To assess the quality of the lipid film, the ophthalmologist examines the palpebral free edge, i.e. the transition zone between the skin and the conjunctiva of the eyelid. He looks for telangiectasia (a skin condition characterized by the dilation of small blood vessels) and/or meibum plugs in or on the orifices of the meibomian glands.
It also controls eyelashes, lacrimal meatus and the conjunctiva itself. He is also interested in meibum quality. It normally has the appearance of a light yellow fluid oil. If it’s dark yellow or white, or if its consistency is thick, granular or pasty, then it’s considered pathological.
Finally, the ophthalmologist can assess the state of the Meibomian glands and their atrophy by everting the eyelids or using a retro-illuminator.
A final point of attention: inflammation. It may be obvious on examination, but this is not always the case. Tests can be used to refine the estimate. In just a few seconds, tears are sampled and a reagent is added.
The search for facial dermatological pathologies associated with dry eye (rosacea, dermatitis) completes the diagnosis.
A standard but thorough clinical examination will ensure that nothing is overlooked.