Treatment of dry eye disease

The major goal of dry eye disease (DED) therapeutic management is to restore homeostasis of the ocular surface by breaking the vicious cycle of the disease and offering long‐term treatment options. TFOS DEWS II Report recommends a specific evidence‐based treatment approach: Step 1: education regarding DED, modification of local environment, potential dietary modifications, identification and modification of offending medications (systemic/topical), ocular lubricants, lid hygiene, warm compresses. Step 2: non‐preserved ocular lubricants, tea tree oil treatment for Demodex, tear conservation (e.g. punctal occlusion), overnight treatments (ointment, moisture chamber devices), in‐office physical heating and expression of the Meibomian glands, device‐assisted therapies, in‐office intense pulsed light therapy, prescription drugs: topical corticosteroids (limited duration), topical antibiotics or antibiotic/steroid combinations applied to the lid margins for blepharitis, topical secretagogues, topical non‐glucocorticoid immunomodulatory drugs (e.g. cyclosporine), topical LFA‐1 antagonist drugs, oral macrolide or tetracycline antibiotics. Step 3: oral secretagogues, autologous serum eye drops, therapeutic contact lenses. Step 4: topical corticosteroids (longer duration), amniotic membrane grafts, surgical punctal occlusion, other surgical approaches (e.g. tarsorrhaphy). Careful follow‐up strategies are important to monitor changes in patients` symptoms and signs and to ensure that patients are applying the recommended management options successfully. Moreover, therapies should be applied over a certain period of time before it can be concluded that no improvement will occur. It is essential to understand the multiple pathogenetic processes in dry eye patients to select effective therapies, especially as DED is a complex condition that varies in severity and character from patient to patient.