Journal ArticleDOI
TFOS DEWS II pathophysiology report
Anthony J. Bron,Anthony J. Bron,Cintia S. de Paiva,Sunil K. Chauhan,Stefano Bonini,Eric E. Gabison,Sandeep Jain,Erich Knop,Maria Markoulli,Yoko Ogawa,Victor L. Perez,Yuichi Uchino,Norihiko Yokoi,Driss Zoukhri,David A. Sullivan +14 more
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TLDR
The TFOS DEWS II Pathophysiology Subcommittee reviewed the mechanisms involved in the initiation and perpetuation of dry eye disease, finding the targeting of the terminal duct in meibomian gland disease and the influence of gaze dynamics and the closed eye state on tear stability and ocular surface inflammation to be important.Abstract:
The TFOS DEWS II Pathophysiology Subcommittee reviewed the mechanisms involved in the initiation and perpetuation of dry eye disease. Its central mechanism is evaporative water loss leading to hyperosmolar tissue damage. Research in human disease and in animal models has shown that this, either directly or by inducing inflammation, causes a loss of both epithelial and goblet cells. The consequent decrease in surface wettability leads to early tear film breakup and amplifies hyperosmolarity via a Vicious Circle. Pain in dry eye is caused by tear hyperosmolarity, loss of lubrication, inflammatory mediators and neurosensory factors, while visual symptoms arise from tear and ocular surface irregularity. Increased friction targets damage to the lids and ocular surface, resulting in characteristic punctate epithelial keratitis, superior limbic keratoconjunctivitis, filamentary keratitis, lid parallel conjunctival folds, and lid wiper epitheliopathy. Hybrid dry eye disease, with features of both aqueous deficiency and increased evaporation, is common and efforts should be made to determine the relative contribution of each form to the total picture. To this end, practical methods are needed to measure tear evaporation in the clinic, and similarly, methods are needed to measure osmolarity at the tissue level across the ocular surface, to better determine the severity of dry eye. Areas for future research include the role of genetic mechanisms in non-Sjogren syndrome dry eye, the targeting of the terminal duct in meibomian gland disease and the influence of gaze dynamics and the closed eye state on tear stability and ocular surface inflammation.read more
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TFOS DEWS II Definition and Classification Report
Jennifer P. Craig,Kelly K. Nichols,Esen K. Akpek,Barbara Caffery,Harminder S Dua,Choun Ki Joo,Zuguo Liu,J. Daniel Nelson,J. Daniel Nelson,Jason J. Nichols,Kazuo Tsubota,Fiona Stapleton +11 more
TL;DR: The new definition recognizes the multifactorial nature of dry eye as a disease where loss of homeostasis of the tear film is the central pathophysiological concept and central to the scheme is a positive diagnosis of DED with signs and symptoms, and this is directed towards management to restore homeostosis.
Journal ArticleDOI
TFOS DEWS II Diagnostic Methodology report
James S. Wolffsohn,Reiko Arita,Robin L. Chalmers,Ali R. Djalilian,Murat Dogru,Kathy Dumbleton,Preeya K. Gupta,Paul M. Karpecki,Sihem Lazreg,Heiko Pult,Benjamin Sullivan,Alan Tomlinson,Louis Tong,Edoardo Villani,Kyung Chul Yoon,Lyndon Jones,Jennifer P. Craig +16 more
TL;DR: The role of the Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) II Diagnostic Methodology Subcommittee was to identify tests used to diagnose and monitor dry eye disease (DED) to identify those most appropriate to fulfil the definition of DED and its sub-classifications.
Journal ArticleDOI
TFOS DEWS II Management and Therapy Report
Lyndon Jones,Laura E Downie,Donald R. Korb,Jose M. Benitez-del-Castillo,Reza Dana,Sophie X. Deng,Pham N. Dong,Gerd Geerling,Richard Y Hida,Yang Liu,Kyoung Yul Seo,Joseph Tauber,Tais Hitomi Wakamatsu,Jianjiang Xu,James S. Wolffsohn,Jennifer P. Craig +15 more
TL;DR: It became clear that many of the treatments available for the management of dry eye disease lack the necessary Level 1 evidence to support their recommendation, often due to a lack of appropriate masking, randomization or controls and in some cases due to issues with selection bias or inadequate sample size.
Journal ArticleDOI
TFOS DEWS II Tear Film Report
Mark D. P. Willcox,Pablo Argüeso,Georgi As. Georgiev,Juha M. Holopainen,Gordon W. Laurie,Tom J. Millar,Eric B. Papas,Jannick P. Rolland,Tannin A. Schmidt,Ulrike Stahl,Tatiana Suarez,Lakshman N. Subbaraman,Ömür Ö. Uçakhan,Lyndon Jones +13 more
TL;DR: The members of the Tear Film Subcommittee reviewed the role of the tear film in dry eye disease (DED), biophysical and biochemical aspects of tears and how these change in DED and recommended areas for future research.
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