Dry Eye Disease (Keratoconjunctivitis Sicca) Differential Diagnoses

Updated: Jun 06, 2023
  • Author: Trent Tsun-Kang Chiang, MD, MS; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Diagnostic Considerations

The differential diagnoses for dry eye disease (DED), or keratoconjunctivitis sicca (KCS), are numerous. Conditions to consider are those that include conjunctivitis (allergic, bacterial, giant papillary, and viral, as well as atopic and vernal keratoconjunctivitis), filamentary keratitis, infectious diseases (chlamydia, herpes simplex and herpes simplex keratitis, and herpes zoster), corneal abnormalities (abrasion, erosion, foreign body, and mucous plaques), and other keratitis (interstitial) and keratopathies (neurotrophic and pseudophakic bullous). Demodex infestation can cause blepharitis with associated inflammation. 

Other problems to consider include the following:

  • Cranial nerve V trauma
  • Cranial nerve VII trauma or disease such as Bell palsy
  • Corneal surgery
  • Medications, topical and systemic
  • Nocturnal lagophthalmos and lid deformities
  • Thygeson superficial punctate keratopathy

See Etiology for a more comprehensive list.

Differential Diagnoses