Current Trends in the Recognition and Treatment of Dry Eye: A Survey of Ophthalmologists

Wung Jae Kim; Hyun Seung Kim; Man Soo Kim

doi:10.3341/jkos.2007.48.12.1614

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Kim, Kim, and Kim: Current Trends in the Recognition and Treatment of Dry Eye: A Survey of Ophthalmologists

Original Article

J Korean Ophthalmol Soc 2007;48(12):1614-1622.

Published online: 30 August 2007

DOI: https://doi.org/10.3341/jkos.2007.48.12.1614

Current Trends in the Recognition and Treatment of Dry Eye: A Survey of Ophthalmologists

Wung Jae Kim, M.D., Hyun Seung Kim, M.D., Man Soo Kim, M.D.

Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea

Address reprint requests to Hyun Seung Kim, M.D., Department of Ophthalmology, St. Mary's Hospital, College of Medicine, The Catholic University, #62 Yoido-dong, Youngdeungpo-gu, Seoul 150-713, Korea, Tel: 82-2-3779-1243, Fax: 82-2-761-6869, E-mail: sara514@catholic.aakr

Received 18 May 2007 Accepted 21 September 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Based on the questionnaires for dry eyes in 2006, we have investigated the current status and new trends in the recognition and management of the dry eye.

Methods

We ask the 15 questionnaires to 197 ophthalmologists. After reorganizing the data based on each questions, we compared the result with the most current studies in Korea and other countries as well. Then, we report the current trends in the diagnosis and treatment of dry eye.

Results

Dry eye patients account for take up about 20-30% of total outpatients and it is currently accepted etiology that dry eye inflammation is related to the function of the immune system. Patient's symptoms and slit lamp examination are important for diagnosis. An anti-inflammatory therapy is needed for patients with moderate to severe dry eye.

Conclusions

Increasingly, there are positive attitudes toward accepting that persistent dry eye is an inflammatory disease; therefore, there are increases in use of an anti-inflammatory agent for treatment.

Keywords: Dry eye, Dysfunctional tear syndrome, Lacrimal functional unit

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Figure 1.

A proportion of dry eye patients in outpatient clinics.

Red numbers mean the percentage of respondents.

Parenthesized red numbers mean the number of respondents.

Figure 2.

Most commonly used diagnostic tests for evaluating a patient with probable dry eye.

Red numbers mean the percentage of respondents.

Parenthesized red numbers mean the number of respondents.

Figure 3.

The gold diagnostic method for dry eye Red numbers mean the percentage of respondents.

Parenthesized red numbers mean the number of respondents.

Figure 4.

Most useful indicator of improvement in treatment of dry eye.

Red numbers mean the percentage of respondents.

Parenthesized red numbers mean the number of respondents.

Table 1.

Levels of severity of dry eye syndrome without lid margin disease according to symptoms and signs

Severity^*	Patient Profiles
Level 1	Mild to moderate symptoms and no signs
	Mild to moderate conjunctival staining
Level 2	Moderate to severe symptoms
	Tear film signs
	Mild corneal punctate staining
	Conjunctival staining
	Visual signs
Level 3	Severe symptoms
	Marked corneal punctate staining
	Central corneal staining
	Filamentary Keratitis
Level 4	Severe symptoms
	Severe corneal staining, erosions
	Conjunctival scarring

^* At least one sign and one symptom of each category should be present to qualify for the corresponding level assignment.

Table 2.

Percentage of selected managements of dry eye according to its severity level

Management	Level 1	Level 2	Level 3	Level 4
Environmental management	31.3%	17.5%	12.5%	9.3%
Preserved tear	35.9%	10.9%	4.0%	3.3%
Unpreserved tear	9.3%	19.1%	17.5%	13.5%
Gels & Ointments	3.5%	17.6%	15.4%	13.4%
Nutritional support (containing omega-3,6 fatty acids)	1.9%	1.9%	2.4%	2.6%
Lid hygiene	12.5%	11.0%	9.1%	7.8%
Anti-inflammatory agent	4.4%	13.6%	13.1%	10.8%
Secretagogues	0.4%	1.5%	4.0%	4.7%
Autologous serum		0.4%	3.9%	5.4%
Punctal plug	0.2%	4.9%	11.1%	12.1%
Topical vitamin A	0.4%	0.5%	0.3%	0.7%
Contact lens		0.5%	4.7%	6.3%
Antimetabolites		0.4%	1.7%	3.3%
Surgery (tarsorrhapy, Amniotic membrane transplantation)				5.9%
Others	0.2%	0.3%	0.3%	0.8%

Table 3.

Newly suggested treatment strategies of dry eye (N=50)

Treatment Modality	Percentage (Number of people)
Strong immunosuppresent eyedrop	32.8% (19)
New Secretagogues	25.9% (15)
Lipid supplement	8.6% (5)
Long acting artificial tear	8.6% (5)
Mucin layer stabilizer	6.9% (4)
Treatment of underlying disease	3.4% (2)

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