FFinalistSouthampton · 2027
Ophthalmology
AKT · Ophthalmology/Lids & surfacelow yield

Dry eye disease (KCS)

Tear-film instability/deficiency (evaporative MGD or aqueous-deficient, e.g. Sjögren)

Overview

Keratoconjunctivitis sicca — a multifactorial disease of tear-film instability causing ocular surface inflammation. Evaporative (MGD-related) is commonest; aqueous-deficient forms include Sjögren syndrome. Diagnosis and primary management are symptom-led; refer for serious causes or non-response.

Recognise

  • Bilateral grittiness, burning, foreign-body sensation, fluctuating blurred vision relieved by blinking
  • Paradoxical watering (reflex tearing); worse with screens, air-conditioning, low humidity
  • Signs: reduced tear break-up time, punctate corneal staining, low tear meniscus; Schirmer test reduced in aqueous deficiency

Red flags

  • Red flags of a serious cause (severe pain, photophobia, marked visual loss) → same-day ophthalmology
  • Suspected Stevens–Johnson syndrome or ocular cicatricial pemphigoid → urgent referral
  • Dry eyes + dry mouth + arthralgia → investigate for Sjögren syndrome

Differentials & how to tell them apart

Blepharitis/MGDlid-margin disease that causes/overlaps dry eye
Allergic conjunctivitisitch-dominant with chemosis
Exposure keratopathylagophthalmos/ectropion/VII palsy preventing lid closure

Investigations

Clinical with fluorescein (tear break-up time, staining). Schirmer test. Screen for Sjögren (anti-Ro/La, salivary symptoms) if suggestive.

Management

Ocular lubricants + lid hygiene; preservative-free if used frequently

  1. 1Lubricants (preservative-free if used >4–6×/day), lid hygiene/warm compresses for MGD, environmental advice (screen breaks, humidity).Gate: Same-day referral for red-flag/serious causes; urgent referral if SJS or cicatricial pemphigoid suspected; investigate Sjögren if sicca symptoms
  2. 2No response after 4–12 weeks → ophthalmology; options include topical ciclosporin (NICE TA for severe disease), punctal plugs, autologous serum.
Ocular lubricants (artificial tears, gels, ointment) — first-line; preservative-free if frequent use
Lid hygiene + warm compresses — for evaporative/MGD component
Topical ciclosporin — NICE: for severe disease not improving despite artificial tears
Punctal plugs / autologous serum drops — specialist options for severe aqueous-deficient disease

Key points

Common, chronic, symptom-led. The integration point: dry eye + dry mouth = Sjögren — look for the systemic disease.

Monitor & prognosis

Symptom control; corneal staining.

Chronic but manageable.

Source: NICE CKS Dry eye disease; TFOS DEWS II; College of Optometrists CMG