How to examine a dry eye patient.

Last week, I was doing my normal dry eye exam and asked the patient to close her eyes so I can examine them. She said confused, "wait, why close them!?"⁠

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She brought up a great question.⁠

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Q: Why do I examine a patients eyes when they are closed?⁠

A: Because the eyelids play a huge role in dry eye disease. ⁠

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I need to look at the lids and lashes to determine a variety of things: ⁠

🔸do the lids close properly (many don't!)?⁠

🔸is there excessive bacteria on the lashes? ⁠

🔸are there demodex mites present on the lashes?⁠

🔸are there extra blood vessels growing on the lash line suggesting inflammation?⁠

🔸does the oil properly flow out of the oil glands?⁠

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Who knew dry eye disease had so much to do with the lids! ⁠