Treatment

Dry eye treatment

The treatment of dry eye is complex and depends on the symptoms, causes and objective signs that have been diagnosed through previous examinations by an eye specialist.

Based on the recommendation of the TFOS expert group, the following step-by-step plan is proposed for the management and treatment of dry eye (Jones et al., 2017 [a1]):

Step 1:

- Explanation of the disease, treatment and prognosis

- Modification of the local environment (humidity, room ventilation, etc.)

- Omega 3 supplements topically or as a dietary supplement

- Elimination of drugs that can cause dry eye

- Various types of tear substitutes for:

• Improvement of the visco-elastic properties of the tear film
• Increase lubricity - decrease friction
• Reduce inflammation over time
• Production of a normal tear film to improve the epithelial layer

- Eyelid hygiene (e.g. with sterile cleaning wipes) to clean and remove crust or deposits 

- Warm compresses (approx. 45 ° C) of various types for ~ 5 minutes

- Lid massage to squeeze out secretions from the meibomian glands

Step 2:

If the above options aren't enough, consider: 

- Tear substitutes without preservatives in order to avoid preservative-induced toxicity

- Tea tree oil treatment against Demodex (if available)

- Preservation of the existing tear fluid

- Overnight treatments (such as ointments or moist chamber products)

- Physical warming and expression of the meibomian glands carried out by qualified personnel (including device-assisted therapies such as LipiFlow)

- Intensive pulsed light therapy for MGD carried out by specialist staff

- Prescription Drugs for Dry Eye Management

Step 3:

If the above options are not enough, consider:

- Preparations that promote secretion 

- Serum eye drops made from the body's own / transplanted cells

- Options for therapeutic contact lenses

• Soft lens bandage  e.g. Alcon Night & Day
• Scleral lenses

Step 4:

If the above options aren't enough, consider:

- Topical corticosteroids (hormone ointments) taken for a long time

- Amniotic membrane transplantation

- Surgical occlusion of the lacrimal duct with Punctum Plug

- Other surgical approaches (e.g. surgical sutures between the upper and lower eyelids, salivary gland transplantation)