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  • -

    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.

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DRY EYE

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

  • -

    Topical cylosporine-A

  • -

    Tarsorrhaphy

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    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.

  • 1.

    Sudden exacerbation of otherwise chronic signs and symptoms (discharge, hyperaemia, and pain).

  • 2.

    Symptoms and signs becoming more pronounced unilaterally.

  • 3.

    Exacerbation of symptoms and signs accompanied by deterioration of visual acuity (denoting corneal involvement).

  • 4.

    No improvement on given therapy, previously efficient therapy not helping anymore.

  • 5.

    Concomitant systemic condition

(autoimmune disease, systemic therapy that may affect dry eye condition).

REFERENCES

  • 1.

    Murube J., Benitez Del Castillo J.M., ChenZhuo L., Berta A., Rolando M.: The Madrid Triple Classification of Dry Eye. Arch. Soc. Esp. Oftalmol. Vol. 78:587–594 (2003)

  • 2.

    Murube J., Nemeth J., Hoh H., Kaynak-Hekimham P., Horwath-Winter J., Agarwal A., Baudoin C., Benitez Del Castillo J.M., Cervenka S., ChenZhuo L., Ducasse A., Duran J., Holly F., Javate R., Nepp J., Paulsen F., Rahimi A., Raus P., Shalaby O., Sieg P., Sorino H., Spinelli D., Ugurbas S.H., Van Setten G.: The triple classification of dry eye for practical clinical use. Eur. J. Ophthal. Vol. 15:660–667 (2005)

  • 3.

    Lemp M.A.: Report of the National Eye Institute/Industry Workshop on Clinical Trials in Dry Eyes. CLAO

    • J.

      21:221–232 (1995)

  • 4.

    Brewitt H.: Diagnostik und Therapie des ‘trockenen Auges’. Z Prakt Augenheilkd 16:349–54 (1995)

  • 5.

    Rheinstrom S.D. in: Yanoff-Duker: Ophthalmology (1999)

  • 6.

    McCulley J..P, Shine W.E., Aronowicz J. et al.: Presumed Hyposecretory/Hyperevaporative KCS: Tear Characteristics. Trans Am Ophthalmol Soc. Vol 101:141–154 (2003)

  • 7.

    Jacobsson L.T., Axell T.E., Hansen B.U. et al.: Dry eyes or mouth-an epidemiological study in Swedish adults, with special reference to primary Sjoegren’s syndrome. J Autoimmun 2:521–527 (1989)

  • 8.

    Hikichi T., Yoshida A., Fukui Y. et al.: Prevalence of dry eye in Japanese eye centers. Graefes Arch Clin Exp Ophthalmol 233:555–558 (1995)

DRY EYE

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