Poll Results
Participate in Poll, Choose Your Answer.
A 47-year-old office worker presents with a 6-month history of:
-
Burning sensation
-
Fluctuating blurry vision
-
Tearing throughout the day
-
Worse symptoms at the computer
-
Feels better when she closes her eyes
She denies itching.
She uses artificial tears “sometimes.”
No contact lens wear.
No systemic autoimmune disease.
Clinical Examination
Visual Acuity: 20/20 OU
Slit Lamp Findings:
-
Mild lid margin telangiectasia
-
Thickened meibomian gland secretions
-
Tear break-up time: 4 seconds
-
Minimal corneal staining
-
Schirmer test: 18 mm in 5 minutes
What is your diagnosis?
Correct Answer:
B) Evaporative Dry Eye
Here’s Why: Tear break-up time is reduced (unstable tear film)
Schirmer is normal (adequate tear production)
Meibomian gland dysfunction is present
Symptoms worse during screen time (reduced blink rate)
Tearing = reflex tearing from surface irritation
This is classic evaporative dry eye driven by MGD.
Why the Others Are Wrong:
Aqueous-deficient dry eye
→ Schirmer would be low.
Allergic conjunctivitis
→ Would have itching as the dominant symptom.
Sjögren’s
→ Usually severe dryness, often systemic symptoms, low Schirmer.