Ophthalmic Research Group, Aston University, Birmingham, UK.
Department of Ophthalmology, Itoh Clinic, Saitama, Japan.
Ocul Surf. 2017 Jul;15(3):539-574. doi: 10.1016/j.jtos.2017.05.001. Epub 2017 Jul 20.
The role of the Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) II Diagnostic Methodology Subcommittee was 1) to identify tests used to diagnose and monitor dry eye disease (DED), 2) to identify those most appropriate to fulfil the definition of DED and its sub-classifications, 3) to propose the most appropriate order and technique to conduct these tests in a clinical setting, and 4) to provide a differential diagnosis for DED and distinguish conditions where DED is a comorbidity. Prior to diagnosis, it is important to exclude conditions that can mimic DED with the aid of triaging questions. Symptom screening with the DEQ-5 or OSDI confirms that a patient might have DED and triggers the conduct of diagnostic tests of (ideally non-invasive) breakup time, osmolarity and ocular surface staining with fluorescein and lissamine green (observing the cornea, conjunctiva and eyelid margin). Meibomian gland dysfunction, lipid thickness/dynamics and tear volume assessment and their severity allow sub-classification of DED (as predominantly evaporative or aqueous deficient) which informs the management of DED. Videos of these diagnostic and sub-classification techniques are available on the TFOS website. It is envisaged that the identification of the key tests to diagnose and monitor DED and its sub-classifications will inform future epidemiological studies and management clinical trials, improving comparability, and enabling identification of the sub-classification of DED in which different management strategies are most efficacious.
泪膜和眼表面学会(TFOS)干眼工作组(DEWS)II 诊断方法学小组委员会的职责是:1)确定用于诊断和监测干眼疾病(DED)的测试;2)确定最适合满足 DED 及其亚型定义的测试;3)提出在临床环境中进行这些测试的最合适的顺序和技术;4)为 DED 提供鉴别诊断,并区分 DED 是合并症的情况。在诊断之前,借助分诊问题排除可能模仿 DED 的情况非常重要。使用 DEQ-5 或 OSDI 进行症状筛查可确认患者是否患有 DED,并促使进行非侵入性泪膜破裂时间、渗透压和眼表面荧光素及丽丝胺绿染色等诊断测试(观察角膜、结膜和眼睑边缘)。睑板腺功能障碍、脂质厚度/动态和泪液量评估及其严重程度可对 DED 进行亚分类(主要为蒸发过强型或水液缺乏型),这有助于指导 DED 的管理。这些诊断和亚分类技术的视频可在 TFOS 网站上查看。预计确定用于诊断和监测 DED 及其亚型的关键测试将为未来的流行病学研究和管理临床试验提供信息,提高可比性,并能够确定不同管理策略最有效的 DED 亚类。
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