45-year-old woman with watery, red, gritty eyes

The image is consistent with a diagnosis of dry eye disease:

• Dry eye disease, or keratoconjunctivitis sicca, is a condition of reduced tear production, change in the composition of tears, or increased tear evaporation.
• Eyes may burn or feel dry or gritty, and patients may have the sensation of a foreign object in the eye. People may also experience light sensitivity, blurry vision, and, paradoxically, watery eyes.
• Dry eye is a relatively common condition, particularly in people older than 40 years.
• There are many different causes, including environmental factors, eyelid abnormalities, Sjögren syndrome, and medications.

Dry eye is primarily a clinical diagnosis. Primary or emergency care providers will take a history, perform a basic eye exam, diagnose dry eye, and offer first-line treatments of artificial tears and patient education.

If these treatments are unsuccessful, patients should be referred to an ophthalmologist for further evaluation and treatment.

• Perform a slit-lamp exam; findings may include conjunctival injection, punctate epithelial erosions, and epithelial filaments on the corneal surface.
• Perform further testing to evaluate for etiology, such as additional staining of the eye surface with fluorescein and tear production testing.
• Prescribe treatments, provide patient education, and follow-up.

The treatment of dry eye includes the following:

• adjusting the environment and avoiding triggers (eg, using a humidifier, avoiding air blowing in the eyes)
• using artificial tears or other ocular lubricants
• addressing any treatable underlying etiologies (eg, adjusting medications, applying a warm compress for meibomian gland dysfunction, undergoing surgical treatment of eyelid abnormalities)
• second-line medical management with corticosteroids or anti-inflammatories
• using punctal plugs to reduce tear drainage

Why Does the Eye Get Red?

The Lacrimal Apparatus

Scleral and Conjunctival Causes of Red Eye

Painful Red Eye: AAO Interactive Case

Ocular Manifestations of Rheumatoid Arthritis

Careers in Ophthalmology: Comprehensive Ophthalmology