Skip to main content
  • AAO PPP Cornea/External Disease Committee, Hoskins Center for Quality Eye Care
    Cornea/External Disease
    By the American Academy of Ophthalmology Preferred Practice Pattern Cornea/External Disease Committee: Guillermo Amescua, MD,1 Sumayya Ahmad, MD, Methodologist,2 Albert Y. Cheung, MD,3 Daniel S. Choi, MD,4 Vishal Jhanji, MD, FRCS, FRCOphth,5 Amy Lin, MD,6 Shahzad I. Mian, MD,7 Michelle K. Rhee, MD,8 Elizabeth T. Viriya, MD,9 Francis S. Mah, MD, Co-Chair,10 Divya M. Varu, MD, Co-Chair11

    As of November 2015, the PPPs are initially published in the Ophthalmology journal and may be freely downloaded in their entirety by all visitors. Open the PDF for this entire PPP or click here to access the PPP on the journal's site. Click here to access the journal's PPP collection page.

    1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
    2Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
    3Virginia Eye Consultants, Norfolk Virginia, Assistant Professor, Department of Ophthalmology, Eastern Virginia Medical School
    4Cataract and Vision Center of Hawaii, Honolulu, Hawaii
    5Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
    6John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
    7Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
    8Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital, Mount Sinai Services, Elmhurst, New York
    9Department of Ophthalmology, Lincoln Hospital/NYC Health+ Hospitals, Bronx, New York
    10Departments of Cornea and External Diseases, Scripps Clinic Torrey Pines, La Jolla California
    11Dell Laser Consultants, Austin, Texas

    Highlighted Findings and Recommendations for Care

    Dry eye syndrome is a common ocular condition that has a substantial impact on the quality of life of afflicted individuals owing to discomfort and visual disability. Dry eye may compromise results of cataract, corneal, and keratorefractive surgery.

    Clinical examination is the gold standard for diagnosing dry eye syndrome (also known as dry eye disease or keratoconjunctivitis sicca). No single test is adequate for establishing the diagnosis of dry eye syndrome. The constellation of findings from multiple tests can add to the clinician's understanding of the patient's condition.

    Pharmacological and procedural treatments are associated with improvements in patient symptoms and clinical signs; although these are rarely curative, long-term treatment is typically necessary.

    US. Food and Drug Administration (FDA)-approved treatments for dry eye syndrome include topical loteprednol 0.25%, lifitegrast 0.5%, cyclosporine 0.05% and 0.09%, varenicline nasal spray, and perflurohexyloctane ophthalmic solution. They may lead to improvements of patient symptoms and/or signs but non has been proven more effective than the other in head-to-head trials. No direct comparison in a prospective clinical trial is available in the literature.

    Patients with dry eye syndrome considering keratorefractive and lens-based surgery should be cautioned that the dry eye symptoms could become worse after surgery. If pre-existing factors contributing to dry eye syndrome can be improved preoperatively, the chance of worsened dry eye syndrome can be reduced. Dry eye symptoms are common in the first few months after keratorefractive and lens-based surgery and often subside with time.

    Dry eye syndrome is one of the main reasons for patient dissatisfaction following intraocular refractive and/or cataract surgery. Dry eye symptoms that continue beyond the normal postoperative period of 3 months are seen in about one third of individuals. Baseline ocular surface and tear film parameters predict the patients at risk. Therefore, all patients undergoing lens-based surgery should be evaluated and managed for dry eye preoperatively and postoperatively.

    Approximately 10% of patients with clinically aqueous tear deficiency dry eye have underlying Sjӧgren’s syndrome. A meta-analysis found that, among autoimmune diseases, primary Sjӧgren’s syndrome is the most strongly associated with lymphoid proliferative malignancy.

    Literature Search

    Dry Eye Syndrome PPP - 2023 - Literature Search