Dysfunctional tear syndrome dry eye disease and associated tear film disorders

Dysfunctional tear syndrome (DTS) is a common and complex disease that affects the ocular surface. The health and normal function of the ocular surface depends on a sufficiently stable tear film. In recent years, due to the expanded research and publication of diagnostic and treatment guidelines related to diseases that cause DTS, including treatment recommendations from the Delphi DTS team (2006) and the International Dry Eye Symposium, doctors’ understanding of diseases that affect the ocular surface has Enhancement (DEWS) (2007), Meibomian Gland Dysfunction Symposium (MGD) (2011), and the American Academy of Ophthalmology’s updated guidelines for preferred practices related to dry eye and blepharitis (2013). Since the release of existing guidelines, new diagnostic techniques and treatment options have been available, providing opportunities for better patient management. Doctors now have access to a wealth of information to help them obtain the differential diagnosis and treatment of DTS patients. This review provides a practical and targeted approach to the diagnosis and treatment of DTS patients, emphasizing treatments tailored to specific disease subtypes and severity of the disease.



In recent years, due to new clinical research and the publication of guidelines for the diagnosis and treatment of diseases that cause DTS, the awareness of physicians about diseases that affect the ocular surface has increased. These guidelines include the Delphi group treatment recommendations for DTS (2006) [1], the International Symposium on Dry Eye (DEWS) (2007) [4], the International Symposium on Meibomian Gland Dysfunction (MGD) (2011) [5], and the American Academy of Ophthalmology updated guidelines on preferred practice models for dry eye and blepharitis (2013) [6,7]. These guidelines generally recommend treatment based on the severity of the DTS subtype. New diagnostic methods and medications can be used to further inform severity-based decisions to help better manage DTS and related cloaking conditions. In order to combine the latest evidence-based methods of diagnosis and management of DTS with existing guide-based methods, we assembled a professional group made up of experts from the Association for Corneal, External and Refraction Diseases (CEDARS), hereinafter referred to as the DTS group, in order to provide a clinical method that uses the latest diagnostic tools and guidelines to guide the treatment of specific disease subtypes. This article reviews the evidence for various diagnostic methods, including recently developed techniques, and a comprehensive review of new and established treatments for the management of DTS and its subtypes. Include case studies to show how the new method can be applied to specific clinical settings.

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