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Early detection and aggressive treatment of dry eye syndrome (DES), or keratoconjunctivitis sicca (KCS),
may help prevent corneal ulcers and scarring. The frequency of follow-up care depends on the severity of
the signs and symptoms.
Although supplemental lubrication is the mainstay of treatment for mild and moderate aqueous-deficient
DES, any concomitant lid disease must also be treated. The use of topical cyclosporine has been shown to
enhance the production of the aqueous component of the tear layer, as well as increase goblet cell density.
The use of oral omega-3 fatty acids has beneficial anti-inflammatory properties that aid in the production of
tears.
Other forms of treatment include the use of plugs that block the puncta (the hole that drains the tears on
the lid). Temporary punctal occlusion may be accomplished with collagen (dissolvable) or silicone
(permanent) plugs; if these are ineffective, electrocauterization of the puncta may be performed. In some
cases, other surgical options may be considered.
Environment-related issues that may exacerbate the DES should be discussed; alternatives may be
needed.
Treatment of very severe DES or DES associated with a connective tissue disorder (CTD), including
Sjgren syndrome (SS), should be coordinated with an internist or a rheumatologist.
Agents that have been used to treat DES include the following:
Absorbable plugs These plugs are made of collagen or polymers and either
dissolve by themselves or may be removed by saline irrigation; occlusion duration ranges
from 7 to 180 days
Hydrogel plugs (eg Oasis Form Fit; Sigma Pharmaceuticals, Monticello, IA)
A study by Mataftsi et al found that punctal plugs offer an effective and safe treatment for
children with persistent symptoms and should be considered.[21]
If mucous strands or filaments are present, they should be removed with forceps, and 10%
acetylcysteine should be administered 4 times a day. In general, surgical treatment of DES is
reserved for very severe cases in which ulceration or impending perforation of the sterile
corneal ulcer occurs.
Surgical options include the following: