Which finding is more characteristic of evaporative dry eye than aqueous-deficient dry eye?

• A. MGD
• B. Tear osmolarity > 308
• C. Tear meniscus < 0.2 mm
• D. Decreased Schirmer findings

Answer: (A)

Evaporative dry eye is driven by lipid-layer instability that increases tear evaporation, most commonly from meibomian gland dysfunction. This makes meibomian gland dysfunction the finding that best points to the evaporative form, since it directly reflects the defective lipid layer causing faster tear loss and a unstable tear film.

Tear osmolarity can be elevated in dry eye in general but isn’t specific to evaporative versus aqueous-deficient. A reduced tear meniscus and a low Schirmer value indicate decreased aqueous tear production or volume, which is more characteristic of aqueous-deficient dry eye and less specific to evaporation alone.