Keep in mind that, after instillation, the majority of artificial tears usually protect the ocu- lar surface for 10 – 20 minutes only, and therefore frequent instillation is necessary. Some newer products are reported to have longer protection times.
Recommend instilling artificial tears before situations that are known to worsen the symp- toms (going outdoors, watching TV etc.).
In cases of irritation, recommend preservative-free artificial tears. If that does not help, recommend periodic change of brand.
In case of filamentary keratitis (severe hyposecretory dry eye) consider acetylcysteine eye- drops.
At bedtime and in cases of more pronounced symptoms during the daytime, it might be use- ful to prescribe artificial tears in the form of a gel, since they are more efficient in protecting the ocular surface. The main drawback with these products is blurred vision because of the thick gel layer covering the cornea and this can limit the usefulness of gels in everyday use.
In case of contact lens irritation, recommend frequent instilling of preservative-free arti- ficial tears. In case of serious discomfort and/or clinical signs, consider advising disconti- nuation of contact lens wear.
HYPEREVAPORATIVE DRY EYE Artificial tears
Through excessive evaporation of tears, ocular surface discomfort may be severe. Therefore, artificial tears should be prescribed here not so much as a form of substitution therapy, but more as a symptomatic therapy through their lubricating action.
Meibomian gland secretion stimulation
Daily use of hot compresses applied over closed eyelids, followed by gentle massage in the direction of the eyelid margins may in some cases alleviate hyperevaporative dry eye symptoms by promoting meibomian gland function.
During the day, gentle massage of the eyelids by rotatory movements with the palms of the hands may bring temporary relief.
Eyelid margin hygiene
In case of scales and hyperaemic eyelid margins (blepharitis), recommend eyelid margin
hygiene with either 25 % baby shampoo, or saline. Forceful blinking
Recommend forceful intentional blinking (to express secretions from the meibomian
glands) during computer work or watching TV to reduce tearing. Short course of topical corticosteroid therapy
In case of periodic worsening of symptoms, a short course of topical corticosteroids may
help the patient. Course of topical antibiotic therapy to reduce bacterial population
In case of pronounced blepharitis (meibomian gland orifices blocked, no secretion expres- sed, eyelid margins hyperaemic, dried secretion on margins), a short course of broad spec- trum topical antibiotic (accompanied by eyelid margin hygiene) may reduce symptoms by reducing the bacterial population that feeds on lipids.
OTHER THERAPEUTIC OPTIONS Apart from those listed above, there are other therapeutic procedures available for treatment of dry eye. However, they are most commonly used in treating more severe forms of dry eye,
and therefore are not in widespread use among GP/GPPs and general ophthalmologists.
Therapeutic contact lenses, combined with artificial tears
Occlusion of the lacrimal puncta
WHEN DRY EYE PATIENTS SHOULD BE REFERRED TO THE OPHTHALMOLOGIST? Dry eye patients may be successfully treated and followed up for years by general practitioners. However, in the course of his/her disease, every dry eye patient may potentially develop some other medical condition that may be potentially dangerous to his/her visual function. In those cases, patients should be referred to an ophthalmologist.
Below are listed conditions that are best referred for further testing and treatment to an ophthalmologist.
Sudden exacerbation of otherwise chronic signs and symptoms (discharge, hyperaemia, and pain).
Symptoms and signs becoming more pronounced unilaterally.
Exacerbation of symptoms and signs accompanied by deterioration of visual acuity (denoting corneal involvement).
No improvement on given therapy, previously efficient therapy not helping anymore.
Concomitant systemic condition
(autoimmune disease, systemic therapy that may affect dry eye condition).
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