Dry Eye Syndrome After Artificial Tears Are Not Enough
Clinical scenario
Artificial tear substitutes are the established first step for dry eye, aiming to stabilise the tear film, prolong tear break-up time, and lower tear osmolarity. When a patient continues to experience signs and symptoms despite consistent use of lubricants, a defined next step is indicated.
Why escalation is triggered
The previous line — artificial tear solutions, gels, ointments, or a hydroxypropyl cellulose insert — did not achieve its target goals: stabilisation of the tear film, prolonged tear break-up time, and decreased tear osmolarity. Failure to reach those targets is the defined trigger for this protocol.
Next-step approach (partial overview)
When lubricant therapy alone is insufficient, an anti-inflammatory agent is added. Whether the course is short-term or intended for long-term use depends on disease severity and individual clinical factors. The complete protocol — including agent selection and sequencing — is accessible via the link below.
Treatment goals
The aim is a meaningful decrease in dry eye signs and symptoms, including reduced itching and blurred vision. Full therapeutic effect typically requires several weeks to become apparent.
References
DOI: 10.4140/TCP.n.2016.96
- When a patient continues to have signs and symptoms despite reducing risk factors and adhering to a tears-substitute regimen, an ophthalmologist will add an additional treatment modality, most often an anti-inflammatory agent or a punctal plug, spectacle side shields, or moisture chambers.
- Ophthalmic corticosteroids decrease symptoms and signs of dry eye by decreasing inflammation and may be used on a short-term basis, normally several weeks, for moderate-to-severe dry eye.
- This medication is quite effective in decreasing dry eye signs and symptoms in many patients, with full effect seen after four to eight weeks.
- A 2013 review of published clinical trials comparing cyclosporine with placebo noted that cyclosporine at the approved dosage improved patient symptoms, for example, itching and blurred vision; it also improved the physician's evaluation of treatment response in DED.
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