TFOS DEWS II and beyond – utilising evidence base to inform the management of dry eye disease

11 March 2019
Volume 20, Issue 1

This review outlines the key outcomes from the TFOS DEWS II reports which are most relevant to clinical practice.


Dry eye disease is among the most common chronic ophthalmic conditions encountered in clinical practice. In the context of the rapidly expanding academic literature devoted to the condition, the Tear Film and Ocular Surface Society´s Dry Eye Workshop II (TFOS DEWS II) was convened to review the contemporary literature with the aim of providing an evidence-based global consensus view of the current understanding of dry eye disease. An updated definition and classification scheme was introduced, highlighting tear film homeostatic disturbance as a central hallmark of dry eye disease, and acknowledging the substantial overlap between the two aetiological subtypes, aqueous tear deficiency and evaporative disease, which are viewed to exist as a continuum. Streamlined diagnostic criteria for dry eye disease were developed for the first time, and require the presence of both clinical signs and symptoms of tear film homeostatic disruption. A global consensus management algorithm was proposed, and provides a framework for treatment initiation with conventional, low-risk, easily accessible patient applied therapies in early-stage disease, followed by progression to more advanced management therapies targeted at particular pathophysiological aspects of dry eye disease. In addition, the underlying aetiological causes and pathophysiological mechanisms of dry eye disease were outlined, and a systematic literature review was conducted on the population prevalence patterns, natural history and risk factors for the condition, including age, sex, comorbidities and iatrogenic causes. The current review outlines key outcomes from the TFOS DEWS II reports that are most relevant to clinical practice, to provide clinicians with a basic framework within which to utilise the evidence base for informing contemporary management of dry eye disease.

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