Abstract
Dry eye disease (DED) is a growing public health concern affecting quality of
life and visual function, with a significant socio-economic impact. It is
characterised by the loss of homoeostasis, resulting in tear film instability,
hyperosmolarity and inflammation of the ocular surface. If the innate immune
response is unable to cope with internal bodily or environmental adverse
conditions, the persistent, self-maintaining vicious circle of inflammation leads
to the chronic form of the disease. Treatment of DED should be aimed at the
restoration of the homoeostasis of the ocular surface system. A proper diagnostic
approach is fundamental to define the relevance and importance of each of the DED
main pathogenic factors, namely tear film instability, epithelial damage and
inflammation. Consideration also needs to be given concerning two other pathogenic
elements: lid margin changes and nerve damage. All the factors that maintain the
vicious circle of DED in the patient’s clinical presentation have to be considered
and possibly treated simultaneously. The treatment should be long-lasting and
personalised since it has to be adapted to the different clinical conditions
observed along the course of the disease. Since DED treatment is frequently unable
to provide fast and complete relief from symptoms, empathy with patients and
willingness to explain to them the natural history of the disease are mandatory to
improve patients’ compliance. Furthermore, patients should be instructed about the
possible need to increase the frequency and/or change the type of treatment
according to the fluctuation of symptoms, following a preplanned rescue
regimen.
Subject
Cellular and Molecular Neuroscience,Sensory Systems,Ophthalmology
Cited by
72 articles.
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