Redesigning the Management and Treatment Algorithm For Dry Eye Clinicians

Student thesis: Doctoral ThesisDoctor of Philosophy


Dry eye disease multifactorial aetiologies and complexity makes a single treatment not functional enough to manage different subtypes. Instead, a tailored-managed-therapy plan is needed to lead to an effective treatment of signs and symptoms.
An organisation tool to manage dry eye disease was created in 2017 by Tear Film & Ocular Surface Society Dry Eye WorkShop II, yet no differentiation between disease subtype (evaporative dry eye or aqueous dry eye) or severity, was made as a cause of lack of level 1 studies.
This thesis sought to compile a series of experimental studies to provide; Additional scientific evidence of management strategies (Chapter 1:), by the means of; identifying therapeutic effects from all different treatment stages (Chapter 2:), assessing if further modifications of this guideline are needed (Chapter 3:) and to disseminate the current prescribing patterns of therapies across the globe (Chapter 4:).
Accordingly, this thesis has found that:
• Dry eye is being managed worldwide similarly to TFOS DEWS II recommendations, with exception of home-made facecloths.
Products prescribed for evaporative dry eye and aqueous dry eye are different.
North American and Asia/Middle Eastern regions tend to use a more pharmacological approach at lower levels of dry eye disease severity.
• Between liposomal drops, liposomal sprays and emulsion-drops, the decrease in symptomatology was similar, no statistically significant changes happened to homeostatic markers during a 2-week treatment.
• Only lipid-based artificial tear provides relief for patients with the evaporative subtype of dry eye, and both lipid-based and a non-lipid based artificial tears, show a 1-month symptomatology decrease for both dry eye subtypes, with signs taking 3-4 months to show a statistically significant improvement.
• The use of an automatic massaging-mask provides improvement in symptomatology (subjectively improving severity) after 2 weeks of mask-treatment twice a day.
• Eyelid warming therapy, improves Meibomian gland expression quality, regardless of its dropout extent. Debridement helps removing orifice obstruction in patients with Meibomian gland dropout, yet forcible expression provides nonadditional benefit on partial MGs.
Date of AwardSept 2021
Original languageEnglish
SupervisorJames Wolffsohn (Supervisor), Gurpreet Bhogal-Bhamra (Supervisor) & Jennifer Craig (Supervisor)


  • dry eye disease
  • algorithm
  • management
  • therapy
  • treatment
  • artificial tears
  • eye mask
  • meibomian gland dysfunction
  • cardiovascular health
  • eye care practitioners

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