Advances in procedural management of dry eye disease.

PURPOSE OF REVIEW: The purpose of this article is to provide a summary of in-office procedures available for dry eye treatment. Dry eye is a multifactorial condition of the ocular surface with increasing prevalence among patients. There have been advances in nonpharmacological treatment options for patients in recent years. Most of these new treatments are geared towards evaporative dry eye due to meibomian gland deficiency.

RECENT FINDINGS: Standard treatment of dry eye usually starts with topical treatments, such as artificial tears and inflammation modulators. However, options have now broadened to in-office procedural treatments. Most devices and procedures available for dry eye syndrome focus on the health of the lid structures involved in tear secretion, specifically the meibomian glands. There are fewer procedural options that address aqueous deficiency dry eye cases. The recent recall in over-the-counter eye drops may have caused patients to research nonpharmacological alternatives.

SUMMARY: There are now numerous nonpharmacological options for dry eye therapy. A range of thermal devices are used for the purpose of assisting in meibomian gland expression. Intense pulsed light (IPL) is also a popular therapy option. In addition to thermal properties to melt the meibum, it also has the benefit of an anti-inflammatory effect. Radiofrequency can be used in combination with IPL. Meibomian gland probing is an option as a rejuvenator for improving meibomian gland function. Treating aqueous deficiency dry eye still favors topical treatments, but the surgical procedure of salivary gland transplantation is occasionally used.