What is dry eye disease?
Dry eye disease is a long-term condition in which the tear film stops protecting the front of the eye. The Tear Film & Ocular Surface Society (TFOS) defines it as a disease that always causes symptoms. Unstable or overly salty tears, inflammation, surface damage and nerve changes all play a part.
The tear film has an oily top layer over a watery layer. The oil comes from the meibomian glands, a row of small glands along each eyelid edge. TFOS reports that at least two-thirds of people with dry eye have the evaporative form, where tears dry off too fast. In the other main form, aqueous deficiency, the eyes make too little tear fluid; many people have some of both.
Typical symptoms are grittiness, burning, redness, and blurred vision that clears when you blink. The US National Eye Institute lists age 50 or older, being female and wearing contact lenses among the risk factors.
Which tests diagnose dry eye, and which are in the package?
Testing has two jobs: confirm the diagnosis, then find what drives it in your eyes. TFOS DEWS III, the 2025 international report, names the tests and cut-offs for each:
| Test | What it measures | Job and cut-off | In the package? |
|---|---|---|---|
| Symptom questionnaire (OSDI-6; earlier OSDI or DEQ-5) | How often symptoms occur and how much they limit daily tasks | Diagnosis: 4 or more on the six-question OSDI-6 | Not listed |
| Non-invasive tear break-up time (NIBUT) | Seconds from a blink until the tear film first breaks, read without dye | Diagnosis: under 10 seconds | Not listed |
| Tear osmolarity | How salty a tiny tear sample is | Diagnosis: 308 mOsm/L or more in either eye, or more than 8 mOsm/L between the eyes | Not listed |
| Surface staining (fluorescein and lissamine green dyes) | Damaged cells on the cornea, the white of the eye and the lid edge | Diagnosis: more than 5 corneal spots, more than 9 conjunctival spots, or a lid-edge stain at least 2 mm long and 25% wide | Not listed |
| Lipid layer interferometry | Thickness of the oily top layer, from light reflected off the tears | Driver (oil): under 72 nm on the LipiView instrument | Yes: "Tear film lipid layer analysis" |
| Tear meniscus height | Height of the tear strip along the lower lid, a guide to tear volume | Driver (tear fluid): 0.20 mm or lower | Yes |
| Blink analysis | How often you blink, and how many blinks close only partly | Driver (blinking): partial blinks in more than 40% of blinks | Yes: "Blinking frequency test" and "Blinking movement analysis" |
| Meibography | An infrared photograph of the meibomian glands, showing shortened or missing glands | Driver (glands): gland length under 75% | Yes: "Meibomian gland imaging" |
| Lid margin exam and gland expression | Blocked gland openings, and the oil pressed out of the glands | Driver (lid margin): oil that is not clear, or little oil released | Yes: "Doctor's eyelid examination" |
| Schirmer test | How far tears wet a paper strip hooked over the lower lid for 5 minutes | Driver (tear fluid): 10 mm or less is usually called abnormal; TFOS calls the test invasive | Not listed |
New Dawn Health's Eye Health Exam - Dry Eye Package at Berkeley Ophthalmology in Taipei lists the tests that show why eyes are dry. Its card does not list a questionnaire, a break-up time, osmolarity or staining, the tests TFOS uses to confirm the diagnosis. Your coordinator confirms whether the doctor adds a break-up time or staining. Berkeley Ophthalmology's services page lists LipiView, a non-invasive tool that images the tear film and meibomian glands.
How do international, US and Asian guidelines define a diagnosis?
Every approach needs symptoms; they differ in which sign confirms the diagnosis.
| Source | Symptoms | Sign needed |
|---|---|---|
| TFOS DEWS II (international, 2017) | OSDI 13 or more, or DEQ-5 6 or more | Any one of: NIBUT under 10 seconds, raised osmolarity, or staining (cut-offs as above) |
| TFOS DEWS III (international, 2025) | OSDI-6 of 4 or more | The same three signs; staining must cover the cornea, conjunctiva and lid edge. Without a NIBUT instrument, a dye break-up time under 5 seconds counts. |
| American Academy of Ophthalmology (US, 2023) | Part of the clinical examination | No fixed cut-off: clinical examination is the reference, and no single test is adequate |
| Asia Dry Eye Society | Dry eye symptoms | Dye break-up time of 5 seconds or less |
| Taiwan Society of Cataract and Refractive Surgeons (2024) | OSDI or DEQ-5 | Any one of: dye break-up time 5 seconds or less, non-invasive break-up time 10 seconds or less, or corneal staining |
The authors of a 2025 study at three Taiwanese tertiary hospitals write that Taiwan has no consensus on dry eye diagnosis or treatment. Taiwan's National Health Insurance has used an abnormal Schirmer test as its criterion for reimbursing artificial tears. TFOS adds a caution: one abnormal sign diagnoses dry eye, but at least two must be checked before it is ruled out.
Who is the exam for, and who should go elsewhere first?
| If you have | What fits |
|---|---|
| Gritty, burning or tired eyes, or blur that clears when you blink | A dry eye exam, to find the driver. |
| Discomfort with contact lenses | A dry eye exam, plus a lens review: TFOS says a different lens material, fit or wearing schedule may help. |
| Cataract or other lens surgery coming up | A check beforehand. The Taiwan cataract surgeons' consensus says dry eye should be treated before cataract surgery, and the AAO says baseline tear measurements predict who is at risk afterwards. |
| No eye symptoms | Not this exam: dry eye is defined by its symptoms. A comprehensive eye exam answers more questions. |
| Pain, one red eye, discharge, or a sudden change in vision | Same-day medical care, not a booked test. See the urgent symptoms below. |
Vision, eye pressure and the retina are not on the Dry Eye Package card. Berkeley Ophthalmology's Eye Health Exam - Basic Package covers those.
Do contact lenses, screens and long flights make dry eye worse?
TFOS DEWS II counts contact lens wear, computer use and low humidity among the consistent risk factors for dry eye.
| Trigger | What happens | What helps |
|---|---|---|
| Contact lenses | Lens wearers with dry eye have a thinner, patchy oil layer, a less stable tear film and less tear volume (TFOS). | A lens review. The AAO advises glasses for a break, and never sleeping in lenses. |
| Screens | People normally blink 10 to 15 times a minute (TFOS); the AAO says that falls to about 5 to 7 at a screen. Fewer blinks spread the tears less and let more evaporate. | Look away into the distance regularly (AAO). TFOS says better blinking habits help the eye's surface. |
| Long flights | A 2022 review reports cabin humidity of 10% to 25% on international flights. In a chamber study it cites, people with dry eye became more symptomatic at 5% humidity. | Keep lubricating drops in your carry-on; the AAO advises preservative-free drops if you use them more than six times a day. |
How do I prepare?
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1Note your symptomsWhen they started, what makes them worse (screens, wind, air conditioning, lenses), and whether blur clears when you blink.
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2List your medicines and dropsTFOS DEWS II links antihistamines, antidepressants, anti-anxiety drugs and isotretinoin with dry eye. Bring every eye drop you use.
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3Ask about drops and contact lensesDrops add fluid to the tears these tests measure. Ask your coordinator how long before the test to skip them, and whether to come without lenses. Bring your glasses.
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4Avoid testing straight off the planeTFOS advises controlling humidity and air flow during and just before tear measurements. A long, dry flight can leave readings worse than usual.
What happens on the day, and are there risks?
The Dry Eye Package is listed at about 30 minutes. TFOS recommends testing from the gentlest to the most invasive, because bright light, held-open eyes and dye drops all change the tears. Its example order, applied to the package tests, runs like this; the clinic's own order may differ:
- Questions about symptoms, medicines and lenses.
- Blink analysis: the instrument records how often and how fully you blink.
- Tear meniscus height: a non-invasive measurement of the tear strip on the lower lid.
- Oil-layer imaging: light reflected from your tears is read while you blink naturally.
- Eyelid examination: the doctor may press the lid edge gently; TFOS grades the oil from clear to toothpaste-like.
- Meibomian gland imaging: a non-invasive infrared photograph.
- Warm compress instruction before you leave.
The imaging uses light, not X-rays. The card lists no dilating drops, so the hours of blur described on the eye exam page should not apply; your coordinator confirms this. If a Schirmer test is added, a 2025 Taiwan study notes it can be uncomfortable without numbing drops.
What can the exam find, and what can't it?
- How thick the oily layer is and how it spreads
- How much tear fluid sits along the lower lid
- How often you blink, and how many blinks are incomplete
- Shortened or missing glands, blocked openings, and the quality of the oil
- Confirm dry eye on their own. TFOS requires symptoms plus a break-up time, osmolarity or staining result.
- Check the retina, optic nerve or eye pressure. A comprehensive eye exam does that.
- Find a body-wide cause such as Sjögren's disease. TFOS advises shared care with a rheumatologist or other specialist.
- Explain pain with no visible signs. The Taiwan consensus says that calls for assessment for nerve-related (neuropathic) pain.
What happens after the results, in Taiwan and at home?
Each driver points to a different first step in the TFOS DEWS II staged plan, which starts with low-risk home care:
| Finding | Points to | Typical first steps |
|---|---|---|
| Thin oil layer, shortened or blocked glands | Meibomian gland dysfunction | Warm compresses and lid hygiene; then in-office gland heating and expression, or intense pulsed light (IPL) |
| Low tear meniscus | Too little tear fluid | Lubricating drops, prescription anti-inflammatory drops, punctal plugs that keep tears on the eye |
| Many incomplete blinks | Blink-related dry eye | Better blinking habits and screen breaks |
| Dandruff-like collars at the lash base | Demodex mites (blepharitis) | Lid treatment aimed at the mites |
How strong is the evidence for each treatment?
- Artificial tears: the usual first step. In the 2025 Taiwan study they were the first treatment for 95.8% of patients, and corticosteroids for 85.0%.
- Prescription drops: the AAO lists several US-approved drugs, including cyclosporine and lifitegrast, and says none has proven more effective than another head to head. TFOS lists steroid drops for limited periods only.
- Omega-3 supplements: in the US DREAM trial of 535 patients, 3,000 mg a day of fish-oil omega-3 for a year did no better than an olive-oil placebo.
- Thermal pulsation (LipiFlow): heat and pressure that clear blocked glands. The AAO says studies suggest it eases symptoms for six months to a year. Berkeley Ophthalmology's services page lists it.
- Intense pulsed light (IPL): light pulses on the skin near the eyelids. The FDA classified IPL devices for dry eye from gland dysfunction as prescription devices in 2021. A 2025 review of 13 trials found IPL probably eases symptoms compared with placebo, but its benefit on top of standard care is unclear and evidence on side effects is very uncertain. The AAO says it is not suitable for darker skin. Berkeley Ophthalmology's services page does not list IPL, so ask before planning around it.
Before you fly home
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1Get the written reportAsk for each value with its unit, the instrument used, and the gland images. TFOS notes that tear meniscus readings depend on the instrument, so a US clinic may set its own baseline.
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2Write down each drop by its active ingredientBrand names differ between countries. For steroid drops, ask how long to use them and who checks your eyes after that.
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3Ask the price before any in-office treatmentTreatment is not on the package card. Ask how many sessions are planned and whether they fit your stay.
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4Book an eye doctor at homeDry eye usually needs long-term care. Your ophthalmologist or optometrist takes over the plan and repeats the tests the same way over time.
Which eye symptoms need urgent care?
How much does it cost, and will insurance help?
The live price further down this page is New Dawn Health's booking price for the Eye Health Exam - Dry Eye Package at Berkeley Ophthalmology. Any treatment the doctor suggests is not on the package card; ask its price before you agree to it.
- Testing in Taiwan is self-funded for visitors. Short-term visitors are not covered by Taiwan's National Health Insurance.
- US insurers differ on dry eye procedures. Capital Blue Cross, for example, classes thermal pulsation, IPL with gland expression, and near-infrared dual imaging of the meibomian glands as investigational. Ask your own insurer before paying for treatment you hope to claim.
