Fast Five Quiz: Are You Familiar With Dry Eye Disease?

Robert H. Graham, MD

Disclosures

September 29, 2017

The TFOS DEWS II treatment recommendations are stratified according to the severity of the disease.

Step 1 treatment consists of the following:

  • Education about the condition and possible dietary modifications

  • Modification of the local environment

  • Identification of any offending medications and subsequent elimination/modification

  • Ocular lubricant use

  • Lid hygiene and warm compress use

If step 1 treatment is inadequate, step 2 measures are considered, including the following:

  • Nonpreserved ocular lubricants

  • Tea tree oil treatment

  • Tear conservation (punctal occlusion, moisture chamber spectacles/goggles)

  • Overnight treatments (eg, ointment, moisture chamber devices)

  • In-office, physical heating and expression of the meibomian glands and pulsed light therapy

  • Prescription drugs (ie, topical antibiotic or antibiotic/steroid combinations, topical corticosteroid, topical secretagogues, topical nonglucocorticoid immunomodulatory drugs, topical LFA-1 antagonist drugs, oral macrolide or tetracycline antibiotics)

If step 2 treatment is inadequate, step 3 measures are considered, including the following:

  • Oral secretagogues

  • Autologous/allogenic serum eye drops

  • Therapeutic contact lens options (ie, soft bandage lenses, rigid scleral lenses)

If step 3 treatment is inadequate, step 4 treatment is considered, including the following:

  • Topical corticosteroids for a longer duration

  • Amniotic membrane grafts

  • Surgical punctal occlusion and other approaches (eg, tarsorrhaphy, salivary gland transplantation)

For more on the treatment of dry eye disease, read here.

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