Diagnostic methods for managing dry eyes

Table 1 Search components and resulting algorithms

Search component	Keywords used
Diagnostic	"diagnosis" [MeSH Terms] OR "diagnosis" [All Fields] OR "diagnostic" [All Fields] OR "diagnostical" [All Fields] OR "diagnostically" [All Fields] OR "diagnostics" [All Fields]
Method	"methods" [All Fields] OR "methods" [MeSH Terms] OR "methods" [All Fields] OR "method" [All Fields] OR "methods" [MeSH Subheading] AND "manage" [All Fields]
Manage	"manage" [All Fields] OR "managed" [All Fields] OR "managements" [All Fields] OR "managements" [All Fields] OR "manager" [All Fields] OR "managers" [All Fields] OR "managers" [All Fields] OR "manages" [All Fields] OR "managing" [All Fields] OR "management" [All Fields] OR "organization and administration" [MeSH Terms] OR ("organization" [All Fields] AND "administration" [All Fields]) OR "organization and administration" [All Fields] OR "management" [All Fields] OR "disease management" [MeSH Terms] OR ("disease" [All Fields] AND "management" [All Fields]) OR "disease management" [All Fields])
Dry eye syndromes	("dry eye syndromes" [MeSH Terms] OR ("dry" [All Fields] AND "eye" [All Fields] AND "syndromes" [All Fields]) OR "dry eye syndromes" [All Fields] OR ("dry" [All Fields] AND "eye" [All Fields]) OR "dry eye" [All Fields])) AND ((ffrft[Filter]) AND (2020: 2024[pdat])).

Table 2 Diagnostic methods for dry eye curated from sampled records

Method	Ref.	Sample size	Diagnostic rubric
American-European consensus group classification criteria	Lee et al[48]	187 serum samples of age matched females	Authors suggest peptides treated with malondialdehyde increase the formation of autoantibodies, suggesting that they have diagnostic utility for primary Sjögren's Syndrome
Existing data analyses	Acar-Denizli et al[49]	12084 patients with ESSDAI scores	Combination patterns of two antibodies-anti-Ro/SSA and anti La/SSB was used to define Sjogrens syndrome
Machine learning algorithm using routine healthcare data	Dros et al[50]	1411 primary Sjögren's Syndrome patients and 929179 non-primary Sjögren's Syndrome patients	The task entailed employing logistic regression and random forest models for the purpose of categorizing patients. The models used characteristics such as age, gender, medical conditions, symptoms, medication prescriptions, and visits to general practitioners
Diagnostic criteria by Japanese research committee on severe cutaneous adverse reaction	Sotozono et al[51]	94 Stevens-Johnson syndrome and toxic epidermal necrolysis patients with severe ocular complications	The diagnostic criteria for ocular involvement in instances of Stevens-Johnson syndrome and toxic epidermal necrolysis include particular ocular abnormalities, such as the creation of pseudo-membranes and defects in the epithelium. These symptoms are regarded to be high-risk indicators for ocular complications
DryEyeRhythm mobile app	Inomata et al[52]	4454 individuals	The diagnostic rubric involved assessing subjective symptoms reported by the participants via the DryEyeRhythm app. The DryEyeRhythm is a mobile application that facilitates real-time monitoring of DED symptoms, allowing for remote symptom tracking and prompt intervention
Ultrasonographic techniques (grayscale and color Doppler sonography) and contrast-enhanced ultrasonography	Xu et al[53]	161 patients with primary Sjögren's Syndrome and 66 non primary Sjögren's Syndrome patients	The diagnostic approach entailed assessing the ultrasonographic characteristics of the parotid and submandibular glands. Ultrasonographic methods, encompasses grayscale and Doppler imaging, to evaluate lacrimal gland structure and vascularity in patients with DED

DED: Dry eye disease; ESSDAI: European league against rheumatism Sjogren's syndrome disease activity index.

Table 3 Ocular surface disease index questionnaire and scoring system¹

Category	Questions	Scoring (0-4)
Ocular symptoms	Dryness, grittiness, discomfort	0 (None) to 4 (Severe)
Visual function	Blurred vision, difficulty reading	0 (None) to 4 (Severe)
Environmental factors	Wind sensitivity, air conditioning	0 (None) to 4 (Severe)

¹The ocular surface disease index score is calculated as: Total score = (Sum of responses) × 25/number of questions answered, giving a 0-100 range.

Table 4 Standard patient evaluation of eye dryness questionnaire¹

Question type	Symptoms evaluated	Scoring (0-4)
Frequency	Burning, grittiness, fatigue	0 (Never) to 4 (Constant)
Severity	Discomfort level	0 (None) to 4 (Severe)

¹The total standard patient evaluation of eye dryness score (0-28) provides a measure of symptom burden, aiding in dry eye disease diagnosis.

Table 5 McMonnies questionnaire¹

Question type	Symptoms evaluated	Scoring (0-4)
Risk factors	Age, sex, contact lens use, medications, systemic diseases (e.g., Sjögren’s)	Yes/No responses (Binary)
Symptoms frequency	Dryness, grittiness, burning, excessive tearing	0 (Never) to 3 (Frequent)
Symptom severity	Eye discomfort, irritation, redness	0 (None) to 3 (Severe)
Triggers	Environmental factors (wind, air condition, smoke), screen time impact	Yes/No responses (Binary)

¹The total McMonnies score (0-45) helps assess dry eye disease severity, with higher scores (≥ 14) indicating significant dry eye disease.

Table 6 Management of dry eyes

Category	Ref.	Management tool	Details description
Management strategies	Akpek et al[118]	Topical cyclosporine 0.1%	A water-free cyclosporine formulation that improves the ocular surface in moderate-to-severe dry eye
	Fogagnolo et al[124]	Hyaluronic acid and ginkgo biloba drops	Effective in improving symptoms, especially post-cataract surgery
	Wirta et al[131]	Recombinant human nerve growth factor	Promising in treating moderate-to-severe dry eye by enhancing corneal nerve regeneration
	Hu et al[138]	Mesenchymal stem cells	Shows promise in managing Sjögren's syndrome, potentially aiding in ocular surface repair
Surgical options	Wang et al[136]	Punctal cauterization	Heat treatment that is useful for severe dry eye, particularly in preventing scarring
	Ji et al[139]	High-frequency radiowave electrosurgery	Improves conjunctivochalasis, reducing symptoms and improving management outcomes
Post-COVID-19 Considerations	Castillo et al[144]	Telehealthcare	Utilized to mitigate DED-linked ocular morbidity, particularly relevant post-COVID-19

DED: Dry eye disease; COVID-19: Coronavirus disease 2019.