A table of guidelines for treatment of dry eye posted in my doctor's office

[ringo]

Table 2.
A Modified Delphi Technique to Obtain Consensus on the Treatment of Dry Eye Disease

Severity Level & Signs & Symptoms
-- Recommended Treatment


1. Mild-to-moderate symptoms & no signs
Mild-to-moderate conjunctival signs

--Patient counseling, preserved tears,
environmental management, allergy eye drops,H2O intake, hypoallergenic products.

If NI,add level 2.

2. Moderate-to-severe symptoms
Tear film signs
Mild corneal punctate staining
Conjunctival staining
Visual signs

--Unpreserved tears, gels, ointments, topical
cyclosporine A (0.05%, 0.2%, 0.5%, 1.0%),
secretagogues (i.e. Pilocarpine),
topical steroids (i.e. fluorometholone), nutritional support ( i.e. flaxseed oil).

If NI, add level 3.

3. Severe symptoms
Marked corneal punctate staining
Central corneal staining
Filamentary keratitis:

--Tetracycline, punctal plugs

If NI, add level 4

4. Severe symptoms
Severe corneal staining, erosions
Conjunctival scarring:

--Systemic anti-inflammatory therapy ( i.e. oral corticosteroids), oral cyclosporine, moisture goggles, acetylcysteine (topical and oral),
punctal cautery, surgery

At least one sign and one symptom of each category should be present to qualify for corresponding level assignment.

Adapted from Behrens A, et al. Cornea. 2006;22:61-66.

[Rebecca Petris]

The DEWS model got some things right and some things really REALLY really wrong. They fail to account for the lack of correlation between pain and corneal signs - though this lack of correlation is supposedly so well known.

For example... moisture goggles as you will see is in the category where you're looking at severe corneal involvement. That flatly contradicts our community experience here. How many people here whose doctor sees no serious corneal signs are wearing or have worn moisture chambers of some kind and are experiencing relief with them? A lot.

They also pretty much ignore (in the above chart) meibomian gland dysfunction altogether. How many people here have MGD and did not start getting relief of their pain till they started treating it? A lot.

[LasikLady]

Big ditto to what Rebecca is saying. Especially about the moisture chamber goggles. Imagine reading that chart in a doctor's office and because your eyes are not "severly" dry not using goggles to eliminate/reduce your pain. Heck, I put my onion goggles on in the evening after an intense computer day and I can sit comfy and watch movies, read books, do all the stuff without them I wouldn't be in severe pain but I would not be comfortable. And in car airconditioning they are a must. Though I usually use my panoptyx in the car.

In fact, I would go so far as to say that I think there should be a medical company that manufactures inexpensive goggles, much like the onion goggles, that a doctor can write a prescription for, like a wheel chair, and dry eye patients can obtain and insurance would pay for. I get mine on amazon for 20 bucks and I have pairs of them all over the house in case I need them.

Although out of the house I still feel a bit self conscience, I think goggles are the fastest, most efficient way of reducing pain/discomfort due to dry eye. Even for "mild" dry eye patients.

[ringo]

You are absolutely right about the goggles! I was also wondering why they put them in the most severe level of dry eye....

I posted this, so everyone can see what doctors are taught and advised in their professional environment on how to approach dry eye disease.

I had to wear goggles when my symptoms really started bothering me, and there was no competent doctor in sight to even dagnose me properly with dry eye. So, to me, the goggles should be in the first or second level of dry eye severity.

This table is also very general, and it has not mentioned meiboian gland dysfunction separately, but I guess that is because the table has not differentiated between different types of dry eye. Also, it does mention both symptoms and clinical signs ( i mean they say that if you have severe symptoms, i.e. pain for ex., with as little as one correlating clinical sign you still qualify for the higher level corresponding assignment).

What is your opinion about the rest of the guidelines? How does that compare to your doctors' recommendations ? To what extent do you think this table of guidelines is helpful or has been helpful in your experience?

From your own experience how would you edit this table, would you add or subtract anything to make it more suited for patients' needs?