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  1. Louis Tong, senior consultant ophthalmologist 1, associate professor2,
  2. Jeremy Tan, family physician3, lecturer4,
  3. Julian Thumboo, adjunct professor4, head and senior consultant5,
  4. Gabriel Seow, family physician6
  1. 1Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore
  2. 2Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore
  3. 3Faith Medical Group, 211 Toa Payoh Lorong 8, #01-19, Singapore
  4. 4Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  5. 5Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
  6. 6Woodlands Clinic, Blk 131, Marsiling Rise #01-204, Singapore
  1. Correspondence to: L Tong, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751 Louis.tong.h.t{at}snec.com.sg
  • Accepted 31 October 2012

A 30 year old woman visits her general practitioner complaining of itchy eyes for six months, aggravated by computer use in her job as a clerk. Dry eye is a common multifactorial condition of the tear and ocular surface. In ambulatory settings it may commonly result from increased tear evaporation (resulting from, for example, blepharitis or contact lens wear); tear hyposecretion (from, for example, age related or anticholinergic drugs); and mucous dysfunction (mucus secreting goblet cells in the conjunctiva may be damaged after previous infectious conjunctivitis). Severe dry eye resulting from systemic diseases is uncommon in primary care but conditions predisposing to dry eye should be documented (box ).

What you should cover

History

  • Are the symptoms consistent with dry eye?—Ask about symptoms of dry eye, such as chronic burning, grittiness, and visual fluctuations. Paradoxically, patients may complain of watery eyes owing to eye irritation and reflex tearing. A complaint strongly suggestive of dry eye is worsening of symptoms by prolonged visual tasks, exposure to wind, and air conditioning.

  • Is the dry eye part of a systemic condition?—Take note …

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