9
Management
Î Patients with dry eye who are evaluated by non-ophthalmologist health
care providers should be referred promptly to the ophthalmologist if
moderate or severe pain, lack of response to therapy, corneal infiltration
or ulceration, or vision loss occurs. (III, G, S)
Î The ophthalmologist should educate the patient about the natural
history and chronic nature of dry eye. (III, G, S)
Î Realistic expectations for therapeutic goals should be set and discussed
with the patient. (III, G, S)
Î Particularly effective treatments for evaporative tear deficiency include
environmental modifications, eyelid therapy for conditions such as
blepharitis or meibomianitis, artificial tear substitutes, moisture
chamber spectacles, and/or surgery such as tarsorrhaphy. (III, In, D)
Î The sequence and combination of therapies should be determined
on the basis of the patient's needs and preferences and the treating
ophthalmologist's medical judgment. (III, G, S)
Î Specific therapies may be chosen from any category regardless of the
level of disease severity, depending on physician experience and patient
preference. (III, G, S)
Î Patients who have suggestive symptoms without signs should be placed
on trial treatments with artificial tears when other potential causes of
ocular irritation have been eliminated. (III, In, D)
Î For patients with a clinical diagnosis of mild dry eye, potentially
exacerbating exogenous factors such as antihistamine or diuretic
use, cigarette smoking and exposure to second-hand smoke, and
environmental factors such as air drafts and low-humidity environments
should be addressed. (III, G, S)
Î Measures such as lowering the computer screen to below eye level to
decrease lid aperture, scheduling regular breaks, and increasing blink
frequency may decrease the discomfort associated with computer and
reading activities. (III, In, D)
Î Emulsions, gels, and ointments can be used. (III, In, D)
Î The use of artificial tears may be increased, but the practicality of
frequent tear instillation depends on the lifestyle or manual dexterity of
the patient. (III, In, D)
Î Nonpreserved tear substitutes are generally preferable. However, tears
with preservatives may be sufficient for patients with mild dry eye and
an otherwise healthy ocular surface. (III, In, D)
Î When tear substitutes are used frequently and chronically, nonpreserved
tears are generally recommended. (III, In, D)
