Expert Opinion in the Management of Aqueous Deficient Dry Eye Disease (DED)

Aileen Sy; Kieran S. O'Brien; Margaret P. Liu; Puja A. Cuddapah; Nisha R. Acharya; Thomas M. Lietman; Jennifer Rose-Nussbaumer


BMC Ophthalmol. 2015;15(133) 

In This Article


DED results from reduced tear production or excessive tear evaporation and is estimated to affect 1,000 000 to 4.9,000 000 people in the United States, primarily in elderly and female populations.[1] Symptoms of burning and tearing can cause a significant reduction in quality of life for patients. In severe cases, they may develop complications such as corneal scarring, bacterial keratitis, and vision loss.[1,2]

DED is divided by etiology into two categories: aqueous deficient (keratoconjunctivitis sicca) and evaporative disorders. Treatment of aqueous deficient DED has traditionally started with artificial tears and topical lubricants.[3] Topical anti-inflammatory medications, including corticosteroids and cyclosporine A 0.05 %, are commonly used for more moderate to severe cases.[3] Although not fully understood, ocular surface damage from either disorder may incite an inflammatory response that further worsens DED.[4] This has inspired many studies exploring new anti-inflammatory treatments for both aqueous deficient and evaporative DED, including topical tacrolimus, topical autologous serum, oral tetracyclines and omega fatty acid supplements.[5–8]

In this study, we conduct an international survey of dry eye experts to identify the most common treatments used for aqueous deficient DED beyond traditional therapies such as preservative free artificial tears (PFATs).