Walsh & Hoyt: Examination

The examination of a patient with a disturbance of lacrimation is directed toward three main abnormalities: decreased tear production, increased tear production, and partial or complete obstruction of the lacrimal drainage apparatus. Lid function is critical to spreading the tear film and should be assessed in any patient suspected of having an abnormality of tear function. Disturbances of eyelid structure and function can be detected both by simple external examination and by slit-lamp biomicroscopy. Slit-lamp examination can also detect punctate staining of the inferior cornea related to dry eyes, exposure (lagophthalmos), or a lid abnormality.