Dry eye 1 – evaporative component only

The historical classification of dry eye disease (DED) has typically considered two distinct disease entities:

The latest thinking from the tear film and ocular surface society (TFOS) DEWs II report suggests moving away from this separation and more towards a blurring of the lines between the two classically considered sub-types. In other words, we should consider the disease as more of a continuum of these two sub-types rather than separate entities.

The latest classification scheme encourages a simplified diagnostic strategy to help triage patients (figure 1). The scheme also importantly considers the cases where patients exhibit dry eye symptoms without evidence of obvious signs or, at the opposite end of the spectrum, present with marked signs but have no dry eye symptoms. It also includes a clinical decision guide for practitioners. The classification also recognises the necessity of symptomatic involvement and the need for presence of associated ocular surface signs in making an actual diagnosis of DED. In this series of case studies, I aim to focus on these cases with different levels of influence of each sub-type and show how management differed.