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Dry eye disease (DED) is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance and tear instability with potential damage to the ocular surface. It is often accompanied by hyperosmolarity of the tear film and inflammation of the ocular surface. The symposium Severe Dry Eye Disease  Facing the Treatment Challenges held at the International Symposium on Ocular Pharmacology and Therapeutics (ISOPT) included four presentations from ophthalmological experts. The first presented a clinicalbased approach to facilitate the evaluation of DED in clinical practice and to provide ophthalmologists with straightforward tools to address objective signs of the disease and to alleviate subjective patients symptoms. This was followed by a description of a stepwise approach to anti-inflammatory treatment of severe DED, highlighting the usefulness of topical ciclosporin for treating inflammatory conditions of the ocular surface such as severe DED. This was illustrated by the third speaker who presented the results of a clinical study (SICCANOVE) showing that, compared with vehicle, treatment with ciclosporin 0.1% yielded reduced corneal damage in patients with severe DED that appeared to be enhanced in patients with more severe keratitis. Last, a diagnostic algorithm of severe DED provided by a group of European experts (ODISSEY) was presented to facilitate important decision-making in advanced stages of the disease. The need for a consensus in diagnosis, terminology and therapy at a European and international level was emphasised. Aside from the intention to make diagnosis less complicated and technically advanced, the aspects of immunomodulatory treatment were addressed as an area for future research. Other future objectives in the treatment of DED include detection of possible precursor stages to offer the possibility of preventative care. Social economic effects are also important and increased international collaboration will be needed to address global inconsistencies in treatment.

Severe Dry Eye Disease – Facing the Treatment Challenges