Dry Eye Syndrome

Publication Date: January 1, 2019
Last Updated: March 14, 2022


Dry eye is a common ocular condition that has a substantial impact on the quality of life of afflicted individuals owing to discomfort and visual disability. Dry eye may compromise results of corneal, cataract, and refractive surgery.

No single test is adequate for establishing the diagnosis of dry eye. The constellation of findings from multiple tests can add greatly to the clinician's understanding of the patient's condition.

Pharmacological and procedural treatments are associated with improvements in patient symptoms and clinical signs, although chronic therapy and patient compliance are necessary in most instances.

Omega-3 fatty acid products without ethyl esters have been recommended and widely used in the treatment of dry eye. However, a prospective, multicenter, masked large-scale trial of 3000 mg of omega-3 fatty acids for 12 months did not show any benefit in patient symptoms or signs over placebo.

Topical cyclosporine treatment has long been used in the treatment of dry eye and shown to have clinical benefits. Topical cyclosporine, in some instances, leads to long-term treatment-free remission of patient symptoms and signs.

Lifitegrast is a lymphocyte function-associated antigen-1 antagonist developed to treat dry eye syndrome (also known as dry eye disease), but the exact mechanism of action of lifitegrast in dry eye is unknown. Topical lifitegrast 5% has been approved by the US Food and Drug Administration for treatment of dry eye. Published studies show benefit in signs (corneal and conjunctival staining) as well as symptoms (eye dryness score and ocular discomfort) over a period of 3 months.

Although the drug seems to be safe over 12 months, long-term efficacy and side effects are unknown.

Dry eye patients considering keratorefractive surgery, particularly LASIK, should be cautioned that the dry eye condition could become worse after surgery. Dry eye symptoms are common in the first few months after surgery and tend to subside with time. Patients can safely undergo LASIK surgery if a pre-existing dry eye condition can be improved preoperatively.

Dry eye is one of the main reasons for patient dissatisfaction following cataract surgery.

Dry eye symptoms that continue beyond the normal postoperative period of 3 months might be seen in about one third of individuals.

Baseline ocular surface and tear film parameters predict the patients at risk.

Therefore, all patients undergoing cataract surgery should be evaluated and managed for dry eye preoperatively.
Approximately 1/10 patients with clinically significant dry eye have an underlying Sjögren syndrome A recent meta-analysis found that, among autoimmune diseases, primary Sj□gren syndrome is the most strongly associated risk factor for malignancy, with an incidence rate of 18.9% (95% CI, 9.4–37.9).

Therefore timely diagnosis and appropriate management of patients with underlying Sjögren syndrome is relevant. (, , )

Recommendation Grading




Dry Eye Syndrome

Authoring Organization

Publication Month/Year

January 1, 2019

Last Updated Month/Year

June 9, 2022

Document Type


External Publication Status


Country of Publication


Document Objectives

Establish the diagnosis of dry eye and differentiate it from other causes of ocular irritation and redness that may complicate both patient care and research on tear deficiency. Identify the local and systemic causes of dry eye disease. Recommend appropriate therapy, relieve discomfort, prevent worsening of symptoms and clinical findings, and educate and involve the patient in the management of this disease


Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Ambulatory, Emergency care, Outpatient

Intended Users

Optometrist, optician, nurse, nurse practitioner, physician, physician assistant


Counseling, Diagnosis, Management

Diseases/Conditions (MeSH)

D015352 - Dry Eye Syndromes


dry eye, red eyes, ocular irritation, mucus discharge, fluctuating vision

Source Citation

Akpek, E. K., Amescua, G., Farid, M., Garcia-Ferrer, F. J., Lin, A., Rhee, M. K., … Mah, F. S. (2018). Dry Eye Syndrome Preferred Practice Pattern®. Ophthalmology. doi:10.1016/j.ophtha.2018.10.023


Number of Source Documents
Literature Search Start Date
March 1, 2017
Literature Search End Date
June 1, 2018