Mild Dry Eye

- 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 (e.g.,
use of ceiling fans), and low-humidity environments should be addressed.
- As the severity of the dry eye increases, aqueous enhancement of the eye using
topical agents is appropriate. Emulsions, gels, and ointments can be used.
- Contributing ocular factors such as blepharitis or meibomianitis should also be treated
Moderate Dry Eye
- Anti-inflammatory therapies may be considered in addition to aqueous enhancement
therapies. Cyclosporine is a fungus-derived peptide that prevents activation and
nuclear translocation of cytoplasmic transcription factors that are required for T-cell
activation and inflammatory cytokine production. It also inhibits mitochondrial
pathways of apoptosis. topical cyclosporine 0.05%.
- Corticosteroids have been reported to decrease ocular irritation symptoms, decrease
corneal fluorescein staining, and improve filamentary keratitis. Commercially
available loteprednol etabonate 0.5%
- Use of systemic omega-3 fatty acid supplements for dry eye treatment
- For patients with aqueous tear deficiency, punctal occlusion is considered when the
medical means of aqueous enhancement are ineffective or impractical. Punctal
occlusion can be accomplished with non-absorbable materials such as silicone or
thermal labile polymer plugs that are lodged at the punctal orifice in patients who will
need long-term occlusion.
- Eyeglass side shields and moisture chambers are noninvasive therapies that can be
used. These types of eyeglasses are frequently worn by motorcyclists and mountain
climbers and can be purchased at stores or online. Moisture inserts (hydroxypropyl
cellulose, Lacrisert, Aton Pharma, Inc., Lawrenceville, NJ) are occasionally helpful
for patients who are unable to use frequent artificial tears.

Severe Dry Eye
- Oral medications are also available to treat severe dry eyes, especially for patients
with combined dry eye and dry mouth (Sjgren syndrome). Cholinergic agonists,
pilocarpine, and cevimeline, have been approved by the FDA to treat the symptoms
of dry mouth in patients with Sjgren syndrome.
- Autologous serum drops have been reported to improve ocular irritation symptoms as
well as conjunctival and corneal dye staining in patients with Sjgren syndrome and
GVHD
- Filamentary keratitis can be treated with debridement of the filaments or application
of topical mucolytic agents, such as acetylcysteine 10% four times a day.
- Permanent punctal occlusion can be accomplished by means of thermal or laser
cautery.
- Rigid gas-permeable scleral lenses have been employed successfully in the treatment
of severe dry eye for years. Widespread use of scleral lenses
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may be limited by
fitting difficulties (particularly in the presence of conjunctival cicatrization), patient
willingness and ability to wear the lenses, and high costs.