Dry eye 2 – mixed dry eye

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

• Aqueous deficient
• Evaporative

The latest thinking from the 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.

Case 2

For any patient being assessed for dry eye disease, the first step is a sequence of triage questions. It is also important to establish risk factors that might be present. As the exact nature of the DED will dictate the best management, a planned approach to diagnostic tests will yield the best results and allow the practitioner to design the best tailored management strategy. This stepped approach is nicely summarised in the TFOS DEWSII flow chart shown in figure 1.