Keratoconjunctivitis sicca, also known as dry eye disease, is a condition that results in dryness of the conjunctiva and cornea due to decreased function of tear glands or rapid evaporation of tears.¹ The prevalence of dry eye disease is greater among women than among men and increases with age.² The symptoms of dry eye disease include a dry gritty feeling in the eyes that is often accompanied by burning, redness, and the sensation of a foreign object in the eye. If left untreated, dry eye disease can damage the delicate tissues of the surface of the eye that may lead to impaired vision.³

To develop current treatment recommendations for dry eye disease from consensus of expert advice. Of 25 preselected international specialists on dry eye, 17 agreed to participate in a modified, 2-round Delphi panel approach. Based on available literature and standards of care, a survey was presented to each panelist. A two-thirds majority was used for consensus building from responses obtained. Treatment algorithms were created. Treatment recommendations for different types and severity levels of dry eye disease were the main outcome. A new term for dry eye disease was proposed: dysfunctional tear syndrome (DTS). Treatment recommendations were based primarily on patient symptoms and signs. Available diagnostic tests were considered of secondary importance in guiding therapy. Development of algorithms was based on the presence or absence of lid margin disease and disturbances of tear distribution and clearance. Disease severity was considered the most important factor for treatment decision-making and was categorized into 4 levels. Severity was assessed on the basis of tear substitute requirements, symptoms of ocular discomfort, and visual disturbance. Clinical signs present in lids, tear film, conjunctiva, and cornea were also used for categorization of severity. Consensus was reached on treatment algorithms for DTS with and without concurrent lid disease. Panelist opinion relied on symptoms and signs (not tests) for selection of treatment strategies. Therapy is chosen to match disease severity and presence versus absence of lid margin disease or tear distribution and clearance disturbances.