Criteria type | Evaluations | Scenario A | Scenario B | Scenario C |
---|---|---|---|---|
Determinant Criteria | Schirmer test: <3 mm | X | X | X |
MGD or eyelid inflammation: severe | X | X | X | |
Conjunctival staining (also conjunctivochalasis/conjunctival folds: severe degree | X | X | X | |
Impaired visual function (photophobia, visual acuity modifications, low contrast sensitivity, or any combination of the above) | X | X | X | |
Filamentary keratitis | X | X | NA* | |
Blepharospasm | X | X | X | |
Hyperosmolarity: >328 mOsm/L | X | X | X | |
Impression cytology: ≥grade 3 (Nelson Scale) | X | X | X | |
Corneal sensitivity: deeply impaired | X | NA†2 | NA† | |
Contributory Criteria | TBUT <3 s | X | X | NA‡ |
Refractory to standard disease treatments | X | X | X | |
Aberrometry | X | X | X | |
Confocal microscopy | X | X | X | |
Inflammatory markers: HLA-DR, MMP9, cytokines and proteomics | X | X | X |
Criteria are ranked (highest to lowest) in order of perceived value for diagnosis. Inclusion of one or more accepted additional criterion is sufficient to establish DED as severe.
*Filamentary keratitis is not considered as an additional determinant criterion in Scenario C, as CFS has already established ocular surface damage to be low-level in this case.
†Adequate corneal sensitivity has already been confirmed by OSDI score in Scenarios B and C, and is thus not considered as an additional determinant criterion in these cases.
‡In Scenario C, when CFS is low, the TBUT test is considered as pre-requisite to reconfirm DED diagnosis (in light of primary criteria results).
MGD, meibomian gland disease, DED, dry eye disease, HLA-DR, human leukocyte antigen-DR, MMP, matrix metalloproteinase, TBUT, tear break-up time, sec, second, mOsm, milliosmole, L, litre, mm, millimetre, NA, not applicable, CFS, corneal fluorescein staining, OSDI, Ocular Surface Disease Index.