title: The triple classification of dry eye for practical clinical use.
abstract: OBJECTIVE
  "Dry Eye is a condition produced by the inadequate interrelation between lacrimal film and ocular surface epithelium, and is caused by quantitative and qualitative deficits in one or both of them. It can be produced by one or combined etiologic causes, affecting one or several of the secretions of the glands serving the ocular surface, and producing secondary manifestations of different grades of severity". Clinicians need a practical classification to face diagnosis, prognosis and treatment. Dry eyes have many etiologies and pathogenesis, different affectation of the various dacryoglands and ocular surface epithelium, and diverse grades of severity. The specialists in xero-dacryology must know these three parameters to evaluate any case of dry eye, and to establish an adequate treatment.
  
  
  METHODS
  To facilitate this, an open session in the 8th congress of the International Society of Dacryology and Dry Eye (Madrid, April, 2005) proposed modifying the Triple Classification of dry eye approved in the XIV congress of the European Society of Ophthalmology (Madrid, June, 2003). There was consensus of all conclusions.
  
  
  CONCLUSIONS
  The following classification has been established: First, a classification of the etio-pathogenesis, distributed in ten groups: age-related, hormonal, pharmacologic, immunopathic, hyponutritional, dysgenic, infectious/inflammatory, traumatic, neurologic and tantalic. Second, a classification of the affected glands and tissues, which under the acronym of ALMEN includes the Aqueo-serousdeficient, Lipodeficient, Mucindeficient and Epitheliopatic dry eyes, and the Non dacryological affected exocrine glands (saliva, nasal secretion, tracheo-pharyngeal secretion, etc). And thirdly, a classification of severity, in three grades: Grade 1 or mild (symptoms without slitlamp signs), grade 2 or moderate (symptoms with reversible signs), and grade 3 or severe (symptoms with permanent signs).
authors.affiliation: Department of Ophthalmology, University of Alcala, Madrid - Spain.
authors.forename: J
authors.initials: J
authors.lastname: Murube Spain
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authors.lastname: Nemeth Hungary
authors.forename: H
authors.initials: H
authors.lastname: Hoh Germany
authors.forename: P
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authors.lastname: Kaynak-Hekimhan Turkey
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authors.lastname: Horwarth-Winthers
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authors.lastname: Agarwal India
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authors.lastname: Baudouin France
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authors.initials: JM
authors.lastname: Benitez Del Castillo
authors.forename: S
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authors.lastname: Cervenka Czech Republic
authors.forename: L
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authors.lastname: ChenZhuo China
authors.forename: A
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authors.lastname: Ducasse France
authors.forename: J
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authors.lastname: Duran Spain
authors.forename: F
authors.initials: F
authors.lastname: Holly Usa
authors.forename: R
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authors.lastname: Javate Philippines
authors.forename: J
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authors.lastname: Nepp Austria
authors.forename: F
authors.initials: F
authors.lastname: Paulsen Germany
authors.forename: A
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authors.lastname: Rahimi Iran
authors.forename: P
authors.initials: P
authors.lastname: Raus Belgium
authors.forename: O
authors.initials: O
authors.lastname: Shalaby Egypt
authors.forename: P
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authors.lastname: Sieg Germany
authors.forename: H
authors.initials: H
authors.lastname: Soriano Argentina
authors.forename: D
authors.initials: D
authors.lastname: Spinelli Italy
authors.forename: S H
authors.initials: SH
authors.lastname: Ugurbas Turkey
authors.forename: G
authors.initials: G
authors.lastname: van Setten Sweden