THE PITFALLS IN DRY EYE MANAGEMENT

A comprehensive search was performed on Medline (PubMed) and Google Scholar for published studies related to DED and evidence-based treatments.

Many protocols to approach the disease and its management are available, but still there are some mistakes and misconceptions among eye care practitioners (ECPs). Thirteen pitfalls in DED management were identified.

• Listening carefully to the patient and giving them enough time to tell their story with dry eye is as important as educating them about the disease and management plan.
• DED is a multifactorial complex disease, where there is poor correlation with signs and symptoms.
• Avoid using artificial tears as the foundation of the management, new formulas such as Osmoprotectants, omega 3, another, and visco enhancers are potential effective treatments.
• Inflammation plays and important role in the aetiology of DED and should be treated early.
• Topical steroids are critical to restore ocular surface integrity. However, they should be used strategically as prolonged use of steroids increases the risks of premature cataract formation, infection, and glaucoma.
• The routine use of Punctal plugs can exacerbate inflammation.
• Scleral lenses can be a treatment option for DED, especially in severe ocular surface disease, but if the underlying causes of DED are not addressed, even some of the most robust treatments, may fail.
• Combined advanced treatment procedures with omega-3 fatty acid supplementation, lid hygiene, blink exercises, and immunomodulators, seem to have a promising role in DED management.

It is important to implement therapies thoughtfully including polytherapy by listening and educating the patient to increase compliance and improve treatment outcomes. ECPs should keep track of treatments utilized and patient’s responses in a logical and consistent fashion. Dry eye is a chronic and progressive disease, so it typically develops over a long period. Likewise, treatment response often requires a significant amount of time.