A Narrative Review on the Diagnosis of Dry Eye Disease: Insights from the Italian Dry Eye Consensus (IDEC) Group

The purpose of this manuscript is to report the state-of-the-art advances and consensus proposed by an Italian Dry Eye Consensus Group (IDEC) for the diagnosis of dry eye disease (DED). A targeted review of the literature was carried out, not intended as a meta-analysis or systematic review, but as a selection of authoritative evidence-based guidelines and consensus papers issued by scientific societies or expert panels, which provided the basis for structured group discussion. The diagnostic criteria reported in these publications were organized in tables with a subdivision into levels, from basic to more complex tests, and were discussed in light of both the published data and daily clinical experience. The IDEC consensus highlights a pragmatic, stepwise diagnostic workflow: careful documentation of symptoms (using validated questionnaires where possible), identification of risk factors, slit-lamp assessment with vital stains (fluorescein and lissamine green), and measurement of tear film stability by tear break-up time (TBUT)-or by noninvasive TBUT measurement (NIBUT) where available, and corneal sensitivity-represent the minimum cost-effective core set. A series of second-level targeted tests can then be selectively applied to refine the diagnosis, including corneal sensitivity, osmolarity, meibography, Schirmer I test or meniscometry, and ocular surface imaging. The group also discussed the potential role of all-in-one high-tech devices and digital tools (e.g., smartphone-based applications) as these become more accessible. Grounded in real-life clinical experience, the IDEC consensus offers a pragmatic and cost-effective diagnostic workflow that complements international guidelines and can be readily applied in daily practice.