The patient’s visual acuity was 20/20 in both eyes, but he had a variable refraction that changed by 0.5 to 0.75 D depending on the visit. Anterior segment evaluation was unremarkable. Fluorescein staining demonstrated inferior punctate epithelial keratopathy bilaterally. The tear film breakup time was less than 6 seconds, and lissamine green demonstrated minimal conjunctival staining.
It could be seen during the slit lamp evaluation with fluorescein that tear volume was reduced. The patient’s tear osmolarity was slightly elevated at 318 mOsm/L in one eye and 315 mOsm/L in the other. Corneal topography showed abnormalities consistent with moderate to severe dry eye. Interferometry demonstrated incomplete blink, and a light test with a transilluminator indicated presence of microlagophthalmos. Meibography and tear MMP levels were unremarkable.