Dry Eye Disease Workflow

DED workup

- Patient survey
- Review Meds/environmental factors
- TearLab Osmolarity Test
- Lid/Meibomian Gland eval
- Tear Meniscus Height Eval.
- Staining/dye eval. (i.e. TBUT, SPK)
- Schirmer’s
- Fundus exam to rule out Diabetes/Lupus etc. (if not performed)

Aqueous Tear Deficiency*
Treatment
- Dietary/Environmental Management
- Medication interactions
- Artificial Tears
- Schedule follow up exam

Follow-up Exam
- Repeat TearLab Osmolarity Test
- Perform indicated clinical tests
- Review environmental
- Resolve medication Interactions
Is patient responding to Therapy?*
Inform Patient to Continue Therapy
Moderate Deficiency

Evaluation or Follow-up Exam
- Significant DED signs and symptoms persist
- Confirm patient compliance
- TearLab Osmolarity Test remains elevated
- Perform indicated clinical tests
- Artificial tears are not providing one hour of relief or requires four or more treatments per day

Treatment In addition to mild DED treatments consider adding:
- Loteprednol QID for 2 weeks then BID for 4 weeks
- Cyclosporine BID for 3-6 months
- Consider omega fatty acids supplement
- Schedule follow-up exam
- Increased frequency with non-preserved or increased viscosity

Follow-up exam
- DED signs and symptoms persist?
- Confirm patient compliance
- TearLab Osmolarity Test
- Perform indicated clinical tests/IOP
- Continue to taper off Loteprednol
- Discuss coclysporine for long term use
- Consider punctual plugs – (collagen or silicone) or cauterization
Is Patient responding to Therapy?
Inform Patient to continue Therapy

Return to clinic as appropriate
Severe
Evaluation or Follow-up exam Significant DED symptoms persist with treatments thus far and/or elevated TearLab Osmolarity Test, EBMD, RCE, or significant staining and desiccation present.

Treatment In addition to moderate DED treatments consider adding: (if therapy does not include)
- Punctal Plugs – collagen or silicone
- Viscoelastics
- Immunomodulators
- Autologus Serum TID
- Evoxac™ 30mg TID for Sjögren’s patients
- Schedule follow-up exam

Follow-up exam
- DED signs and symptoms persist?
- Confirm patient compliance
- TearLab Osmolarity Test
- Perform indicated clinical tests/IOP
- Taper Loteprednol (if using)
- Discuss therapy for long term use
- Stress compliance
- Schedule follow-up exam

Follow-up exam
- DED signs and symptoms persist?
- Confirm patient compliance
- TearLab Osmolarity Test
- Perform indicated clinical tests/IOP
- Continue to taper or discontinue Loteprednol (if using)
- Perform Tarsorrhaphy
- Consider referral

Inform Patient to continue therapy

Return to Clinic as appropriate

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