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.
Therapeutic contacts and oral medications
In the third step, for patients with more severe DED, oral secretagogues, such as pilocarpine or cevimeline, or autologous/allogeneic serum (AS) eye drops may be helpful. AS tears are more effective than traditional tears in decreasing dry eye symptoms and improving tear film stability6 but are challenging to produce.
Patients must not have any blood-borne infectious conditions and their blood must be drawn regularly. AS drops are also expensive and not always covered by insurance.
Therapeutic contact lenses, such as soft bandage and rigid scleral lenses, are another option for patients with severe DED who have failed all previous treatments, or in whom treatment has not alleviated symptoms. Although these lenses are generally efficacious and well tolerated, clinicians should exercise caution due to the risk of infection.7
In the fourth step, surgical intervention may become necessary. Although rare, patients who experience corneal injuries and subsequent vision loss may need additional interventions such as amniotic membrane grafts, surgical punctal occlusion, tarsorrhaphy, or salivary gland transplantation.
Topical corticosteroids should also be considered for a longer duration (but bear in mind long-term use of topical corticosteroids can lead to an IOP increase and/or early cataract formation). These interventions are recommended only for the most extreme dry eye cases.
The incidence of DED is increasing, and patients are experiencing dry eye symptoms at younger ages. Fully understanding the TFOS DEWS II DED management recommendations can be a key component to proper treatment.
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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