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When assessing a patient with dry eye, I try to determine the primary problem.
Many of these patients also have meibomian gland dysfunction and some have conjunctivochalasis, so oftentimes it can be multifactorial. At that first exam, it is nice to get a good picture of what is contributing to their symptoms.
There are a lot of tests on the market that can help, such as LipiView (Johnson & Johnson Vision) or other forms of meibography. There are tests for tear osmolarity, as well