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

• Oral secretagogues
• Autologous serum
• Therapeutic soft contact lenses
• Rigid [gas-permeable] scleral lenses (eg, BostonSight® PROSE) are other possibilities.

• 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.