Is the definition that you have for dry eye a good one? When was the last time that you reassessed your perception of this disease state and modified your methods of treatment? In preparing for lectures, articles that we write, and after seeing either an early- or end-stage dry eye disease patient, we find that our definition of the disease changes. Like many of you, we are looking for a definition that will lead us to detecting the disease in its earliest stages so that we can impact the lifetime of the patients we see today.

Where Do You Draw the Dry Eye Line?

Again through their exceptional work, we have more information from the Tear Film & Ocular Surface Society (TFOS) on what dry eye disease is all about. The TFOS Dry Eye Workshop II (DEWS II) gave us a new definition of dry eye: “Dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles,” (Bron et al, 2017).

DEWS II provided an incredible amount of knowledge about what happens to the ocular surface for patients who have dry eye (Bron et al, 2017). It is important for all of us to look back at our own personal definitions of what dry eye is and is not to each of us.

First, prevention may be possible; for many patients, if we can maintain homeostasis of the tear film, they may not progress to having dry eye disease. For those instances and times when patients encounter slight disruption that is transient, we have categorized this stage as “dry eye” for our patients. To maintain the normal everyday homeostasis of the tear film, patients need to be warned about and monitored on digital device use, blinking abnormalities, maintaining water intake, and proper ocular surface hygiene.

At some point, “dry eye” becomes “dry eye disease,” and it becomes time to act. At this point, patients may have some or all of the following: symptoms, instability of their tear film, hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities. At this stage, it’s clear that patients have a disease and need treatment.

The Verdict

We have noted a transition in our prescribing since DEWS II. Seeing a transformation in practitioners around the globe has been encouraging. More and more of us are redefining dry eye disease and starting treatment earlier in the disease process when the homeostasis is disrupted.

If you see patients frequenting a treatment on their own to manage their symptoms, it is likely that their homeostasis has shifted. Consider evaluating how you define dry eye and whether your patients might benefit from a new definition. CLS

For references, please visit www.clspectrum.com/references and click on document #269.