Table 3

Summary of determinant (ie, validated) and contributory (ie, indicative) diagnostic criteria and grading recommended by the ODISSEY panel to be used to establish severe DED in the case of symptom and sign discordance (ie, scenario A, B, or C)

Criteria typeEvaluationsScenario AScenario BScenario C
Determinant CriteriaSchirmer test: <3 mmXXX
MGD or eyelid inflammation: severeXXX
Conjunctival staining (also conjunctivochalasis/conjunctival folds: severe degreeXXX
Impaired visual function (photophobia, visual acuity modifications, low contrast sensitivity, or any combination of the above)XXX
Filamentary keratitisXXNA*
Hyperosmolarity: >328 mOsm/LXXX
Impression cytology: ≥grade 3 (Nelson Scale)XXX
Corneal sensitivity: deeply impairedXNA†2NA†
Contributory CriteriaTBUT <3 sXXNA‡
Refractory to standard disease treatmentsXXX
Confocal microscopyXXX
Inflammatory markers: HLA-DR, MMP9, cytokines and proteomicsXXX
  • 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.