ICO International Clinical Guidelines:

Dry Eye Syndrome (Management Recommendations)

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On this page:

• Care management
  
  
• Patient Education

Care Management

• Treat any causative factors that are amenable to treatment as patients with dry eye symptoms often have many contributory factors [A:III]
  
  
• Sequence and combination of therapies is determined based on the patient’s needs and preferences and the treating ophthalmologist’s medical judgment [A:III]
  
  
• For mild dry eye, the following measures are appropriate:
  
  
• • Education and environmental modifications [A:III]
    
    
  • Elimination of offending topical or systemic medications [A:III]
    
    
  • Aqueous enhancement using artificial tear substitutes, gels/ointments [A:III]
    
    
  • Eyelid therapy (warm compresses and eyelid hygiene) [A:III]
    
    
  • Treatment of contributing ocular factors such as blepharitis or meibomianitis [A:III]
    
    
• For moderate dry eye, in addition to above treatments, the following measures are appropriate:
  
  
  • Anti-inflammatory agents (topical cyclosporine [A:I] and corticosteroids, [A:II] systemic omega-3 fatty acids supplements [A:II])
    
    
  • Punctal plugs [A:III]
    
    
  • Spectacle side shields and moisture chambers [A:III]
    
    
• For severe dry eye, in addition to above treatments, the following measures are appropriate:
  
  
  • Systemic cholinergic agonists [A:I]
    
    
  • Systemic anti-inflammatory agents [A:III]
    
    
  • Mucolytic agents [A:III]
    
    
  • Autologous serum tears [A:III]
    
    
  • Contact lenses [A:III]
    
    
  • Correction of eyelid abnormalities [A:III]
    
    
  • Permanent punctal occlusion [A:III]
    
    
  • Tarsorrhaphy [A:III]
    
    
• Monitor patients prescribed corticosteroids for adverse effects such as increased intraocular pressure, corneal melting, and cataract formation [A:III]

Patient Education

• Counsel patients about the chronic nature of dry eye and its natural history. [A:III]
  
  
• Provide specific instructions for therapeutic regimens. [A:III]
  
  
• Reassess periodically the patient's compliance and understanding of the disease, risks for associated structural changes and realistic expectations for effective management, and reinforce education. [A:III]
  
  
• Refer patients with manifestation of a systemic disease to an appropriate medical specialist. [A:III]
  
  
• Caution patients with pre-existing dry eye that keratorefractive surgery may worsen their dry eye condition. [A:III]

* Adapted from the American Academy of Ophthalmology Summary Benchmarks, November 2008 (www.aao.org)

(Download this Guideline as a PDF file - 103 KB)

Next: Diabetic Retinopathy (Initial and follow-up evaluation)

Also see:

• International Clinical Guidelines (Preface)
  
  
• Introduction to the Guidelines
  
  
• List of Guidelines