10
Management
Î Contributing ocular factors such as blepharitis or meibomianitis should
also be treated. (II++, G, D)
Î Azithromycin should be used with caution to treat dry eye in patients
who have cardiovascular problems. (II+, G, S)
Î Eyelid abnormalities resulting from blepharitis should be corrected.
(II++, M, D)
Î Eyelid abnormalities resulting from trichiasis should be corrected.
(III, In, D)
Î Eyelid abnormalities resulting from lid malposition should be corrected.
(III, In, D)
Î Low-dose topical corticosteroid therapy can be used at infrequent
intervals for short periods of time (i.e., several weeks) to suppress
ocular inflammation. (I-, M, D)
Î Patients prescribed corticosteroids for dry eye should be monitored
for adverse effects such as increased intraocular pressure and cataract
formation. (III, G, S)
Î Omega-3 fatty acid products without ethyl esters may be beneficial in
the treatment of dry eye, though the evidence is insufficient to establish
the effectiveness of any particular formulation. (I-, In, D)
Î Use of systemic omega-3 fatty acid supplements for dry eye treatment
has been reported to be potentially beneficial, but there is no evidence
of their efficacy. (I-, In, D)
Î For patients with aqueous tear deficiency, punctal occlusion is
considered when the medical means of aqueous enhancement are
ineffective or impractical. (I++, G, S)
Î Punctal plugs may be helpful in moderate to severe cases of aqueous
deficient dry eye and meibomian gland dysfunction. (I++, G, S)
Î Patients treated with punctal plugs should be monitored regularly to
ensure that the plugs are present and in the proper position. (III, In, D)
Î The largest plug that can be inserted should be used to reduce the
likelihood of extrusion. (III, In, D)
Î Patients who benefit from having punctal plugs in place but
spontaneously lose them may have the lost plug(s) replaced or undergo
permanent closure of their punctum by a thermal cautery or alternative
means. (III, In, D)
Î Noninvasive therapies such as eyeglass side shields and moisture
chambers can be used. (III, G, S)
