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Dry eye syndrome. Limited revision.

American Academy of Ophthalmology Cornea/External Disease Panel. Dry eye syndrome. Limited revision. San Francisco (CA): American Academy of Ophthalmology (AAO); 2011. 28 p. [免費全文下載 Free full-text: Guidelines at AAO website | Guideline Summary at National Guideline Clearinghouse]

[EXCERPTS]

Major Recommendations 

Diagnosis 

Patient History

Questions about the following elements of the patient history may elicit helpful information:

• Symptoms and signs: [A:III] e.g., irritation, tearing, burning, stinging, dry or foreign body sensation, mild itching, photophobia, blurry vision, contact lens intolerance, redness, mucous discharge, increased frequency of blinking, eye fatigue, diurnal fluctuation, symptoms that worsen later in the day
• Exacerbating conditions: [B:III] e.g., wind, air travel, decreased humidity, prolonged visual efforts associated with decreased blink rate such as reading and computer use
• Duration of symptoms [A:III]
• Topical medications used, their frequency, and their effect on symptoms: [A:III] e.g., artificial tears, "eyewash," antihistamines, glaucoma medications, vasoconstrictors, corticosteroids
• Contact lens wear, schedule, and care [A:III]
• Allergic conjunctivitis [B:III]
• Ocular surgical history: [A:III] e.g., prior keratoplasty, cataract surgery, keratorefractive surgery
• Ocular surface disease [A:III] e.g., herpes simplex virus, varicella zoster virus, ocular mucous membrane pemphigoid, Stevens-Johnson syndrome, aniridia, graft versus host disease (GVHD)
• Punctal surgery [A:III]
• Eyelid surgery: [A:III] e.g., prior ptosis repair, blepharoplasty, entropion/ectropion repair
• Bell palsy [A:III]
• Smoking or exposure to second-hand smoke [A:III]
• Dermatological diseases: [A:III] e.g., rosacea
• Technique and frequency of facial washing including eyelid and eyelash hygiene [A:III]
• Atopy [A:III]
• Menopause [A:III]
• Systemic inflammatory diseases: [A:III] e.g., Sjogren syndrome, GVHD, rheumatoid arthritis, systemic lupus erythematosus, scleroderma
• Other systemic conditions: [A:III] e.g., lymphoma, sarcoidosis
• Systemic medications: [A:III] e.g., antihistamines, diuretics, hormones and hormonal antagonists, antidepressants, cardiac antiarrhythmic drugs, isotretinoin, diphenoxylate/atropine, beta-adrenergic antagonists, chemotherapy agents, any other drug with anticholinergic effects
• Trauma: [B:III] e.g., chemical
• Chronic viral infections: [B:III] e.g., hepatitis C, human immunodeficiency virus (HIV)
• Nonocular surgery: [B:III] e.g., bone marrow transplant, head and neck surgery, trigeminal neuralgia surgery
• Radiation of orbit [B:III]
• Neurological conditions: [B:III] e.g., Parkinson disease, Bell palsy, Riley-Day syndrome, trigeminal neuralgia
• Dry mouth, dental cavities, oral ulcers [B:III]

Examination

The physical examination includes a visual acuity measurement, [A:III] an external examination, [A:III] and slit-lamp biomicroscopy. [A:III]

Treatment

Treatment Recommendations for Dry Eye Syndrome by Disease Severity Level*

*Adapted with permission from Pflugfelder SC (Chair). Management and therapy Subcommittee of the International Dry Eye Workshop. Management and therapy of dry eye disease: report of the Management and Therapy Subcommittee of the International Dry Eye Workshop (2007). Occul Surf 2007;5:174.

Provider and Setting

Patients with dry eye who are evaluated by non-ophthalmologist health care providers should be referred promptly to the ophthalmologist if any of the following occurs: [A:III]

• Visual loss
• Moderate or severe pain
• Lack of response to the therapy
• Corneal infiltration or ulceration

Counseling/Referral

The most important aspects of caring for patients with dry eye are to educate them about the chronic nature of the disease process and to provide specific instructions for therapeutic regimens. It is helpful to reassess periodically the patient's compliance and understanding of the disease, the risks for associated structural changes, and to re-inform the patient as necessary. [A:III] The patient and physician together can establish realistic expectations for effective management.

Patients with pre-existing dry eye should be cautioned that refractive surgery, particularly laser-assisted in situ keratomileusis (LASIK), may worsen their dry eye condition (Nettune & Pflugfelder, 2010). [A:III] Patients who have dry eye and are considering refractive surgery should have the dry eye treated before surgery (American Academy of Ophthalmology Basic and Clinical Science Course Subcommittee, 2011).

Definitions:

Ratings of Importance to Care Process [available online] 

Ratings of Strength of Evidence [available online]

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