoma medications.

The patient’s medical history may be significant for coexisting connective tissue disease (CTD), rheumatoid arthritis (RA), or thyroid abnormalities. A thorough review of systems should be obtained, focusing specifically on dry mouth, arthritis, cutaneous changes, malaise, weight loss, and lymphadenopathy.

Within the veteran population, a study found an increased incidence of dry eye disease in both men and women that was also strongly connected to cases of posttraumatic stress disorder and depression. [28]