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TFOS DEWS III: Diagnostic Methodology.

James S Wolffsohn¹, José M Benítez-Del-Castillo², Denise Loya-Garcia³

¹School of Optometry (J.S.W.), College of Health and Life Sciences, Aston University, Birmingham, UK.

American Journal of Ophthalmology

|June 1, 2025

Summary

This summary is machine-generated.

A standardized approach to diagnosing dry eye disease is essential for consistent patient care and understanding prevalence. The Tear Film & Ocular Surface Society (TFOS) DEWS III report revises the definition and provides diagnostic criteria for this multifactorial disease.

Keywords:

blepharitis, meibomian gland dysfunction (MGD)definition diagnosis differential diagnosis dry eye disease (DED)subclassification subtypes

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Area of Science:

Ophthalmology
Ocular Surface Disease

Background:

A consistent diagnostic approach for dry eye disease is crucial for patient care and public health.
The Tear Film & Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) III reviewed existing evidence since 2017.

Purpose of the Study:

To revise the definition of dry eye disease.
To provide updated diagnostic criteria and subclassification methods for dry eye disease.

Main Methods:

Reviewed evidence base for dry eye disease diagnosis.
Revised the definition of dry eye disease.
Established diagnostic criteria including screening questionnaires, tear film breakup time, tear film hyperosmolarity, and ocular surface staining.

Main Results:

Dry eye disease is defined as a multifactorial, symptomatic disease involving tear film instability, hyperosmolarity, inflammation, and neurosensory abnormalities.
Recommended OSDI-6 questionnaire (cut-off ≥4) combined with objective measures for diagnosis.
Provided subclassification based on tear film deficiencies, eyelid anomalies, and ocular surface abnormalities with specific clinical tests and cut-offs.

Conclusions:

The revised definition and diagnostic criteria offer a standardized approach to dry eye disease.
Accurate diagnosis and subclassification are key to informing appropriate management and therapy for dry eye disease.