Dry eye management

Conservative management

For decrease aqueous ( reduce Schirmer value )
- artificial tears contain high sod chloride content and polyvinyl alcohol ( which has stablising effect )

For evaporative
- product contain povidone act similar like mucin that decrease surface tension of tear film
- product with hypromellose and carboxymethylcellulose will help increase therapeutic effect of medication to ocular surface.

If involve ocular surface staining
- dextran and retinol help re- epithelization
- further epithelization using hemoderivatum or dexpanthenol

Long lasting application of drugs with preservatives may cause disruption of the epithelial cell–cell contacts, allergic reaction, decreased goblet cell density or inflammation.

Benzalkonium chloride, chlorobutanol and cetrimide are the most common preservatives in artificial tears that after a prolonged application induce toxic epitheliopathy.

Generally, when the patient drops more than four times a day, preservative-free tears are recommended.

Anti inflammatory agent

0.1% fluorometholone BD to QID if the pathomechanism involve immune in severe and advanced dry eye disease - as supplementary only.

Topical cyclosporine A (0.05%) also has a beneficial effect on dry eye conditions and is capable of improving the Schirmer value, corneal fluorescein staining and goblet cell density.

Eyelid therapy
In pt with meibomian gland dysfx, meibomitis or blepharitis
- lid hygiene
- tetracycline that have effect of anti inflammatory, anti angiogenic and antibacterial.

Others

Autologous serum
several growth factors, vitamin A and fibronectin, and also has an anti-inflammatory effect; therefore it has been beneficial in advanced and severe cases of the disease.

Free fatty acids
Omega-3 fatty acids (eicosapentaenoic acid, docosahexaenoic acid and α-linolenic acid) are especially beneficial in patients with systemic autoimmune inflammatory disorders associated with dry eye disease.
The American Dietetic Association and the Dietitians of Canada recommended a 500 mg/day intake of omega-3 fatty acids.
However, twice-daily usage of oral linolenic acid (28.5 mg) has been proven to reduce ocular surface inflammation and symptoms

Eye and ocular surface protection
E.g contact lens

Semi invasive therapy

Temporary or permanent punctal occlusion
- for seve and advanced disease for pt with decrease tears assoc with significant corneal staining epitheliopathy


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