The CMGs offer information on the diagnosis and management of a range of conditions that present with varying frequency in primary and first contact care.
Dry eye (keratoconjunctivitis sicca) occurs due to loss of tear film homeostasis as a result of increased tear film instability and hyperosmolarity, leading to inflammation of the ocular surface. Prevalence increases with age, and is higher in post-menopausal women and people of East Asian ethnicity. Cases can be related to systemic inflammatory conditions, drug side effects, eyelid abnormalities or disorders of the meibomian glands. This Clinical Management Guideline outlines the aetiology, signs and symptoms and evidence-based recommendations for diagnosing and treating dry eye. It provides recommendations for non-pharmacological management and pharmacological treatment, and for when routine or urgent referral may be appropriate.
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What is dry eye disease?
Dry eye disease is also known by the medical term keratoconjunctivitis sicca, which means inflammation of the conjunctiva (the membrane overlying the white of the eye) and the cornea (the clear window of the eye) caused by dryness resulting from a deficiency or disorder of the tear film (the thin layer of tears covering the surface of the eye). It is a common condition affecting many people in the later decades of life. Most cases have no apparent cause but some are related to various inflammatory conditions, surgical treatment or as a side-effect of drug treatment. Some are caused by abnormalities of the eyelids or blinking, or by disorders of the meibomian (oil) glands of the eyelid margin.
Patients complain of irritation of the eyes, a feeling that there is something in the eye, a discharge from the eye, and sometimes blurred vision. They notice that their symptoms are worse in windy or dry conditions or when irritants such as smoke are in the air. When they are examined in the clinic they may be found to have reduced tear production or increased tear evaporation (sometimes due to lack of normal oil gland secretion). There may be damage to the surface of the eye produced by the increased saltiness of the tears.
How is dry eye disease managed?
Tears can be supplemented with various drops and ointments. It is also possible to conserve natural tears by blocking the openings of the tear ducts, either temporarily with tiny plugs or permanently by surgery. Where the problem relates to a disorder of the oil glands, treatment is directed to the eyelids.