Dry Eye Syndrome (DES)

Dry Eye Syndrome (DES)
SYMPTOMS Dryness | Tearing | Discomfort | Transient blur | Photophobia
SIGNS Injection | Tearing | Discharge | Cornea/conjunctiva stain with NaFl/LG | Low tear meniscus
WORK-UP Thorough history. Slit lamp examination
TREATMENT
Treatment depends on the severity of the condition (non-exhaustive list)
Mild DES: Preservative-free artificial tears 1 gtt bid-qid | Hot compresses (i.e. Bruder mask)
Moderate DES: Mild DES tx PLUS: High quality omega-3 supplementation (i.e. PRN, Nordic Naturals) | Lubricating gel/ointment qhs | Xiidra 1 gtt bid | Restasis 1 gtt bid | Pulse topical steroid (Lotemax 1 gtt qid) | Punctal plugs
Severe DES: Moderate DES tx PLUS: Moisture chamber goggles qhs | Scleral lenses | Autologous serum drops | Regener-Eyes drops | Intense pulsed light therapy | Punctal cautery | Meibomian gland probing
FOLLOW-UP Follow-up depends on the severity of the condition. Mild DES may be monitored annually. Severe DES requires more frequent follow-up.
ADDITIONAL LAB | TESTS NaFl stain | Lissamine green stain | Tear break-up time | Phenol red thread | Meibography | MMP-9 | Tear osmolarity | Schirmer test
ETIOLOGY There is no single cause of dry eye, and there are many potential contributors to the condition including: Age | Hormones | Allergies | Autoimmune disorders | Medications | Ocular surgery | Contact lens wear, etc.
DIFFERENTIAL DX Allergic conjunctivitis | Episcleritis | Blepharitis |C CLARE | Filamentary keratitis
NOTES Symptoms from DES can vary from no symptoms to debilitating

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