Passive Smoking as a Risk Factor of Dry Eye in Children

Table 1

Dry eye severity grading scheme.

Dry eye severity level	1	2	3	4^∗
Discomfort, severity and frequency	Mild and/or episodic; occurs under environmental stress	Moderately episodic or chronic, stress or no stress	Severely frequent or constant without stress	Severe and/or disabling and constant
Visual symptoms	None or episodic mild fatigue	Annoying and/or activity-limiting episodic	Annoying, chronic and/orconstant, limiting activity	Constant and/or possiblydisabling
Conjunctival injection	None to mild	None to mild	±	+/++
Conjunctival staining	None to mild	Variable	Moderate to marked	Marked
Corneal staining (severity/location)	None to mild	Variable	Marked central	Severe punctate erosions
Corneal/tear signs	None to mild	Mild debris and ↓ meniscus	Filamentary keratitis, mucus clumping, and ↑ tear debris	Filamentary keratitis, mucus clumping, and ↑ tear debris, and ulceration
TFBUT (sec)	Variable	≤10	≤5	Immediate
Schirmer score (mm/5 min)	Variable	≤10	≤5	≤2

^*Must have signs and symptoms; TBUT: fluorescein tear breakup time; reprinted with permission from Behrens A, Doyle JJ, Stern L et al. Dysfunctional tear syndrome. A Delphi approach to treatment recommendations (Cornea 2006; 25: 90–7).