title: The correct diagnosis and therapeutic management of tear dysfunction: recommendations of the P.I.C.A.S.S.O. board.
abstract: OBJECTIVE
  To describe a standard approach to manage tear dysfunction (TD), in order to obtain a clinically favourable outcome. TD is a highly prevalent, yet largely underdiagnosed, condition that affects from 5 to 30% of the population above 50 years old. Left untreated, TD is associated with eye discomfort and ocular surface disease, substantially affecting quality of life. Although the prevalence of this problem is increasing significantly, a standard approach to its prevention and treatment is not available yet.
  
  
  METHODS
  In September 2015, a team of Ocular Surface Italian Experts convened for a roundtable to discuss on the latest knowledge about diagnosis and treatments for TD and the real issues in the management of these patients. The discussion centred on the appropriate definition of TD, proposing a new classification of risk factors and how to identify them, how to make a correct diagnosis choosing the rational therapy (questionnaires, symptoms' time relation, seasonality, low tech diagnostic manoeuvres, specific tests for the detection of tear film disturbances leading to recognition of the level of disease and of the ocular system elements involved), which artificial tear matches the ideal profile for a rational therapy and which questions should be done to the patient.
  
  
  RESULTS
  A multi-item flowchart for tear film dysfunction, with point-by-point explanatory guide, to better identify and manage the patient with this disorder is provided.
  
  
  CONCLUSIONS
  The growing prevalence of TD demands increased attention. An appropriate prevention and a treatment pattern for the patient, combined with greater patient-practitioner interaction, and patient education is offered.
authors.affiliation: IsPre Oftalmica, Ocular Surface Center, Genoa, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rolando
authors.affiliation: Israelitic Hospital, Rome, Italy.
authors.forename: Emilia
authors.initials: E
authors.lastname: Cantera
authors.affiliation: Eye Clinic, University of Firenze, Florence, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Mencucci
authors.affiliation: Eye Clinic, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
authors.forename: Pierangela
authors.initials: P
authors.lastname: Rubino
authors.affiliation: Eye Clinic, Department of Biomedical Sciences, University of Messina, Messina, Italy. paragona@unime.it.
authors.forename: Pasquale
authors.identifier: http://orcid.org/0000-0002-9582-9799
authors.initials: P
authors.lastname: Aragona
mesh_terms: D003142:Communication; D015352:Dry Eye Syndromes / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D005141:Eyelid Diseases / Q000175:diagnosis; D006801:Humans; D007765:Lacrimal Apparatus / Q000502:physiology; D008537:Meibomian Glands / Q000502:physiology; D010817:Physician-Patient Relations; D011788:Quality of Life; D013666:Tears / Q000502:physiology*
keywords: Diagnosis; Ocular surface; Tear dysfunction; Treatment