Dry eye diagnosis and management in 2004

Purpose of review To document the changes in treatment paradigm for the management of dry eye. Restasis is 0.05% cyclosporine A and is the first immunomodulatory agent approved for treatment of dry eye. Recent findings Mounting evidence supports the inflammatory mechanism as explanation for the occurrence of dry eye disease. Immunomodulation has been shown to be effective in treating patients with moderate to severe dry eye disease caused by keratoconjunctivitis sicca. This addresses one of the two main forms of dry eye. There is a new report that immunomodulation using topical 0.05% cyclosporine A (Restasis) may also have a positive effect on meibomian gland dysfunction, the other main form of dry eye. Summary Dry eye disease is defined as an abnormality of tear film resulting in changes in the ocular surface. These changes may be seen on ocular examination with the use of fluorescein and supravital staining techniques. Classification of dry eye disease shows two main types: aqueous deficiency and evaporative loss. There is hope that both of these types of dry eye will respond to immunomodulation therapy. Restasis shows promise as the first of these agents to be approved as therapy to treat moderate to severe dry eye disease.