An Algorithmic Approach to Diagnosis in Patients with Ocular Surface Discomfort

Abstract

Patients often present with symptoms of ocular surface discomfort. Although a significant proportion of these changes are related to problems of the tear film, other causes exist. Unfortunately, the nature of the symptoms expressed by the patient is nonspecific and does not have a diagnostic significance. In many instances, there is also a significant disconnect between patient-reported symptoms and physician-determined signs of disease. Hence, a methodical approach is required to properly diagnose and manage the problems in such patients. This includes an understanding of normal interrelationships between the various components that constitute the ocular surface, conditions that can impact these, and the resulting changes that can occur. The importance of recognising the other conditions that may coexist with and exacerbate tear film abnormalities, the history-taking process to determine these, and the examination of the eye and other systems is highlighted. Finally, an algorithmic approach that puts together all of the information from the above is discussed. Following this process can help arrive at the proper diagnosis in patients with ocular surface discomfort and help manage their condition appropriately.