What are the diagnostic approaches and treatment goals for dry eye syndrome, neurotrophic keratitis, Meibomian Gland (MG) dysfunction, ectropion, and epiphora?

From the Guidelines

Diagnosis of dry eye and its associated conditions, including neurotrophic keratitis and meibomian gland dysfunction (MGD), involves a comprehensive evaluation of symptoms, tear film analysis, and ocular surface examination 1. Treatment goals for dry eye focus on alleviating symptoms and improving tear quality, with initial management often involving artificial tears (e.g., preservative-free sodium hyaluronate 0.1% qid) and omega-3 fatty acid supplements (e.g., flaxseed oil 1000mg bid) 1.

Key Treatment Approaches

• For neurotrophic keratitis, treatment may include topical antibiotics (e.g., ofloxacin 0.3% tid) and nerve growth factor stimulants (e.g., cenegermin 0.002% bid) 1.
• For MGD, management involves warm compresses, lid hygiene, and anti-inflammatory agents (e.g., azithromycin 1% qid) 1.
• Ectropion and epiphora may require surgical intervention, with preoperative management focusing on controlling symptoms with topical lubricants and anti-inflammatory agents 1.

Additional Considerations

• Punctal occlusion can be considered for patients with aqueous tear deficiency, and may involve the use of silicone plugs or thermal cautery 1.
• Autologous serum and autologous plasma rich in growth factors drops may be beneficial for patients with severe dry eye syndrome 1.
• Rigid gas-permeable scleral lenses and soft contact lenses may be used to manage severe dry eye, but require careful fitting and monitoring 1. Follow-up instructions typically involve regular assessments of symptoms and ocular surface health, with adjustments to treatment regimens as needed to achieve optimal outcomes 1.

From the FDA Drug Label

OXERVATE is a recombinant human nerve growth factor indicated for the treatment of neurotrophic keratitis. OXERVATE® (cenegermin-bkbj) ophthalmic solution 0.002% is indicated for the treatment of neurotrophic keratitis.

The diagnostic approaches and treatment goals for neurotrophic keratitis are not fully described in the provided drug labels. However, the treatment goal for neurotrophic keratitis using cenegermin (OXERVATE) is to administer one drop of OXERVATE in the affected eye(s), 6 times a day at 2-hour intervals for eight weeks 2, 2, 2.

There is no information in the provided drug labels regarding the diagnostic approaches and treatment goals for dry eye syndrome, Meibomian Gland (MG) dysfunction, ectropion, and epiphora.