![]() ![]() A detailed list of these tests and their intended use is presented in Table 1. Given the unsatisfactory results provided by the currently available tests, an increasing number of procedures have been recently described. ![]() Since the ocular surface sensitivity is reduced in advanced ocular surface disease ( Adatia et al 2004), and the tests currently used are far from being perfect, these are poorly associated with subjective symptoms ( Bjerrum 1996 Schein et al 1997 Hai et al 1998 Pflugfelder et al 1998 Nichols, Nichols, et al 2004 Lin et al 2005).Īdditional difficulties arise because tests are used for a variety of purposes (such as, for example, diagnosing dry eye in everyday clinical practice, assessing eligibility in a clinical trial, or following quantitative changes during a clinical trial) and a given test may not be appropriate for all circumstances finally, we should keep in mind that many clinical and experimental studies about dry eye diagnosis are limited by selection bias, due to the fact that the test population may have been classified as affected or non-affected based on the same tests being evaluated for efficacy similarly, the performance of a new test may be compromised when the test is assessed in a sample of dry eye patients who have been diagnosed by means of unestablished criteria. ![]() It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface ( DEWS 2007). According to the DEWS definition, dry eye is “a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage of the ocular surface. However, a few months later, the updated definition proposed by the International Dry Eye Workshop (DEWS) did not refer to DTS and considered dry eye as a part of the ocular surface disease, which includes both aqueous deficient and evaporative dry eye, lid related diseases (such as meibomian gland dysfunction (MGD) and anterior blepharitis), allergic conjunctivitis and other inflammatory, infective o iatrogenic conditions. The term “dry eye” includes a wide spectrum of alterations of the ocular surface with different etiology and pathophysiology as a consequence, even the definition of dry eye is still debated, as demonstrated by the fact that in 2006 a panel meeting, including some of the most experienced subspecialists, recommended using the designation of “dysfunctional tear syndrome” (DTS) instead of dry eye, as “it is sufficiently broad to encompass the myriad of etiologies while still representing a common denominator among them” ( Behrens et al 2006). ![]()
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