This handout is for dry eye disease (aqueous-deficient and evaporative subtypes). Your care team identified this based on: gritty / burning / foreign-body sensation, fluctuating vision, eyes tire with reading or screens (tfos dews ii pmid 28736335).
Other reasons your team may use this plan: paradoxical reflex tearing in dry eye — tear-film instability triggers reflex aqueous secretion (tfos dews ii pmid 28736335); high screen-time, low humidity, contact-lens wear, frequent air-travel, autoimmune disease, anti-cholinergic or systemic-retinoid drugs (tfos lifestyle 2023); sicca symptoms (dry mouth + dry eyes) ± arthralgias or parotid swelling — possible sjögren syndrome (refer rheum).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| patient_education_and_environment_modification | — | — | — | TFOS Lifestyle 2023 + DEWS II (PMID 28736335) — humidity, 20-20-20 screen rule, hydration, smoke avoidance, contact-lens wear-time reduction. |
| warm_compress_and_lid_hygiene_for_mgd | — | — | — | TFOS DEWS II (PMID 28736335) — warm compress 5-10 min + gentle lid massage + commercial lid scrub for evaporative MGD-DED, the commonest subtype. |
| preservative_free_artificial_tears_q1_4h | — | — | — | TFOS DEWS II (PMID 28736335) — preservative-free PRN to as often as q1-2h for symptom relief; avoid BAK-preserved drops in chronic use (TFOS Lifestyle 2023). |
| cessation_of_BAK_preserved_drops | — | — | — | TFOS Lifestyle 2023 — chronic BAK exposure worsens ocular surface; switch glaucoma drops to preservative-free where available. |
| omega_3_dietary_or_supplement | — | — | — | TFOS DEWS II (PMID 28736335) — mixed evidence; reasonable adjunct in MGD; DREAM trial neutral but TFOS retained as conditional. |
Plan: Dry eye disease — TFOS DEWS II + TFOS Lifestyle 2023 stepwise ladder
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Lifelong chronic-disease care. Quarterly to biannual review at stable disease; tighter on therapy initiation or flare. Co-manage Sjögren systemic disease via rheum engine; monitor for lymphoma in Sjögren long-term. Counsel cataract / refractive surgeons on patient pre-existing DED — optimise surface pre-op to avoid postoperative deterioration (TFOS Lifestyle 2023; TFOS DEWS II PMID 28736335).
Guideline: TFOS DEWS II Definition and Classification (Craig et al, Ocul Surf 2017, PMID 28736335) + TFOS DEWS II Diagnostic Methodology (Wolffsohn et al, Ocul Surf 2017, PMID 28736342) + TFOS Lifestyle Reports 2023 series + GOBI + MOJAVE pooled perfluorohexyloctane (Fahmy et al, Front Ophthalmol 2024, PMID 39564145) + ONSET-2 varenicline nasal spray (Wirta et al, Ophthalmology 2021, PMID 34767866)