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This page is for people who suffer from dryness, burning or blurred vision that keeps coming back, despite drops and other home care. Here you will find which tests are done at the clinic, what each test reveals, and how the results help choose a treatment that suits you.
What dry eye tests are
Dry eye tests are a series of simple, non-invasive tests that check the amount of tears, their quality and the condition of the eye surface and eyelids. The aim is to understand not only whether there is dryness, but also what type: dryness from a lack of tear fluid, dryness from tears evaporating too quickly (usually because of the meibomian glands, the glands in the eyelid margins that produce the oily layer of the tears), or a combination of the two. Each type points to a different treatment.
Who the tests are for
- People who have had symptoms of dryness, burning, a foreign-body sensation or fluctuating vision for weeks or months.
- People who use lubricating drops several times a day and still feel no improvement.
- People who have recurring eyelid inflammation, styes or chalazia (lumps in the eyelid).
- People who have a condition linked to dryness, such as Sjögren's syndrome or rosacea, or who have had a bone marrow transplant.
- People planning eye surgery, or who find it hard to wear contact lenses because of dryness.
The tests are not a substitute for urgent care. Severe eye pain, a sudden drop in vision, or severe redness after a blow or exposure to a chemical require an immediate visit to an emergency department or an eye doctor.
How the tests are done at the clinic, step by step
- Conversation and questionnaire. We will ask about your symptoms, when they appear, other medical conditions, medicines, screen use and contact lenses. You will usually fill in a structured questionnaire (such as the OSDI, a questionnaire that rates the severity of symptoms and their effect on daily life).
- Slit lamp examination. A slit lamp is a microscope with a bright light through which the eye is viewed under magnification. The eyelid margins, eyelashes, conjunctiva (the clear membrane covering the white of the eye), cornea and the tear meniscus (the thin strip of tears along the lower lid margin) are examined.
- Tear break-up time (TBUT). A harmless orange dye called fluorescein is dropped into the eye, and the number of seconds from a blink until the tear layer starts to break up is measured. Rapid break-up suggests an unstable tear film.
- Staining of the eye surface. The same dye, and sometimes an additional one, highlights dry or damaged areas on the cornea and conjunctiva. The staining pattern helps assess how severe the dryness is.
- Schirmer test. Thin paper strips are placed at the edge of the lower eyelid for a few minutes, and the length of strip that gets wet is measured. The test estimates the amount of tears the eye produces.
- Meibomian gland assessment. Gentle pressure is applied to the eyelid margin and the secretion is checked: whether it is clear and fluid, or thick and cloudy, and whether some of the glands are blocked.
- Eyelid margin and Demodex check. We look for signs of inflammation of the eyelid margins (blepharitis) and signs of Demodex, a tiny mite that lives at the base of the eyelashes. A typical sign is sleeve-like scales around the base of the lashes (cylindrical dandruff). Sometimes one eyelash is removed for examination under a microscope.
- Summary and plan. At the end, we explain what was found, what type of dryness you have and what the next steps are, at home and at the clinic.
How to prepare for the tests
- Prepare a list of all the drops, ointments and medicines you use, including medicines that are not for the eyes. Some general medicines can increase dryness.
- Bring your glasses and, if you have them, visit summaries and previous test results.
- If you wear contact lenses, you may be asked to remove them before the tests. The exact instruction will be given when you book your appointment.
- Do not stop a medicine prescribed for you without consulting the doctor who prescribed it.
What the results mean
No single test gives the whole picture on its own. Sometimes the symptoms are strong and the tests are almost normal, and sometimes the opposite. That is why all the results are looked at together, alongside what you tell us. When the symptoms are very strong and the tests are normal, it is worth also considering other causes of pain, such as neuropathic eye pain.
What it feels like, and what happens afterwards
Most of the tests are not painful. The orange dye may briefly tint your tears or nasal discharge yellow, and this passes on its own. The Schirmer test may tickle or make your eyes water, and pressing on the eyelid to assess the glands may feel tender.
If numbing drops were used for one of the tests, do not rub your eyes until the numbness wears off. You can usually return to your routine straight after the tests.
Possible side effects and risks
The tests are considered very safe. Possible effects are mild discomfort, watering or temporary redness. An allergic reaction to the dye is very rare. If you know you are sensitive to certain drops or substances, tell us before the tests.
Before the appointment, it is worth noting when your symptoms are strongest (in the morning, at a screen, in the evening, in air conditioning). This information helps interpret the test results.
How the tests fit into treatment
The tests are the basis of every treatment plan. If it turns out that the main problem is in the meibomian glands, treatment may include warm compresses, meibomian gland expression or IPL treatment. If there is inflammation of the eyelid margins or Demodex, eyelid margin cleaning (BlephEx) may be suitable. When there is a real shortage of tear fluid, punctal plugs may be considered, and in severe cases autologous serum eye drops or a bandage contact lens.
Some of the tests are sometimes repeated at follow-up visits, to see whether the treatment is helping. What happens at the first appointment itself is described on the dry eye consultation page.
Cost
The cost is set and discussed at the consultation, according to the treatment that suits you.
Want a basic explanation first?For basic information on dry eye symptoms and diagnosis: the guide on the Mitzmutz site
Frequently asked questions
Are the tests painful?
Most of the tests are not painful. The Schirmer test, in which a thin paper strip is placed at the edge of the eyelid, may be unpleasant for a few minutes, and pressing on the eyelid to assess the glands may cause mild tenderness.
Can I drive after the tests?
Dry eye testing usually does not involve dilating the pupils, and most people can drive afterwards. If a test that blurs your vision is needed, this will be explained to you in advance.
What should I bring to the tests?
A list of all the drops and medicines you use, your glasses, and if you wear contact lenses, their details. Instructions about contact lenses and drops before the tests will be given when you book your appointment.
Why isn't it enough to say I have dry eye and get drops?
Dry eye is several different conditions. Dryness caused by a lack of tear fluid is treated differently from dryness caused by blocked meibomian glands or by inflammation of the eyelid margins. The tests help direct the treatment.
Home care not enough? We can look into it.
At the dry eye clinic in Haifa we find out what is causing the dryness and build a personal treatment plan.
Sources
- Wolffsohn JS, Arita R, Chalmers R, et al. TFOS DEWS II Diagnostic Methodology report. Ocul Surf. 2017;15(3):539-574.
- Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017;15(3):276-283.
- Akpek EK, Amescua G, Farid M, et al. Dry Eye Syndrome Preferred Practice Pattern®. Ophthalmology. 2019;126(1):P286-P334.
- Nichols KK, Foulks GN, Bron AJ, et al. The International Workshop on Meibomian Gland Dysfunction: executive summary. Invest Ophthalmol Vis Sci. 2011;52(4):1922-1929.
- Liu J, Sheha H, Tseng SC. Pathogenic role of Demodex mites in blepharitis. Curr Opin Allergy Clin Immunol. 2010;10(5):505-510.
The information on this site is general only. It is not medical advice and does not replace an examination by an eye doctor.