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Related Experiment Video

Updated: Feb 26, 2026

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TFOS DEWS II Diagnostic Methodology report.

James S Wolffsohn1, Reiko Arita2, Robin Chalmers3

  • 1Ophthalmic Research Group, Aston University, Birmingham, UK.

The Ocular Surface
|July 25, 2017
PubMed
Summary

The Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) II established diagnostic methods for dry eye disease (DED). Key tests identify DED and its subtypes, guiding effective management strategies.

Keywords:
DEWSDiagnosisDry Eye WorkshopDry eye disease (DED)MethodologyMonitoringQuestionnairesSub-classification of dry eyeTests for dry eye

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Area of Science:

  • Ophthalmology
  • Ocular Surface Disease
  • Diagnostic Science

Background:

  • Dry eye disease (DED) diagnosis and management require standardized methodologies.
  • The Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) II aimed to refine diagnostic approaches.

Purpose of the Study:

  • To identify and recommend optimal diagnostic tests for DED.
  • To establish a clear diagnostic pathway and sub-classification methods for DED.
  • To differentiate DED from conditions with similar symptoms.

Main Methods:

  • Review and selection of established DED diagnostic tests.
  • Proposal of a standardized order and technique for conducting these tests.
  • Inclusion of symptom screening tools (DEQ-5, OSDI) and objective measures (tear breakup time, osmolarity, staining).

Main Results:

  • Recommended symptom screening followed by non-invasive breakup time, osmolarity, and ocular surface staining.
  • Meibomian gland dysfunction, lipid layer, and tear volume assessments enable DED sub-classification.
  • A differential diagnosis framework was proposed to distinguish DED from mimic conditions.

Conclusions:

  • Standardized diagnostic and sub-classification methods for DED are crucial for research and clinical trials.
  • Informed sub-classification of DED will optimize the efficacy of management strategies.
  • The TFOS DEWS II provides a framework for consistent DED diagnosis and monitoring.