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

Robert H. Graham, MD


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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