What are the diagnostic criteria and treatment goals for dry eye syndrome, including its subtypes such as Non-Keratinizing (NK) and Meibomian Gland Dysfunction (MGD), as well as associated conditions like ectropion and epiphora?

From the Guidelines

Diagnostic Criteria and Treatment Goals for Dry Eye Syndrome

Diagnosing dry eye and its associated conditions, including meibomian gland dysfunction (MGD) and aqueous tear deficiency, involves a comprehensive evaluation of symptoms, tear film analysis, and ocular surface assessment 1. The diagnostic criteria for dry eye syndrome include a combination of clinical findings, such as abnormal morphology, lid margin abnormalities, and abnormal meibum quality, as well as a positive Schirmer's test without anesthesia (≤ 5 mm/5 min) 1.

Classification of Dry Eye Disease

Dry eye disease can be classified into various subtypes, including evaporative dry eye (EDE), aqueous deficiency dry eye, and mixed-type dry eye 1. The meibomian gland dysfunction (MGD) examination should be performed to classify the dry eye subtype, and additional examinations, such as meibography and lipid layer thickness measurement, may be recommended to enable quantification 1.

Treatment Goals and Options

Treatment goals focus on alleviating symptoms, improving tear quality, and reducing inflammation, with initial management often involving artificial tears (e.g., preservative-free sodium hyaluronate 0.1% qid) and eyelid hygiene 1. For MGD, warm compresses and lid massage are recommended, while ectropion and epiphora may require surgical intervention, such as eyelid tightening or lacrimal duct repair, with post-operative follow-up at 1-2 weeks and 3-6 months to assess healing and symptom resolution 1. In severe cases, medications like cyclosporine 0.05% ophthalmic emulsion (Restasis) or lifitegrast 5% ophthalmic solution (Xiidra) may be prescribed for 3-6 months to reduce inflammation and promote tear production 1.

Associated Conditions and Systemic Diseases

Dry eye syndrome may be associated with various systemic diseases, such as Sjögren's syndrome, lymphoma, sarcoidosis, and amyloidosis, which can lead to infiltration of the lacrimal gland and replacement of the secretory acini 1. Additionally, dry eye may be exacerbated by environmental factors, such as reduced humidity and increased wind, drafts, air conditioning, or heating, as well as by the use of systemic medications, such as diuretics, antihistamines, and antidepressants 1.

Key Points

• Dry eye syndrome is a complex disease that requires a comprehensive evaluation and individualized treatment approach 1.
• The diagnostic criteria for dry eye syndrome include a combination of clinical findings and a positive Schirmer's test without anesthesia 1.
• Treatment goals focus on alleviating symptoms, improving tear quality, and reducing inflammation, with initial management often involving artificial tears and eyelid hygiene 1.
• Dry eye syndrome may be associated with various systemic diseases and environmental factors, which should be considered in the diagnosis and treatment of the condition 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Diagnostic Criteria for Dry Eye Syndrome

• Dry eye disease is characterized by tear film abnormalities, resulting in a damaging cycle of tear hyperosmolarity, desiccating stress, inflammation, and ocular surface injury 2
• Meibomian gland dysfunction (MGD) is a key factor in the development of dry eye disease, causing a disruption in the tear film lipid layer and affecting the rate of tear evaporation 3, 4
• The Ocular Surface Disease Index (OSDI) questionnaire, tear evaluation (BUT, Schirmer and osmolarity test), ocular surface evaluation (fluorescein and lissamine green staining), and clinical grading of MGD are used to diagnose and evaluate dry eye disease and MGD 5, 6

Treatment Goals for Dry Eye Syndrome

• The primary treatment goal for dry eye disease associated with MGD is to restore the tear film lipid layer and decrease evaporation, thereby reducing ocular signs and symptoms 3
• Treatment options for MGD include home care options (eyelid hygiene, warming eye masks, ocular lubricants) and office-based treatments (manual expression, microblepharoexfoliation, thermal pulsation, intense pulsed light, intraductal probing) 3
• Topical ophthalmic prescription medications, such as cyclosporine A, may be used to alter various factors that contribute to dry eye disease, including inflammation and inadequate tear production 5

Subtypes of Dry Eye Syndrome

• Non-Keratinizing (NK) is not mentioned in the provided studies as a subtype of dry eye syndrome
• Meibomian Gland Dysfunction (MGD) is a subtype of dry eye disease, characterized by a reduction in meibum secretion and/or a change in meibum composition, resulting in the disruption of the tear film lipid layer and an increase in the tear film evaporation rate 3, 4

Associated Conditions

• Ectropion and epiphora are not mentioned in the provided studies as associated conditions with dry eye syndrome
• Meibomian gland dysfunction (MGD) is strongly associated with dry eye disease, and many of their risk factors, signs, and symptoms overlap 4
• Chronic allergic conjunctivitis is mentioned as a common diagnosis in patients with dry eye symptoms, after MGD, in one of the studies 6

Emerging Therapies

• Perfluorohexyloctane (PFHO) ophthalmic solution is an emerging therapy that has demonstrated the ability to form a long-lasting barrier that inhibits evaporation in preclinical studies, and has been FDA-approved for the treatment of dry eye disease 2
• NOV03 (perfluorohexyloctane) is another emerging therapy that has demonstrated statistically significant improvements in both signs and symptoms in randomized controlled trials for the treatment of dry eye disease associated with MGD 3