“Missing The Mark: The Gap Between Tear Film Deficits And Artificial Tear Composition”

Despite the heterogeneity of dry eye, clinical practice often defaults to a "one-size-fits-all," where artificial tears are prescribed as a first-line treatment without a definitive diagnosis of which tear film layer—lipid, aqueous, or mucin—is primarily deficient, when each layer has its unique function.

Current prescribing habits often overlook these distinctions, leading to “treatment fatigue," where patients experience minimal symptomatic relief despite frequent instillation of drops. This mismatch between the deficiency type and the substitute combination results in poor patient compliance and suboptimal clinical outcomes. The paper aims to evaluate the clinical efficacy of targeted tear substitutes compared to random prescribing. 

The study was conducted in the ophthalmology department of tertiary care multispecialty hospital in India.

It is a prospective comparative observational study. It was designed to evaluate the efficacy of layer-specific treatment versus conventional non-specific therapy. A total of 20 patients with different etiologies of dry eye were selected and divided into 2 groups. In one eye targeted therapy was used, and the second eye acted as a control. Results were analyzed by using Schirmer’s test, TBUT, and meibomian gland expression.

Patients were evaluated at baseline, week 2, and week 6 using the OSDI questionnaire and objective clinical tests.

In group A eyes, where random drops were prescribed, the relief lasted for not more than 4-6 hours, so the frequency of putting drops was higher.

In the eyes where targeted drops were used, patients experienced better symptomatic relief with less frequency of using drops. There was an increase in tear film breakup time.

Dry eye is a multifactorial condition, where proper history taking plays a very important role. Simple diagnostic tools like slit lamps and Schirmer strips help us to reach the deficient layer of tear film. It is always advisable to start treatment with specific lubricants.