Staged management & treatment recommendations for dry eye disease

[Roland]

The Dry Eye Workshop 2 Report is now available for free and public access from The Ocular Surface journal website.

The most relevant sub-report to the forum participants will be the "Management and Therapy" report.
The current weblink is here: [Link 1]

Similar to the last Dry Eye Workshop report presented ten years ago, a step-wise approach to dry eye management has been proposed for eye care professionals to follow which may be of interest to forum participants:

Staged management & treatment recommendations for dry eye disease^a,b,c.

Step 1: Education regarding the condition, its management, treatment and prognosis Modification of local environment Education regarding potential dietary modifications (including oral essential fatty acid supplementation) Identification and potential modification/elimination of offending systemic and topical medications Ocular lubricants of various types (if MGD is present, then consider lipid-containing supplements) Lid hygiene and warm compresses of various types

Step 2: If above options are inadequate consider: Non-preserved ocular lubricants to minimize preservative-induced toxicity Tea tree oil treatment for Demodex (if present) Tear conservation Punctal occlusion Moisture chamber spectacles/goggles Overnight treatments (such as ointment or moisture chamber devices) In-office, physical heating and expression of the meibomian glands (including device-assisted therapies, such as LipiFlow) In-office intense pulsed light therapy for MGD Prescription drugs to manage DEDd Topical antibiotic or antibiotic/steroid combination applied to the lid margins for anterior blepharitis (if present) Topical corticosteroid (limited-duration) Topical secretagogues Topical non-glucocorticoid immunomodulatory drugs (such as cyclosporine) Topical LFA-1 antagonist drugs (such as lifitegrast) Oral macrolide or tetracycline antibiotics

Step 3: If above options are inadequate consider: Oral secretagogues Autologous/allogeneic serum eye drops Therapeutic contact lens options Soft bandage lenses Rigid scleral lenses

Step 4: If above options are inadequate consider: Topical corticosteroid for longer duration Amniotic membrane grafts Surgical punctal occlusion Other surgical approaches (eg tarsorrhaphy, salivary gland transplantation)

MGD – meibomian gland dysfunction; DED – dry eye disease.

aPotential variations within the disease spectrum are acknowledged to exist between patients and the management options listed above are not intended to be exclusive. The severity and etiology of the DED state will dictate the range and number of management options selected from one or more steps.
bOne or more options concurrently within each category can be considered within that step of the dry eye disease state. Options within a category are not ranked according to importance and may be equally valid.
cIt should be noted that the evidence available to support the various management options differs and will inevitably be lower for newer management options. Thus, each treatment option should be considered in accordance with the level of evidence available at the time management is instigated.
dThe use of prescription drugs needs to be considered in the context of the individual patient presentation, and the relative level of evidence supporting their use for that specific indication, as this group of agents differs widely in mechanism of action.

Source: http://www.theocularsurfacejournal.c...fulltext#tbl16

[Hokucat]

Hi Roland. Thanks for this information. Am happy to see these staged treatment recommendations for eye care professionals that includes treatments like IPL, autologous serum tears, and sclerals which are often not prescribed or not available locally for patients. Hopefully this will broaden treatment options to reach all dry patients. Are these recommendations for primarily in the U.S., or also being communicated worldwide?

I didn't see probing listed as treatment in any of the stages. Was this treatment discussed?

[MGD1701]

Thanks Roland for posting this useful info.
I am still in search of how to thin the oil, apart from taking doxy - could not find such info in the report - unfortunately.

Hokucat: probing - I did find it under ''3.2.3.4. Intraductal probing''

[Hokucat]

Thanks MGD1701 for pointing out where probing is listed....I had only looked at the summary post, not the link. Am glad probing is there.