The diagnosis and management of dry eye - A twenty-five-year review

To review the advances in the diagnosis, pathogenesis, and management of dr y eye disease in the past 25 years. Methods. Literature review. Results. Th e preocular tear film is a hydrated mucus gel that contains soluble antimic robial proteins and growth factors that protect and support the ocular surf ace. The final common pathway in dry eye is a perturbation of the integrate d ocular surface/lacrimal gland reflex unit. Diagnostic tests evaluating te ar composition and clearance appear to show stronger correlation with the s everity of ocular irritation symptoms and keratoconjunctivitis sicca (KCS) than the conventional Schirmer tests. KCS is a condition of abnormal differ entiation and mucus production by the ocular surface epithelium that result s in a poorly lubricated, abnormally permeable ocular surface that has incr eased susceptibility to environmental insults. Chronic subclinical ocular s urface inflammation appears to play a key role in the pathogenesis of KCS. New therapeutic strategies are aimed at reducing the ocular surface inflamm ation of dry eye disease. Conclusions, There has been a tremendous increase in knowledge regarding dry eye disease in the past 25 years that has resul ted in improved diagnostic classification and new targeted therapies.