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Î Dry eye is a common ocular condition that has a high impact on the
quality of life of afflicted individuals owing to discomfort or visual
disability. Although the symptoms improve with treatment, the condition
is usually not curable. Dry eye can be a cause of visual disability and
may compromise results of corneal, cataract, and refractive surgery.
Î No single test is adequate for establishing the diagnosis of dry eye.
The constellation of findings from multiple tests can add greatly to
the clinician's understanding of the patient's condition. Evaluation of
conjunctival staining is helpful but underutilized.
Î About 10% of patients with clinically significant aqueous deficient
dry eye have an underlying primary Sjögren syndrome. Patients with
moderate punctate staining of the cornea and/or conjunctiva should
be considered for testing for an underlying Sjögren syndrome, as these
patients will require a multidisciplinary approach.
Î Pharmacological and procedural treatments are associated with
improvements in patient symptoms and clinical signs, although
chronic therapy and patient compliance are necessary for long-term
management.
Î Punctal plugs may be helpful in moderate to severe cases of aqueous
deficient dry eye. However, patients treated with punctal plugs should
be monitored regularly to ensure that the plugs are present and in the
proper position.
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 and may increase the
risk of prostate cancer.
Î Cyclosporine treatment has been shown to have short-term clinical
benefits in the treatment of dry eye. However, insofar as dry eye is
a life-long condition whose symptoms and signs wax and wane, cost
considerations and the lack of data on long-term effectiveness are
important factors in the decision to prescribe cyclosporine. It is
also unclear whether the estimated benefit is observed in all patient
subpopulations.
Î Dry eye patients considering keratorefractive surgery, particularly
LASIK, should be cautioned that the dry eye condition could become
worse after surgery. Dry eye symptoms are common in the first few
months after surgery and tend to subside with time. Patients can
safely undergo LASIK surgery if a pre-existing dry eye condition can be
controlled preoperatively.
Î Patients with severe dry eye are at greater risk for contact lens
intolerance and associated complications.
