Having been focused on Dry Eye Disease diagnosis and management for years, two recurring issues continue to complicate the issue:
1. Diagnosis of a disease is much more difficult without supporting signs
2. Following and monitoring the effectiveness of treatment by trying to gauge an improvement of symptoms is usually not sufficient.
We learned form Wilson and Stulting the majority of patients are in level 1 and 2 where symptoms are significant; but signs are not easily detected using the ITF Categories (1-4) of Dry Eye. I have recently found measuring tear osmolarity with the TearLab System to be a very effective method to confirm your diagnosis particularly in Levels 1 or 2 as well as monitor the effectiveness of treatment. There has been a positive correlation of decreased osmolarity leading to decrease in symptoms which validates your treatment is correct.
