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TFOS DEWS II Definition and Classification Report.

Jennifer P Craig1, Kelly K Nichols2, Esen K Akpek3

  • 1Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand.

The Ocular Surface
|July 25, 2017
PubMed
Summary

The updated definition of dry eye disease (DED) emphasizes tear film homeostasis loss and includes ocular symptoms and neurosensory abnormalities. The new classification system addresses DED pathophysiology, guiding diagnosis and management for better patient outcomes.

Keywords:
Aqueous deficientClassificationDefinitionDry eye diseaseEvaporativeMechanism

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Area of Science:

  • Ophthalmology
  • Tear Film Research
  • Ocular Surface Disease

Background:

  • Dry eye disease (DED) is a complex condition with multifactorial etiologies.
  • Previous definitions and classifications lacked a comprehensive, evidence-based approach.
  • The Tear Film and Ocular Surface Society (TFOS) initiated a revision to address these limitations.

Purpose of the Study:

  • To establish an evidence-based definition for dry eye disease.
  • To develop a contemporary classification system for DED.
  • To guide clinical management and research in dry eye disease.

Main Methods:

  • Systematic review of existing literature and new data.
  • Consensus-based approach by the TFOS DEWS II Definition and Classification Subcommittee.
  • Development of a diagnostic and management framework based on pathophysiology.

Main Results:

  • A new definition of DED was created, centering on the loss of tear film homeostasis.
  • Key etiologies including tear film instability, hyperosmolarity, ocular surface inflammation, and neurosensory abnormalities were incorporated.
  • A classification scheme was developed, viewing aqueous deficient and evaporative dry eye as a continuum, incorporating signs and symptoms, and acknowledging related manifestations like non-obvious disease and neuropathic pain.

Conclusions:

  • The revised definition and classification provide a contemporary, evidence-based framework for understanding and managing DED.
  • This approach integrates pathophysiology, symptoms, and signs to guide clinical practice and research.
  • The system aims to restore ocular surface homeostasis and improve patient outcomes in dry eye disease.