Unifying Concepts

Diagnostic Criteria of Dry Eye Disease

Dry eye disease (DED) is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface.

Diagnostic Criteria of Dry Eye Disease

Comparison of Dry Eye Definition and Diagnostic Criteria Between JDES/ADES and DEWS II

Definition A multifactorial disease characterized by unstable tear film causing a variety of symptoms and/or visual impairment, potentially accompanied by ocular surface damage. A multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.
Criteria Presence of subjective symptom
Break-Up Time (BUT) <5 seconds
Positive symptomatology (Dry Eye Questionnaire-5 >5 or OSDI >13),
noninvasive Break-Up Time (BUT) <10 seconds,
Osmolarity >308 mOsm/L or interocular difference >8 mOsm/L,
Ocular surface staining (>5 corneal spots, >9 conjunctival spots, or lid margin)



  1. Shimazaki J. Definition and Diagnostic Criteria of Dry Eye Disease: Historical Overview and Future Directions. Invest Ophthalmol Vis Sci. 2018 Nov 1;59(14):DES7-DES12. [Medline]
  2. Tsubota K, Pflugfelder SC, Liu Z, Baudouin C, Kim HM, Messmer EM, Kruse F, Liang L, Carreno-Galeano JT, Rolando M, Yokoi N, Kinoshita S, Dana R. Defining Dry Eye from a Clinical Perspective. Int J Mol Sci. 2020 Dec 4;21(23):9271. [Medline]


Created Jan, 16, 2023.

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