TFOS DEWS II Management and Therapy Report

Lyndon Jones, Laura E. Downie, Donald Korb, Jose M. Benitez-del-Castillo, Reza Dana, Sophie X. Deng, Pham N. Dong, Gerd Geerling, Richard Yudi Hida, Yang Liu, Kyoung Yul Seo, Joseph Tauber, Tais H. Wakamatsu, Jianjiang Xu, James S. Wolffsohn, Jennifer P. Craig

Research output: Contribution to journalReview articlepeer-review

600 Citations (Scopus)


The members of the Management and Therapy Subcommittee undertook an evidence-based review of current dry eye therapies and management options. Management options reviewed in detail included treatments for tear insufficiency and lid abnormalities, as well as anti-inflammatory medications, surgical approaches, dietary modifications, environmental considerations and complementary therapies. Following this extensive review it became clear that many of the treatments available for the management of dry eye disease lack the necessary Level 1 evidence to support their recommendation, often due to a lack of appropriate masking, randomization or controls and in some cases due to issues with selection bias or inadequate sample size. Reflecting on all available evidence, a staged management algorithm was derived that presents a step-wise approach to implementing the various management and therapeutic options according to disease severity. While this exercise indicated that differentiating between aqueous-deficient and evaporative dry eye disease was critical in selecting the most appropriate management strategy, it also highlighted challenges, based on the limited evidence currently available, in predicting relative benefits of specific management options, in managing the two dry eye disease subtypes. Further evidence is required to support the introduction, and continued use, of many of the treatment options currently available to manage dry eye disease, as well as to inform appropriate treatment starting points and understand treatment specificity in relation to dry eye disease subtype.

Original languageEnglish
Pages (from-to)575-628
Number of pages54
JournalOcular Surface
Issue number3
Publication statusPublished - 2017 Jul

Bibliographical note

Publisher Copyright:
© 2017 Elsevier Inc.

All Science Journal Classification (ASJC) codes

  • Ophthalmology


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