This guideline last updated 09/05/2022 10:10:27

Orbit/Lacrimal System

Dry Eye

Differential diagnosis

Blepharitis
Exposure keratopathy
Neurotrophic keratopathy
Sjogren’s syndrome
Drugs
Ocular cicatricial pemphigoid
Refractive laser surgery
Vitamin A deficiency

Possible management by Optometrist

Treatment

Treat underlying blepharitis or rosacea or seborrhoeic dermatitis, if present
Mild to Moderate Symptoms
- Artificial Tears
  - Hypromellose 0.3% at 30 minute intervals till symptoms improve, then less frequently
    - Switch to preservative free alternative if:
      - Used > 6 times a day
      - Soft contact lenses wearers
      - Epithelial toxicity from preservatives
      - Allergic conjunctivitis from preservatives
    - Or Carbomer 0.2% gel four times a day
  - Severe Symptoms
    - Preservative Free Artificial Tears
      - Preservative free Hypromellose 0.3% at 30 minute intervals till symptoms improve, then 3-4 x daily
      - Or Sodium hyaluronate 0.2% at 30 minute intervals till symptoms improve, then 3-4 x daily
    - Unmedicated ointment at bedtime
    - Punctal plugs
  - Symptomatic mucus strands or plaques
    - PoM Acetyl cysteine 5% one drop 4 x daily
      - Drops sting briefly

Advice

Majority of cases idiopathic or related to blepharitis
A few have Sjogren’s syndrome (dry eye, dry mouth, dry vagina) which may be primary or secondary
Avoid aggravating factors
- Smoke
- Wind
- Heat (central heating)
- Inadvertent staring
  - Computer use
  - Reading
  - Watching television
- Encourage patients to discuss with GP whether any medication may be contributing and whether there are any appropriate alternatives

Management Category

Normally no referral
Refer new cases of suspected Sjogren’s to GP for assessment and onward referral as appropriate
- Encourage patients to attend dentist regularly as dry mouth increases risk of severe caries

Possible management by Ophthalmologist

As above
Topical steroid
Topical ciclosporin
Topical autologous serum
Punctal plugs
Punctal occlusion