From the Guidelines
Eye exam findings for dehydration include sunken eyes, decreased tear production, and dry conjunctiva, as dehydration affects the fluid components of ocular structures, leading to reduced tear film and altered ocular surface health 1. When examining a patient for dehydration, it is essential to assess for these ocular signs alongside other clinical indicators. The severity of these findings generally correlates with the degree of dehydration.
- Key findings may include:
- Sunken eyes (enophthalmos) due to reduced orbital fat
- Decreased tear production, leading to dry conjunctiva and reduced tear film
- Dryness and irritation of the ocular surface
- Potential changes in intraocular pressure and corneal luster These signs occur because dehydration reduces overall body fluid volume, impacting the eyes and other bodily systems.
- A comprehensive eye examination, as outlined in the dry eye syndrome preferred practice pattern 1, can help identify these changes and contribute to assessing hydration status. However, it is crucial to consider the most recent and highest-quality evidence, which emphasizes the importance of evaluating tear film and ocular surface health in patients with symptoms suggestive of dry eye or dehydration 1.
From the Research
Eye Exam Findings for Dehydration
The eye exam findings for dehydration can be identified through various studies, including:
- Tear osmolarity (Tosm) measurements, which can indicate suboptimal hydration 2
- Noninvasive tear film breakup time (NITBUT) assessments, which can be affected by dehydration 2, 3
- Ocular Surface Disease Index (OSDI) scores, which can be improved with treatment of dry eye disease, a condition associated with dehydration 3, 4
- Tear meniscus height (TMH) and lipid layer grading, which can be affected by dehydration and dry eye disease 3
Dehydration and Dry Eye Disease
Dehydration can be associated with dry eye disease, and studies have shown that:
- Individuals with dry eye disease have higher plasma osmolality (Posm) levels, indicating suboptimal hydration 2
- Systemic hydration status can affect ocular pathophysiologic processes and disease states, including dry eye syndrome, cataract, and refractive changes 5
- Tear fluid osmolarity may be an effective marker of systemic hydration status 5
Treatment of Dry Eye Disease
Treatment of dry eye disease can include:
- Topical artificial tears, which can improve symptoms and conjunctival signs 3, 4, 6
- Hyaluronate (HU) and carbomer-based lipid-containing artificial tears (CLAT), which can be effective in treating dry eye disease 4, 6
- Cholecalciferol (vitamin D) supplementation, which can enhance the efficacy of topical treatment and may be a useful adjuvant therapy for patients with dry eye disease refractory to topical lubricants 4