The Tear Film and Ocular Surface Society Dry Eye Workshop II report recommends a comprehensive, multistage management algorithm for the disease that is both evidence-based and personalized.
In-office treatments and prescription drugs
If the strategies in Step 1 do not improve DED, TFOS DEWS II recommends a second step that intensifies therapy to prescription medications and in-office treatments.
Prescription medications can include topical antibiotics or antibiotics with steroids for patients with anterior blepharitis, and anti-inflammatory agents (topical lifitegrast and cyclosporine) specifically designed for DED.
Preservative-free ocular lubricants are also recommended, as preservatives can cause ocular toxicity in some patients. The group also cautions that the use of prescription drugs needs to be considered in the context of the individual patient presentation since the mechanism of action varies widely among the classes.
If the patient has MGD and warm compresses have not provided relief, patients may benefit from in-office, device-assisted expression with LipiFlow (Johnson & Johnson Vision) or intense pulsed light (IPL) therapy. LipiFlow takes about 12 minutes and has lasting effects of one year or more with a single treatment.3 IPL needs to be repeated every five to six weeks, and is best used as an adjunctive treatment. Data indicate it does improve tear break-up time.4
Tear conservation with moisture chamber glasses/goggles has been shown to improve blink rates and tear film stability, especially in patients living in environments with low humidity.5 Clinicians should be aware that patients may resist that treatment recommendation for cosmetic reasons.
1. Craig JP, Nelson JD, Azar DT, et al. TFOS DEWS II Report Executive Summary. Ocul Surf. 2017;15(4):802-12.
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4. Toyos R, McGill W, Briscoe D. Intense pulsed light treatment for dry eye disease due to meibomian gland dysfunction; a 3-year retrospective study. Photomed Laser Surg 2015;33(1):41-6.
5. Ogawa M, Dogru M, Toriyama N, et al. Evaluation of the Effect of Moist Chamber Spectacles in Patients With Dry Eye Exposed to Adverse Environment Conditions. Eye Contact Lens 2018;44(6):379-83.
6. Jirsova K, Brejchova K, Krabcova I, et al. The application of autologous serum eye drops in severe dry eye patients; subjective and objective parameters before and after treatment. Curr Eye Res. 2014;39(1):21-30.
7. Bavinger JC, DeLoss K, Mian SI. Scleral lens use in dry eye syndrome. Curr Opin Ophthalmol. 2015;26(4):319-24.