Dry Eye Syndrome: Next-Line Management After Anti-Inflammatory Therapy Has Not Achieved Adequate Symptom Control
In moderate-to-severe dry eye disease, anti-inflammatory agents form a key part of initial management. When this line of treatment does not achieve the expected reduction in signs and symptoms, a further escalation of care is indicated.
Previous Treatment — Goals Not Reached
Prior therapy: An anti-inflammatory agent — either a short-term ophthalmic corticosteroid or long-term cyclosporine ophthalmic emulsion.
Goals not achieved: Adequate decrease in dry eye signs and symptoms — including reduced itching and blurred vision — with full effect expected within four to eight weeks of treatment.
Next-Line Approach (Partial Summary)
When anti-inflammatory therapy has not provided sufficient relief, the next step involves interventions that target tear drainage and retention, as well as — in severe disease — a biologically derived ocular preparation aimed at supporting the ocular surface. The goal is improvement of patient symptoms, including reduced eye pain.
The full protocol, including specific interventions and regimen details, is available via the structured resource below.
References
DOI: 10.4140/TCP.n.2016.96
- Punctal occlusion, eye side shields, or autologous serum tears may be used in patients with moderate-to-severe DED.
- Punctal plugs are placed by the ophthalmologist in the punctal (tear duct) orifice to occlude tear-duct drainage in patients with aqueous tear deficiency.
- Thermal or laser cautery has been used to produce permanent punctal occlusion.
- Eyeglass side shields that mountain climbers or cyclists use may help prevent tear evaporation and may be of benefit in some patients.
- In severe DED, ophthalmic autologous serum tears are used to decrease inflammation and improve patient signs and symptoms if other treatment modalities are not sufficient.
- Regimens from one drop every one to two hours while awake to four times a day have been reported.
- Autologous serum tears regimens have improved patient symptoms, including pain, compared with artificial tears.
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