Which finding is least associated with aqueous-deficient dry eye?

• A. Tear meniscus < 0.2 mm
• B. MGD
• C. Decreased Schirmer findings
• D. Decreased Phenol red thread test

Answer: (B)

Aqueous-deficient dry eye stems from insufficient tear production, so tear volume and production measurements are reduced. That shows up as a very small tear meniscus (<0.2 mm), decreased Schirmer test results, and reduced wetting on the phenol red thread test. Meibomian gland dysfunction, by contrast, causes evaporative dry eye due to a faulty lipid layer and often occurs when tear production is still adequate. It increases evaporation rather than reflecting reduced aqueous tear production, so it is the finding least associated with aqueous-deficient dry eye.