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

European Journal of Ophthalmology · 7 authors, 7 centres

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TL;DR

This study used a consensus methodology with a steering committee and an expert panel of 29 ophthalmologists from 15 European countries.

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This study used a consensus methodology with a steering committee and an expert panel of 29 ophthalmologists from 15 European countries. A questionnaire identified clinical practice gaps, and 18 recommendation statements were developed covering disease severity, patient management, ciclosporin efficacy/safety, and patient education. Consensus was reached (≥75% of experts scoring ≥7 on a 9-point scale) on all statements in one voting round. Follow-up visits at Month 1 and every 3 months were advised, and indefinite ciclosporin use was supported, especially before surgery. Limitations include the European-centric panel and lack of demographic details.

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guidelines

SPECIALTY

ophthalmology

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ORIGINAL PAPER

PMC10152565

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

European Journal of Ophthalmology

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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.

CITATION EXPORT

Elisabeth M Messmer, Sajjad Ahmad, José M Benitez del Castillo et al.. Management of inflammation in dry eye disease: Recommendations from a European panel of experts. European Journal of Ophthalmology. (2022). https://doi.org/10.1177/11206721221141481

AUTHORS

7 · 7 CENTRES

Elisabeth M Messmer, Sajjad Ahmad, José M Benitez del Castillo, Ewa Mrukwa-Kominek, Maurizio Rolando, Oksana Vitovska, Christophe Baudouin

1Department of Ophthalmology, Ludwig Maximilian University, Munich, Germany
24960Moorfields Eye Hospital NHS Foundation Trust, London, UK
3Hospital Clínico San Carlos, Complutense University of Madrid, Clínica Rementería, Madrid, Spain
4Department of Ophthalmology, 49613Medical University of Silesia, Katowice, Poland
5Department of Ophthalmology, 9302University of Genoa, Genoa, Italy
6National Medical University ‘O.O. Bogomolec’, Kiev, Ukraine
7Department of Ophthalmology, Quinze-Vingts National Ophthalmology Hospital and Vision Institute, Paris, France