Stepwise diagnosis of dry eye disease (DED): The “Dry Eye Wheel” concept in clinical practice for ophthalmologists and optometrists

Abstract

Dry eye disease (DED) is a common and underrecognized condition of the ocular surface. Patient management is complicated by uneven access to diagnostic tools, lack of standardized algorithms, and fragmented approaches to diagnosis and treatment. This article presents the Dry Eye Wheel concept – a stepwise framework adaptable to any level of resources, from optometry practices to specialized clinics. The model, based on the World Council of Optometry (WCO) initiative, integrates validated clinical tools including symptom questionnaires (OSDI), tear film stability tests, ocular surface staining methods, tear osmolarity assessment, blink analysis, tear meniscus height measurement, and meibography. The patient pathway is outlined from screening and simple functional tests to refined diagnostics and subtype identification (aqueous-deficient, evaporative, or mixed), followed by personalized treatment and ongoing monitoring. A structured approach based on the Dry Eye Wheel promotes consistency and clarity in diagnosis and therapy, reduces decision-making time, and enhances patients’ quality of life.