Assessment and Management of Dry Eye Disease and Meibomian Gland Dysfunction: Providing a Singapore Framework

Abstract

The purpose of this article is to provide a framework for general ophthalmologists in Singapore to manage dry eye. This framework considers the evidence in the literature as well as recommendations from expert panels such as the Tear Film & Ocular Surface Society Dry Eye Workshop II and the Asia Cornea Society Workgroup. This article covers the assessment of patient medical history and ask triage questions to identify local and systemic causes of dry eye disease (DED), excluding other possible causes, as well as the risk factors for DED and ocular surface inflammation. Evaluation of clinical signs to establish the diagnosis of DED and differentiation from other causes of irritable, red eyes are described. Tests for understanding the underlying disease processes and severity of DED are also presented. Management of dry eye should involve patient education and engagement. Information about the natural history and chronic nature of DED should be provided to improve long-term management of the disease and enhance compliance. Aggravating factors should be removed or lessened. We provide a guide to determine the most appropriate treatment (or combination of treatments) based on the severity and cause(s) of the disease, as well as the patient's needs and preferences. The aim of the management is to relieve ocular discomfort and prevent worsening of symptoms and signs, as well as to optimize visual function and minimize structural ocular damage. We also discuss the systematic follow-up and assessment of treatment response, as well as monitoring side effects of treatment, bearing in mind continuous support and reassurance to patients.

Selective Pharmacologic Therapies for Dry Eye Disease Treatment: Efficacy, Tolerability, and Safety Data Review from Preclinical Studies and Pivotal Trials

“…Key DED symptoms include ocular irritation, pain, dryness, foreign body sensation, and visual disturbance; objective clinical signs include tear film instability and hyperosmolarity, reduced tear volume, ocular surface inflammation and damage, and neurosensory abnormalities [ 1 , 4 , 5 ]. There are several methods for clinically assessing DED signs and symptoms, such as corneal and conjunctival staining to identify ocular surface damage and ocular surface symptom patient questionnaires [ 6 , 7 ]. A low association between DED signs and symptoms makes integrating dry eye clinical research into practice challenging.…”

The Effect of Past Cataract Surgery within the Medium to Long-Term Period on Patients with Dry Eye Disease

“…While much literature is largely focused on preventing devastating outcomes such as endophthalmitis [4][5][6], it is important not to neglect side effects that increase morbidity such as tear disorders producing optical aberrations [7] and meibomian gland dysfunction [8]. DED continues to develop [9] or worsen [10,11] following cataract surgery despite the improvement of cataract surgery techniques. Complete prevention is difficult as several factors influence the development of DED post-cataract surgery.…”

Automated dry eye diagnostics: Are they ready for the clinic?

“…Across the globe, dry eye is a growing burden for patients and the health care system. [1][2][3] The impact on quality of life can be significant due to impacts on a patient's vision, ocular comfort, mental health and appearance. 4,5 Cataract and refractive surgery, contact lens wear, allergy, lifestyle factors and autoimmune disease such as Sjogren's syndrome along with other systemic diseases and medications including aromatase inhibitors, can all induce and/or exacerbate existing dry eye.…”

“…13 For clinicians to efficiently diagnose dry eye in everyday practice such advances need to be easily adoptable into clinical practice and validated across different patient populations. 3,14 Tests able to accurately identify and quantify dry eye pre-operatively have the potential to improve outcomes prior to cataract and refractive surgery. 7 The International Dry Eye Workshop (DEWS II) and the Asia Dry Eye Society both defined dry eye as a multifactorial disease characterised by an abnormal tear film in which symptoms and signs in dry eye arise from factors such as tear film instability, hyperosmolarity, ocular surface inflammation and damage, as well as neurosensory abnormalities.…”

“…Across the globe, dry eye is a growing burden for patients and the health care system 1–3 . The impact on quality of life can be significant due to impacts on a patient's vision, ocular comfort, mental health and appearance 4,5 .…”