Clinical Ophthalmology (Apr 2022)
A Practical Approach to Severity Classification and Treatment of Dry Eye Disease: A Proposal from the Mexican Dry Eye Disease Expert Panel
Abstract
Alejandro Rodriguez-Garcia,1 Alejandro Babayan-Sosa,2 Arturo Ramirez-Miranda,3 Concepcion Santa Cruz-Valdes,3 Everardo Hernandez-Quintela,4 Julio C Hernandez-Camarena,1 Nallely Ramos-Betancourt,5 Regina Velasco-Ramos,2 Raul E Ruiz-Lozano1 1Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Cornea and External Disease Service, Monterrey, Mexico; 2Cornea and Refractive Surgery Service, Fundación Hospital Nuestra Señora de la Luz, I. A. P, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico; 3Cornea and Refractive Surgery Service, Instituto de Oftalmología Conde de Valenciana, I.A.P, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico; 4Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA; 5Asociación para Evitar la Ceguera en México, I.A.P, Mexico City, MexicoCorrespondence: Alejandro Rodriguez-Garcia, Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Cornea and External Disease Service, Hospital Zambrano Hellion, TecSalud, Av. Batallon de San Patricio #112, Col. Real de San Agustin, San Pedro Garza Garcia, N.L. CP. 66278, Mexico, Tel/Fax +52 81 88 88 05 51, Email [email protected]: Dry eye disease (DED) has a higher prevalence than many important systemic disorders like cardiovascular disease and diabetes mellitus, representing a significant quality of life burden for the affected patients. It is a common reason for consultation in general eye clinics worldwide. Nowadays, the diagnostic and therapeutic approach at the high corneal and ocular surface specialty level should be reserved for cases of severe and chronic dry eye disease associated with systemic autoimmune diseases or complicated corneal and ocular surface pathologies. In such cases, the diagnostic and therapeutic approach is often complex, elaborate, time-consuming, and costly due to the use of extensive dry eye questionnaires, noninvasive electronic diagnostic equipment, and clinical laboratory and ancillary tests. However, other eye care specialists attend a fair amount of DED cases; therefore, its diagnosis, classification, and management should be simple, practical, achievable, and effective. Considering that many patients attending non-specialized dry eye clinics would benefit from better ophthalmological attention, we decided to elaborate a practical DED classification system based on disease severity to help clinicians discriminate cases needing referral to subspecialty clinics from those they could attend. Additionally, we propose a systematic management approach and general management considerations to improve patients’ therapeutic outcomes according to disease severity.Keywords: dry eye disease, fluorescein staining, tear breakup time, Schirmer test, tear osmolarity, dry eye questionnaire
