Gary N Foulks1, S Lance Forstot2, Peter C Donshik3, Joseph Z Forstot4, Michael H Goldstein5, Michael A Lemp6, J Daniel Nelson7, Kelly K Nichols8, Stephen C Pflugfelder9, Jason M Tanzer10, Penny Asbell11, Katherine Hammitt12, Deborah S Jacobs13. 1. University of Louisville Department of Ophthalmology and Vision Science, Louisville, KY. Electronic address: foulksgary@gmail.com. 2. Corneal Consultants of Colorado, Denver, CO. 3. University of Connecticut Health Center Division of Ophthalmology, Farmington, CT. 4. Rheumatology Associates of South Florida, Boca Raton, FL. 5. Tufts University School of Medicine, Boston, MA. 6. Georgetown University, Washington, DC. 7. HealthPartners Medical Group, St. Paul, MN. 8. University of Alabama Birmingham School of Optometry (formerly University of Houston School of Optometry, Houston, TX). 9. Baylor College of Medicine, Houston, TX. 10. University of Connecticut School of Dental Medicine, Farmington, CT. 11. Icahn School of Medicine at Mount Sinai, NewYork, NY. 12. Sjogren's Syndrome Foundation, Bethesda, MD. 13. Boston Foundation for Sight, Needham, MA.
Abstract
PURPOSE: To provide a consensus clinical guideline for management of dry eye disease associated with Sjögren disease by evaluating published treatments and recommending management options. DESIGN: Consensus panel evaluation of reported treatments for dry eye disease. METHODS: Using the 2007 Report of the International Workshop on Dry Eye (DEWS) as a starting point, a panel of eye care providers and consultants evaluated peer-reviewed publications and developed recommendations for evaluation and management of dry eye disease associated with Sjögren disease. Publications were graded according to the American Academy of Ophthalmology Preferred Practice Pattern guidelines for level of evidence. Strength of recommendation was according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. RESULTS: The recommendations of the panel are briefly summarized herein. Evaluation should include symptoms of both discomfort and visual disturbance as well as determination of the relative contribution of aqueous production deficiency and evaporative loss of tear volume. Objective parameters of tear film stability, tear osmolarity, degree of lid margin disease, and ocular surface damage should be used to stage severity of dry eye disease to assist in selecting appropriate treatment options. Patient education with regard to the nature of the problem, aggravating factors, and goals of treatment is critical to successful management. Tear supplementation and stabilization, control of inflammation of the lacrimal glands and ocular surface, and possible stimulation of tear production are treatment options that are used according to the character and severity of dry eye disease. SUMMARY: Management guidelines for dry eye associated with Sjögren's disease are presented.
PURPOSE: To provide a consensus clinical guideline for management of dry eye disease associated with Sjögren disease by evaluating published treatments and recommending management options. DESIGN: Consensus panel evaluation of reported treatments for dry eye disease. METHODS: Using the 2007 Report of the International Workshop on Dry Eye (DEWS) as a starting point, a panel of eye care providers and consultants evaluated peer-reviewed publications and developed recommendations for evaluation and management of dry eye disease associated with Sjögren disease. Publications were graded according to the American Academy of Ophthalmology Preferred Practice Pattern guidelines for level of evidence. Strength of recommendation was according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. RESULTS: The recommendations of the panel are briefly summarized herein. Evaluation should include symptoms of both discomfort and visual disturbance as well as determination of the relative contribution of aqueous production deficiency and evaporative loss of tear volume. Objective parameters of tear film stability, tear osmolarity, degree of lid margin disease, and ocular surface damage should be used to stage severity of dry eye disease to assist in selecting appropriate treatment options. Patient education with regard to the nature of the problem, aggravating factors, and goals of treatment is critical to successful management. Tear supplementation and stabilization, control of inflammation of the lacrimal glands and ocular surface, and possible stimulation of tear production are treatment options that are used according to the character and severity of dry eye disease. SUMMARY: Management guidelines for dry eye associated with Sjögren's disease are presented.
Authors: Frederick B Vivino; Steven E Carsons; Gary Foulks; Troy E Daniels; Ann Parke; Michael T Brennan; S Lance Forstot; R Hal Scofield; Katherine M Hammitt Journal: Rheum Dis Clin North Am Date: 2016-08 Impact factor: 2.670