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The Diagnosis and Management of Dry Eye: A Twenty-five–Year Review

Pflugfelder, Stephen C. M.D.; Solomon, Abraham M.D.; Stern, Michael E. Ph.D.


Purpose. To review the advances in the diagnosis, pathogenesis, and management of dry eye disease in the past 25 years.

Methods. Literature review.

Results. The preocular tear film is a hydrated mucus gel that contains soluble antimicrobial proteins and growth factors that protect and support the ocular surface. The final common pathway in dry eye is a perturbation of the integrated ocular surface/lacrimal gland reflex unit. Diagnostic tests evaluating tear composition and clearance appear to show stronger correlation with the severity of ocular irritation symptoms and keratoconjunctivitis sicca (KCS) than the conventional Schirmer tests. KCS is a condition of abnormal differentiation and mucus production by the ocular surface epithelium that results in a poorly lubricated, abnormally permeable ocular surface that has increased susceptibility to environmental insults. Chronic subclinical ocular surface inflammation appears to play a key role in the pathogenesis of KCS. New therapeutic strategies are aimed at reducing the ocular surface inflammation of dry eye disease.

Conclusions. There has been a tremendous increase in knowledge regarding dry eye disease in the past 25 years that has resulted in improved diagnostic classification and new targeted therapies.

From the Ocular Surface and Tear Center (S.C.P., A.S.), Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami School of Medicine, Miami, Florida; and Allergan, Inc. (M.E.S.), Irvine, California, U.S.A.

Submitted February 8, 2000.

Revision received May 22, 2000.

Accepted May 30, 2000.

Supported in part by Public Health Service Research Grant EY11915, Department of Health and Human Services, National Eye Institute, Bethesda Maryland, an unrestricted grant from Research to Prevent Blindness and the Drs. David and Maureen Smith Ocular Surface and Tear Research Fund.

Address correspondence and reprint requests to Dr. Stephen C. Pflugfelder, Bascom Palmer Eye Institute, 900 N.W. 17th Street, Miami, FL 33136, U.S.A. E-mail:

© 2000 Lippincott Williams & Wilkins, Inc.