Updated Dry Eye Treatment According to DEWS II
Trace to mild dry eye syndrome
- Modifying the local environment
- Dietary modifications (eg, essential increasing omega-3 fatty acids and increasing leafy green vegetable consumption)
- Eliminating offending systemic and topical medications, like antihistamines, hormone replacement, etc...
- Eliminating medications, drops, and food with preservatives
- Regarding ocular lubricants, they recommend lipid-containing supplements if there is Meibomian gland disease present.
- Lid hygiene
- Warm compresses
The treatment and modifications in step 1 should be done by ALL dry eye syndrome sufferers. This is the basis to treatment for all disease. Remember that a disease is your body's way of telling you that something YOU are doing is wrong!
Mild to moderate dry eye syndrome
- Changing to a non-preserved topical lubrication
- Using tea tree oil if Demodex is present
- Tear conservation, such as punctal occlusion
- Moisture chamber spectacles or goggles
- Overnight treatments such as ointments
- With meibomian gland dysfunction, in-office treatments, such as LipiFlow® or intense pulsed light therapy
- Topical antibiotics or antibiotic/steroid combinations
- Limited-duration topical steroids
- Topical secretagogues
- Topical anti-inflammatory medications such as cyclosporine (Restasis®)
- Topical LFA-1 antagonists such as lifitegrast (Xiidra®)
- Oral macrolide or tetracycline antibiotics
Moderate to severe dry eye syndrome
- Oral secretagogues
- Autologous serum
- Therapeutic soft contact lenses
- Rigid [gas-permeable] scleral lenses (eg, BostonSight® PROSE) are other possibilities.
Severe dry eye syndrome
- Topical steroids of longer duration (though of course this comes with an increased risk for potential side effects)
- Amniotic membrane grafts
- Surgical punctal occlusion with cautery
- Permanent lateral or even central tarsorrhaphy
- Salivary gland transplantation.
by Dr. Travis Zigler | Posted in artificial, benefits of Omega 3, definition of dry eye, DEWS II, Dr. Travis Zigler, dry eye, dry eye disease, dry eye syndrome, dry eye treatment, Dry Eye Workshop, environmental factors, eye love, Eye Love Dry Eye, MGD and Sever dry eye | |
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