Patient education of condition, management, treatments and prognosis
Environmental modifications (fans, vents, humidifiers, eye masks)
Dietary modifications (fatty acids, Omega 3 vitamins)
Ocular lubricants (including lipid supplements for MGD if present)
Lid hygiene and warm compresses
Preservative-free ocular lubricants
Tea tree oil treatment for Demodex if present
Tear conservation methods (punctal occlusion/plugs)
Overnight treatments (ointments, eye mask)
In-office, physical heating and expression of meibomian glands
In-office IPL for MGD if present
Prescription drugs (Topical antibiotic or antibiotic/steroid combo, topical steroids – short duration, topical secretagogues, cyclosporines (Restasis, Cequa), lifitegrast (Xiidra)), Vevye
Oral secretagogues (Evoxac, Salagen)
Autologous/allogeneic serum eye drops
Therapeutic CL (soft bandages CL, rigid scleral CL)
Topical corticosteroid – longer duration
Amniotic membrane grafts
Surgical punctal occlusion
Other surgical approaches (tarsorrhaphy, salivary gland transplant)
a) “Potential variations within the disease spectrum are acknowledged to exist between patients and the management options listed above are not intended to be exclusive. The severity and etiology of the DED state will dictate the range and number of management options selected from one or more steps”
b) “One or more options concurrently within each category can be considered within that step of the dry eye disease state. Options within a category are not ranked according to importance and may be equally valid”
c) “It should be noted that the evidence available to support the various management options differs and will inevitably be lower for newer management options. Thus, each treatment option should be considered in accordance with the level of evidence available at the time management is instigated”
d) “The use of prescription drugs needs to be considered in the context of the individual patient presentation, and the relative level of evidence supporting their use for that specific indication, as this group of agents differs widely in mechanism of action”