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:
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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Cite this: Fast Five Quiz: Are You Familiar With Dry Eye Disease? - Medscape - Sep 29, 2017.