Dysfunctional tear syndrome: a Delphi approach to treatment recommendations.
OBJECTIVE
To develop current treatment recommendations for dry eye disease from consensus of expert advice.


METHODS
Of 25 preselected international specialists on dry eye, 17 agreed to participate in a modified, 2-round Delphi panel approach. Based on available literature and standards of care, a survey was presented to each panelist. A two-thirds majority was used for consensus building from responses obtained. Treatment algorithms were created. Treatment recommendations for different types and severity levels of dry eye disease were the main outcome.


RESULTS
A new term for dry eye disease was proposed: dysfunctional tear syndrome (DTS). Treatment recommendations were based primarily on patient symptoms and signs. Available diagnostic tests were considered of secondary importance in guiding therapy. Development of algorithms was based on the presence or absence of lid margin disease and disturbances of tear distribution and clearance. Disease severity was considered the most important factor for treatment decision-making and was categorized into 4 levels. Severity was assessed on the basis of tear substitute requirements, symptoms of ocular discomfort, and visual disturbance. Clinical signs present in lids, tear film, conjunctiva, and cornea were also used for categorization of severity. Consensus was reached on treatment algorithms for DTS with and without concurrent lid disease.


CONCLUSIONS
Panelist opinion relied on symptoms and signs (not tests) for selection of treatment strategies. Therapy is chosen to match disease severity and presence versus absence of lid margin disease or tear distribution and clearance disturbances.
Behrens
Ashley
A
Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287-9278, USA. abehrens@jhmi.edu
Doyle
John J
JJ
Stern
Lee
L
Chuck
Roy S
RS
McDonnell
Peter J
PJ
Azar
Dimitri T
DT
Dua
Harminder S
HS
Hom
Milton
M
Karpecki
Paul M
PM
Laibson
Peter R
PR
Lemp
Michael A
MA
Meisler
David M
DM
Del Castillo
Juan Murube
JM
O'Brien
Terrence P
TP
Pflugfelder
Stephen C
SC
Rolando
Maurizio
M
Schein
Oliver D
OD
Seitz
Berthold
B
Tseng
Scheffer C
SC
van Setten
Gysbert
G
Wilson
Steven E
SE
Yiu
Samuel C
SC
D000465:Algorithms; D003697:Delphi Technique; D003941:Diagnostic Techniques, Ophthalmological; D015352:Dry Eye Syndromes / Q000145:classification / Q000175:diagnosis / Q000378:metabolism / Q000628:therapy*; D006801:Humans; D017410:Practice Guidelines as Topic; D013666:Tears / Q000378:metabolism*; D009626:Terminology as Topic