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Curr Opin Ophthalmol. 2017 Jan;27 Suppl 1:3-47. doi: 10.1097/

Dysfunctional tear syndrome: dry eye disease and associated tear film disorders - new strategies for diagnosis and treatment.

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aYale University School of Medicine, New Haven bThe Eye Center of Southern Connecticut, Hamden, Connecticut cOhio State University, Columbus dComprehensive Eye Care of Central Ohio, Westerville, Ohio eHofstra Northwell School of Medicine, Hempstead fSouth Shore Eye Care, Wantagh, New York gFlorida Vision Institute, Jupiter hBascom Palmer Eye Institute, Florida International University, and Center for Excellence in Eye Care, Miami, Florida iVance Thompson Vision, Sioux Falls, South Dakota jNortheastern Eye Institute, Scranton kCommonwealth Medical College, Scranton, Pennsylvania lOphthalmology Consultants, St. Louis, Missouri mJules Stein Eye Institute, Los Angeles nWolstan & Goldberg Eye Associates, Torrance, California oPalm Beach Gardens, Florida pRush University Medical Center, Chicago qChicago Eye Specialists rUniversity of Chicago Hospitals, Chicago sJacksoneye, Lake Villa tMidwest Center for Sight, Des Plaines, Illinois uDuke Eye Center, Durham, North Carolina vChicago Cornea Consultants, Ltd, Hoffman Estates, Illinois wWashington University Department of Ophthalmology and Ophthalmology Associates, St. Louis, Missouri xNYU Langone Medical Center, New York, New York yTulane University School of Medicine, New Orleans, Louisiana zOphthalmic Consultants of Long Island, Lynbrook, New York aaThe Center for Ocular Surface Excellence of New Jersey, Woodland Park, New Jersey bbGeorgetown University Medical Center, George Washington University Medical Center, Washington, DC ccNew York Eye and Ear Infirmary of Mount Sinai and Eye Center of New York, New York, New York ddNVision EyeCenters of Newport Beach, Newport Beach, California eeUniversity of Maryland, Baltimore, Maryland ffAdvanced Vision Care, Century City, California ggKeck School of Medicine, University of Southern California, Los Angeles hhBowie Vision Institute, Bowie, Maryland iiUniversity of North Carolina and TLC Laser Eye Centers, Greensboro, North Carolina jjMercy Eye Specialists, Springfield, Missouri kkWake Forest University, Winston-Salem, North Carolina llStorm Eye Institute and Magill Vision Center, Medical University of South Carolina, Charleston mmClemson University, Mt. Pleasant, South Carolina nnUniversity of South Florida, Tampa ooThe Eye Institute of West Florida, Largo, Florida ppCleveland Eye Clinic, Clear Choice Custom LASIK Center, Brecksville, Ohio qqEastern Virginia Medical School and Virginia Eye Consultants, Norfolk, Virginia, USA *Mark S. Milner, Kenneth A. Beckman, and Jodi I. Luchs are co-chairs.


Dysfunctional tear syndrome (DTS) is a common and complex condition affecting the ocular surface. The health and normal functioning of the ocular surface is dependent on a stable and sufficient tear film. Clinician awareness of conditions affecting the ocular surface has increased in recent years because of expanded research and the publication of diagnosis and treatment guidelines pertaining to disorders resulting in DTS, including the Delphi panel treatment recommendations for DTS (2006), the International Dry Eye Workshop (DEWS) (2007), the Meibomian Gland Dysfunction (MGD) Workshop (2011), and the updated Preferred Practice Pattern guidelines from the American Academy of Ophthalmology pertaining to dry eye and blepharitis (2013). Since the publication of the existing guidelines, new diagnostic techniques and treatment options that provide an opportunity for better management of patients have become available. Clinicians are now able to access a wealth of information that can help them obtain a differential diagnosis and treatment approach for patients presenting with DTS. This review provides a practical and directed approach to the diagnosis and treatment of patients with DTS, emphasizing treatment that is tailored to the specific disease subtype as well as the severity of the condition.

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