Survey of Ophthalmologists Regarding Practice Patterns for Dry Eye and Sjogren Syndrome

Eye Contact Lens. 2018 Nov;44 Suppl 2(Suppl 2):S196-S201. doi: 10.1097/ICL.0000000000000448.


Objective: To survey ophthalmologists about current practice patterns regarding the evaluation of dry eye patients and referrals for a Sjogren syndrome (SS) workup.

Methods: An online survey was sent to ophthalmologists affiliated with the Scheie Eye Institute or Wills Eye Hospital using REDCap in August 2015. Descriptive statistics were used to summarize the data.

Results: Four hundred seventy-four survey invitations were sent out and 101 (21%) ophthalmologists completed the survey. The common traditional dry eye test performed was corneal fluorescein staining (62%) and the most common newer dry eye test performed was tear osmolarity (18%). Half of respondents (51%) refer fewer than 5% of their dry eye patients for SS workups, with 18% reporting that they never refer any patients. The most common reasons for referrals included positive review of systems (60%), severe dry eye symptoms (51%) or ocular signs (47%), or dry eye that is refractory to treatment (42%). The majority (83%) felt that there is a need for an evidence-based standardized screening tool for dry eye patients to decide who should be referred for evaluation for SS.

Conclusions: Ophthalmologists continue to prefer the use of traditional dry eye tests in practice, with the most common test being corneal fluorescein staining. There is an underreferral of dry eye patients for SS workups, which is contributing to the continued underdiagnosis of the disease. Most respondents felt that there was a need for an evidence-based standardized screening tool to decide which dry eye patients should be referred for SS evaluations.

MeSH terms

  • Adult
  • Diagnostic Techniques, Ophthalmological / statistics & numerical data*
  • Dry Eye Syndromes / diagnosis*
  • Female
  • Fluorescein / administration & dosage
  • Humans
  • Male
  • Middle Aged
  • Ophthalmologists*
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Referral and Consultation / statistics & numerical data
  • Sjogren's Syndrome / diagnosis*
  • Staining and Labeling / methods
  • Tears / physiology


  • Fluorescein