TFOS DEWS III: diagnostic methodology

Published in the American Journal of Ophthalmology, the TFOS DEWS III diagnostic methodology report represents one of the most authoritative references for dry eye disease diagnosis worldwide. This update establishes a comprehensive classification system for MGD severity based on subjective symptoms, orifice abnormalities such as plugging, pouting, and capping, lid margin vascularization, mucocutaneous junction displacement, margin irregularity, and gland dropout observed via meibography.

 Critically, the guidelines now explicitly state that imaging both upper and lower lids is important when evaluating meibomian gland structure and function. This recommendation elevates upper eyelid meibography from a supplementary step to a recognized component of the diagnostic standard of care.

For eye care professionals, the inclusion of upper lid imaging in the TFOS DEWS III framework provides clear clinical justification for adopting tools and workflows that make upper eyelid eversion and imaging practical in everyday practice.