Dry Eye Syndrome: Diagnostic and Treatment Tips

Pippa B. Wysong


January 20, 2016

Management Strategies

Generally, in patients not destined for surgery, "the emphasis should be on addressing the patient's symptoms. That's what should drive the aggressiveness of your treatment—not necessarily the clinical findings," Dr Aldave said.

In presurgical patients, the emphasis is on reducing corneal staining and stabilizing the tear film to obtain reliable topography, and to determine candidacy for toric intraocular lens implantation.

In terms of managing DES, Dr Aldave focused on the evidence to support the efficacy of three treatments: topical autologous serum, topical cyclosporine, and oral omega-3 fatty acids.

Autologous serum has been gaining popularity, yet there is limited quality evidence to support its use. A Cochrane review[3] found that "there was inconsistency in the possible benefits of autologous serum in improving patient-reported symptoms and tear breakup time, and lack of effect based on other objective clinical measures," Dr Aldave said.

If doctors want to use autologous serum, "they should tell the patient there's really no good evidence to support this. But there is little downside to trying," he told Medscape in an interview after the symposium.

Cyclosporine has substantial evidence supporting its use, but it works best in instances where ocular surface inflammation plays a role.

Omega-3 fatty acid supplements have increasing evidence supporting their efficacy and are worth using in patients with dry eye, he said.

Hall Chew, MD, assistant professor of ophthalmology at the University of Toronto, noted that while most ophthalmologists know about the three treatment options discussed, many "may not know what the evidence is" for their effectiveness, highlighting the need for increased knowledge in this area.

When it comes to the use of autologous serum, he said that doctors probably don't use it as commonly as other treatments and likely reserve it for the most severe cases.