General Treatment Recommendations

Using a modified, 2-round, Delphi approach, 17 specialists from around the world collaborated to develop treatment recommendation for Dysfunctional Tear Syndrome (DTS), the term they proposed to replace Dry Eye Syndrome. The paper was published in 2006 in the journal Cornea.

The authors discovered that panelists “relied on symptoms and signs (not tests) for selection of treatment strategies.”

The Delphi Panel recommended several approaches to selecting treatments depending on co-morbidities, disease severity and response to previous treatment.

The first table describes first and second-line treatment strategies for DTS with abnormal tear distribution.

The next two tables describe treatment approaches for increasing severity of DTS, without lid margins disease, and with, and without, tear distribution problems.

Algorithm on treatment recommendations for DTS with abnormal tear distribution.

DTS abnormal tear distribution

Algorithm on treatment recommendations for DTS without lid margin disease according to severity.

DTS without Lid Margin Disease diagram

Treatment Recommendations for DTS (Dysfunctional Tear Syndrome aka Dry Eye Syndrome) on the Basis of Level of Severity for Patients without lid margin disease or tear distribution problems.

DTS Severity Treatment Recommendations
Level 1 No treatment
Preserved tears
Water intake
Use of hypoallergenic products
Environmental management
Psychological support
Allergy drops
Avoidance of drugs contributing to dry eye
Level 2 Unpreserved tears
Topical steroids
Topical cyclosporine A
Nutritional support (flaxseed/fatty acids)
Level 3 Tetracyclines
Punctal plugs
Level 4 Surgery
Punctal cautery
Systemic anti-inflammatory
Acetylcysteine therapy
Contact lenses
Oral cyclosporine
Moisture goggles


Dysfunctional tear syndrome: a Delphi approach to treatment recommendations
Behrens A, et al.
2006 Sep;25(8):900-7.
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