Current and emerging therapy of dry eye disease. Part B: non-pharmacological modalities

ABSTRACT

Introduction: Dry eye disease (DED) is a multifactorial condition of the tears and ocular surface. New insight on the pathogenesis of dry eye has resulted in development of novel treatments. Current management paradigms vary from self-administered (e.g. artificial tears) to practitioner-administered (e.g. punctal occlusion) modalities.

Areas covered: In part A of this series, the spectrum of pharmacological agents for treatment of DED was reviewed. Part B discusses the current and emerging non-pharmacological therapeutic modalities, which include punctal occlusion, contact lenses, inserts, eyelid warming devices, thermal pulsation system, intense pulsed light, acupuncture, meibomian gland probing, moisture chamber spectacles, tarsorrhaphy, meibomian gland expression, autologous submandibular gland transplantation, and amniotic membrane placement. In preparing this review, a Medline, PubMed and Cochrane Database search of the medical literature for the period between January 1978 and July 2016 using a wide range of keywords was conducted. Only treatment modalities that had their efficacy and safety investigated in clinical studies are included.

Expert commentary: Many patients have multiple mechanisms contributing to DED and appropriateness of each available treatment should be considered on a case-by-case bases. There are multiple devices under investigation in the pre-clinical stage, which have promising data in treating DED.

KEYWORDS:

• Dry eye disease
• keratoconjunctivitis sicca
• dry eye syndrome treatment
• contact lens
• punctal occlusion
• eyelid warming devices
• thermal pulsation system
• intense pulsed light
• moisture chamber spectacles

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This manuscript has been supported in part by an unrestricted grant to the Kresge Eye Institute at Wayne State University by Research to Prevent Blindness.