Date of last review: Due to be updated

Differential diagnosis

  • Blepharitis
  • Exposure keratopathy
  • Neurotrophic keratopathy
  • Sjogren’s syndrome
  • Drugs
  • Ocular cicatricial pemphigoid
  • Refractive laser surgery
  • Vitamin A deficiency

Possible management by Optometrist

Treatment

  • Treat underlying blepharitis or rosacea or seborrhoeic dermatitis, if present
  • Mild to Moderate Symptoms
    • Artificial Tears
      • Hypromellose 0.3% at 30 minute intervals until symptoms improve, then less frequently
        • Switch to preservative free alternative if:
          • Used > 6 times a day
          • Soft contact lenses wearers
          • Epithelial toxicity from preservatives
          • Allergic conjunctivitis from preservatives
        • Or Carbomer 0.2% gel four times a day
      • Severe Symptoms
        • Preservative Free Artificial Tears
          • Preservative free Hypromellose 0.3% at 30 minute intervals until symptoms improve, then 3-4 x daily
          • Or Sodium hyaluronate 0.2% at 30 minute intervals until symptoms improve, then 3-4 x daily
        • Unmedicated ointment at bedtime
        • Punctal plugs
      • Symptomatic mucus strands or plaques
        • PoM Acetyl cysteine 5% one drop 4 x daily
          • Drops sting briefly

Advice

  • Majority of cases idiopathic or related to blepharitis
  • A few have Sjogren’s syndrome (dry eye, dry mouth, dry vagina) which may be primary or secondary
  • Avoid aggravating factors
    • Smoke
    • Wind
    • Heat (central heating)
    • Inadvertent staring
      • Computer use
      • Reading
      • Watching television
    • Encourage patients to discuss with GP whether any medication may be contributing and whether there are any appropriate alternatives

Management Category

  • Normally no referral
  • Refer new cases of suspected Sjogren’s to GP for assessment and onward referral as appropriate
    • Encourage patients to attend dentist regularly as dry mouth increases risk of severe cases

Possible management by Ophthalmologist

  • As above
  • Topical steroid
  • Topical ciclosporin
  • Topical autologous serum
  • Punctal plugs
  • Punctal occlusion