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.