This paper is concerned with the recognition of the dry eye when the clinical diagnosis is in doubt and other external eye diseases may be present. Papillary conjunctivitis is common to the dry eye as well as other pathological conditions and confuses the diagnosis. We have correlated the factors involved in the assessment for dryness. We have shown that particulate matter in the unstained tear film is associated with low tear lysozyme concentration. Tear flow and tear lysozyme are not necessarily interrelated, but a low lysozyme concentration (tear lysozyme ratio < 1.0) is associated with keratoconjunctivitis sicca. The Schirmer I test can produce false positive results, and we have suggested a modification to overcome this. This modified test will detect the eye with severely depleted lysozyme secretion, but it is unreliable for detecting the eye with moderately depleted secretion. We find that its lowest normal limit should be considered as 6 mm.
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