Medical management of dry eye disease

To describe the medical options for the management of dry eye disease, including the use of contact lenses.

The normal behaviour of the tear film and the mechanism of dry eye disease are briefly discussed to provide a rationale for treatment. A guideline for the medical management of disease includes general environmental measures, the treatment of exacerbating factors and associated disease, the selection of tear substitutes, and the role of contact lenses. Advances in the use of agents that stimulate the production of normal tear components and the use of anti-inflammatory agents are presented.

The basic mechanisms of many of the treatment options used to treat dry eye disease are poorly understood. The evidence for the relative merits of a large range of available treatments is weak. Although the choice of treatment is in part determined by the severity of disease, a reliable algorithm for the sequence of introduction of agents has yet to be developed.

Medical management plays a major role in the initial treatment and control of symptoms of dry eye. Empiric evaluation of the effect of the large range of options still has a major role for the management of individual patients.