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New research · Ophthalmology
Contact lens & anterior eye : the journal of the British Contact Lens Association · 2d
Cross-sectionalContact lens & anterior eye : the journal of the British Contact Lens Association · 2026

What guides treatment decisions in dry eye disease: Signs or symptoms?

Kaleb S Abbott, Jennifer L Patnaik, Karen L Christopher … Cristos Ifantides
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OphthalmologyCross-sectional

Ophthalmologists weight patient symptoms more heavily than signs when starting dry eye treatment.

What guides treatment decisions in dry eye disease: Signs or symptoms?

Kaleb S Abbott … Cristos Ifantides
Contact lens & anterior eye : the journal of the British Contact Lens Association · 2026
Purpose

To determine whether patient-reported symptoms or clinical signs more strongly influence dry eye disease (dry eye disease) treatment decisions and how decisions are made during sign-symptom discordance.

Methods

A cross-sectional survey was distributed via listservs to practicing optometrists (ODs) and ophthalmologists (ophthalmologists) who treat dry eye disease.

n = 208 clinicians
Results

ophthalmologists lean on how patients feel over what the exam shows

Ophthalmologists
61.7%
Optometrists
49%
More results

208 clinicians participated (98 OPHs, 110 ODs).

More results

While most relied on a combination of signs and symptoms to initiate treatment, clinical severity heavily influenced decisions; clinicians were highly likely to initiate treatment for moderate-severe symptoms even when signs were minimal (ophthalmologists 79.8%, OD 70.5%) and to treat moderate-severe signs in asymptomatic patients (ophthalmologists 63.8%, OD 60.6%).

“
Conclusion · 1 of 2

Clinicians routinely navigate sign-symptom discordance by treating high clinical severity in either domain, though subjective symptoms ultimately exert a heavier influence on initial therapy choices and determinations of success.

Conclusion · 2 of 2

Decision-making patterns were similar across clinician types, underscoring the central role of patient-reported symptoms in real-world dry eye disease management.

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