title: Flow chart on surgical approaches to dry eye.
abstract: BACKGROUND
  Based on the type and severity of dry eye, we propose a structured approach to the surgical management of the disease.
  
  
  METHODS
  The guidelines for assessing the form and grade of dry eye as recently suggested by the 'Dry Eye Workshop (DEWS)'. Flow chart on the surgical and medical management are presented.
  
  
  CONCLUSIONS
  Surgery should only be considered if any significant inflammation and concomitant adnexal disease has been controlled and medical management remains insufficient to control signs and symptoms of dry eye. The presence of signs of surface disease is considered mandatory. Although infrequent pre-existing occlusion of the lacrimal drainage system should be excluded, since this can also induce surface disease. The suggested sequence of treatment options makes use of less invasive procedures first while at the same time maximising efficacy and practicality. Often several measures have to be applied simultaneously to prevent loss of vision. Visual rehabilitation should only be attempted (e.g. by means of stem cell transplantation, keratoplasty). Once all concomittant factors have been addressed and measures to substitute the tear have been applied. In persisting aqueous deficiency osteoodontokeratoprosthesis remains the final option to improve visual function.
authors.affiliation: Department of Ophthalmology, University of Würzburg, Würzburg, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Geerling
authors.forename: Horst
authors.initials: H
authors.lastname: Brewitt
mesh_terms: D015352:Dry Eye Syndromes / Q000601:surgery*; D006801:Humans; D013508:Ophthalmologic Surgical Procedures; D017410:Practice Guidelines as Topic