What is the diagnosis and treatment for Keratoconjunctivitis Sicca (Dry Eye Syndrome)?

From the Guidelines

Dry eye syndrome can be effectively managed with a combination of lifestyle changes and treatments, prioritizing the use of over-the-counter artificial tears and prescription options like cyclosporine or lifitegrast for persistent symptoms, as recommended by the most recent guidelines 1. The management of dry eye syndrome involves a multi-faceted approach, including:

• Lifestyle changes: using over-the-counter artificial tears like Systane Ultra or Refresh Tears 4-6 times daily, and considering preservative-free options if using more frequently 1
• Environmental modifications: using a humidifier in dry spaces, taking regular screen breaks following the 20-20-20 rule, and avoiding direct air from fans, heaters, or air conditioners 1
• Prescription options: anti-inflammatory medications like cyclosporine (Restasis) or lifitegrast (Xiidra), which require consistent use for several weeks to show benefit 1
• Punctal plugs: which may be inserted by an eye doctor to block tear drainage and keep eyes more moist 1 It is essential to address any causative factors that are amenable to treatment, and patient education is a critically important aspect of successful management of this condition 1. The use of cyclosporine has been shown to be effective in improving ocular irritation symptoms and aqueous tear production, and may be a disease-modifying agent for dry eye syndrome 1. Lifitegrast has also been approved by the FDA for the treatment of dry eye syndrome, and has been shown to improve signs and symptoms of the condition 1. Overall, the management of dry eye syndrome requires a comprehensive approach, taking into account the severity of the disease, patient preferences, and the potential benefits and risks of different treatments, as outlined in the most recent guidelines 1.

From the FDA Drug Label

1 INDICATIONS AND USAGE Lifitegrast ophthalmic solution 5% is indicated for the treatment of the signs and symptoms of dry eye disease (DED).

• Dry eye syndrome treatment is directly addressed by lifitegrast ophthalmic solution 5% 2.
• The main use of lifitegrast is to treat the signs and symptoms of dry eye disease.
• Cyclosporine is also used to treat dry eye syndrome, specifically keratoconjunctivitis sicca, by acting as a partial immunomodulator 3.

From the Research

Dry Eyes Syndrome Treatment

• Artificial tears are the primary treatment for dry eye disease, and they can also be used for corneal abrasion and wound healing, pain and inflammation management, conjunctivitis, keratitis, contact lens rewetting and removal, and foreign body removal 4.
• The use of topical anti-inflammatory drugs, such as corticosteroids and cyclosporin A, is important in the treatment of dry eye disease, especially in moderate to severe forms 5.
• Hydroxypropyl methylcellulose (HPMC) is a common ingredient in artificial tears, and it has been shown to be effective in improving symptoms and signs of dry eye disease, although combination drops with HPMC and other ingredients may be more effective 6.

Artificial Tears Comparison

• A study comparing different artificial tear formulations found that they had similar effects on noninvasive tear film parameters, but patients reported better relief with sodium hyaluronate (SH)-based lubricants 7.
• Another study found that a preservative-free artificial tear containing carboxymethylcellulose (CMC) and hyaluronic acid (HA) was effective and well-tolerated, and demonstrated a greater potential for symptom relief compared to CMC alone 8.
• Artificial tears containing polyethylene glycol are more effective than those containing carboxymethylcellulose/carmellose sodium and hydroxypropyl methylcellulose, and combination formulations are more effective than single active ingredient artificial tears 4.

Treatment Considerations

• Not all patients with dry eye disease benefit from artificial tears, and alternative management should be considered if there is no benefit after a month of use 4.
• The consistent treatment of Meibomian gland dysfunction is important in the management of dry eye disease, especially in cases of evaporative dry eye 5.
• Understanding the chronicity of the disease and long-term compliance are essential for successful therapy of dry eye disease 5.