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Dry Eye

Jonathan A. Barnett


  • Most common ocular complaint, especially amongst patients admitted to the hospital!
  • Due to insufficient tear production and/or imbalance in the components that make up the tear film
  • Etiology is vast and can include aging, eye strain/overuse, contact lens use, systemic and topical medications, post eye surgery, nutritional deficiencies, autoimmune disease, or concomitant with other ocular conditions.


  • Blurry vision bilaterally that comes and goes (very common–if the patient complains of fluctuating blurriness, Dry Eye should be at the top of your differential!)
  • Excessive tearing/watery eyes
  • Stinging, burning, soreness, discomfort, gritty/foreign body sensation
  • Discomfort with eye movements
  • Trace/mild conjunctival injection

Evaluation and Management

  • If a patient's symptoms sound like Dry Eye, order some preservative-free (PF) artificial tears at least 4x/day and lubricating eye ointment at bedtime to see if the patient's symptoms improve.
  • Polyvinyl alcohol-povidone PF (Refresh Classic)
  • Lubricating ophthalmic ointment (Lubrifresh)
  • Order them SCHEDULED. Do not order these eye drops PRN (patients will not ask for them).
  • If a patient's symptoms fail to improve or worsen on artificial tears, consider paging ophthalmology for additional assistance. If there is no apparent imminent threat to vision, you can place an ophthalmology outpatient referral upon discharge.