Dry Eye Syndrome When Initial Lifestyle Modifications and Omega-3 Supplementation Have Not Improved Symptoms
Not all patients with dry eye syndrome respond adequately to first-line management. When the expected improvement in tear secretion and symptom relief has not been achieved after one month of initial measures, a defined next-step protocol applies.
Previous Treatment — Goal Not Reached
First-line — insufficient response
Initial management — comprising environmental modifications (increasing air humidity, avoiding cigarette smoke, reducing screen time), discontinuation of contributing medications where possible, management of eyelid problems or blepharitis, warm compresses, and omega-3 fatty acid supplementation — did not achieve the expected goals after one month: a meaningful increase in tear secretion and a reduction in tear evaporation.
This Protocol — Next Step
Second-line approach
When symptoms persist, the next-line approach centres on topical lubrication with artificial tear substitutes. The clinical targets are stabilization of the tear film, prolonged tear break-up time, and decreased tear osmolarity. The selection of the appropriate formulation type depends on individual patient factors — the full regimen is in the protocol below.
References
DOI: 10.4140/TCP.n.2016.96
- When clinical symptoms and signs persist, most patients are advised to use tear substitutes.
- Artificial tear substitutes are the most often used treatment for DED, regardless of the severity of the disease.
- Most patients use tear solutions, but products with a longer ocular-retention time, a gel, ointment, or the ophthalmic hydroxypropyl cellulose insert (Lacrisert), may be used if needed.
- Gels and ointments cause more blurred vision than solutions and are normally used at bedtime.
- Lacrisert, available by prescription for moderate to severe dry eye, is placed in the inferior cul-de-sac of the eye once daily, either at bedtime or in the morning.
- It has been shown to be clinically beneficial in that it stabilizes the tear film, prolongs tear break-up time, and lubricates the eye.
- When counseling a patient about any tears substitute, pharmacists will want to ensure that the patient understands that tears substitutes are clinically beneficial as they lubricate the eye, decrease tear osmolarity, and help to maintain moisture to decrease friction between the eyelids and cornea.
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