Dry eye disease management: the pharmacist as first-line health professional

Abstract

Dry eye disease is a disorder of the ocular surface, characterised by tear film instability, hyperosmolarity, inflammation, and neurosensory abnormalities. It is caused by multiple intrinsic and extrinsic factors that disrupt tear film stability and ocular surface homeostasis, from medication, environmental factors and use of contact lenses. Dry eye disease is diagnosed with the presence of symptoms as well as objective diagnostic tests. Patients commonly report dryness, burning, stinging, grittiness, and fluctuating or blurred vision. Treatment focuses on improving tear film stability and relieving symptoms. Eye drop formulations known as artificial tears are the mainstay treatment, which work by reducing inflammation and improving lubrication. The length of therapy varies and is dependent on the severity of symptoms, with acute symptoms treated for 3–14 days and chronic symptoms often for 1 month or more. Alternative therapies like topical corticosteroids, nonsteroidal anti-inflammatory or vitamin A drops are indicated for more severe or chronic symptoms. Furthermore, medical device or surgical intervention may be considered. With most of the first-line treatment available as over-the-counter products, pharmacists are often the first point of contact when seeking healthcare, and pharmacists must be able to differentiate between dry eye disease and other ophthalmic conditions and know when to refer for further specialist follow up.