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Management of inflammation in dry eye disease: Recommendations from a European panel of experts

Messmer, EM; Ahmad, S; Benitez del Castillo, JM; Mrukwa-Kominek, E; Rolando, M; Vitovska, O; Baudouin, C; (2023) Management of inflammation in dry eye disease: Recommendations from a European panel of experts. European Journal of Ophthalmology , 33 (3) pp. 1294-1307. 10.1177/11206721221141481. Green open access

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Abstract

Introduction: Early initiation of anti-inflammatory therapies is recommended for dry eye disease (DED) to break the vicious cycle of pathophysiology. However, there is limited guidance on how to implement topical ciclosporin (CsA) and corticosteroid treatment into clinical practice. This expert-led consensus provides practical guidance on the management of DED, including when and how to use topical CsA. Methods: A steering committee (SC) of seven European DED experts developed a questionnaire to gain information on the unmet needs and management of DED in clinical practice. Consensus statements on four key areas (disease severity and progression; patient management; efficacy, safety and tolerability of CsA; and patient education) were generated based on the responses. The SC and an expanded expert panel of 22 members used a nine-point scale (1 = strongly disagree; 9 = strongly agree) to rate statements; a consensus was reached if ≥75% of experts scored a statement ≥7. Results: A stepwise approach to DED management is required in patients presenting with moderate corneal staining. Early topical CsA initiation, alone or with corticosteroids, should be considered in patients with clinical risk factors for severe DED. Patient education is required before and during treatment to manage expectations regarding efficacy and tolerability in order to optimise adherence. Follow-up visits are required, ideally at Month 1 and every 3 months thereafter. Topical CsA may be continued indefinitely, especially when surgery is required. Conclusion: This consensus fills some of the knowledge gaps in previous recommendations regarding the use of topical corticosteroids and CsA in patients with DED.

Type: Article
Title: Management of inflammation in dry eye disease: Recommendations from a European panel of experts
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1177/11206721221141481
Publisher version: https://doi.org/10.1177/11206721221141481
Language: English
Additional information: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
Keywords: Dry eye disease, ciclosporin, consensus, corticosteroids, disease management, inflammation, patient education, Humans, Ophthalmic Solutions, Cyclosporine, Dry Eye Syndromes, Inflammation, Risk Factors, Tears
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology
URI: https://discovery.ucl.ac.uk/id/eprint/10179009
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