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Modern approach to the treatment of dry eye, a complex multifactorial disease: a P.I.C.A.S.S.O. board review

Dry eye disease (DED) is a growing public health concern affecting quality of life and visual function, with a significant socio-economic impact. It is characterised by the loss of homoeostasis, resulting in tear film instability, hyperosmolarity and inflammation of the ocular surface. If the innate...

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Autores principales: Aragona, Pasquale, Giannaccare, Giuseppe, Mencucci, Rita, Rubino, Pierangela, Cantera, Emilia, Rolando, Maurizio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005804/
https://www.ncbi.nlm.nih.gov/pubmed/32703782
http://dx.doi.org/10.1136/bjophthalmol-2019-315747
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author Aragona, Pasquale
Giannaccare, Giuseppe
Mencucci, Rita
Rubino, Pierangela
Cantera, Emilia
Rolando, Maurizio
author_facet Aragona, Pasquale
Giannaccare, Giuseppe
Mencucci, Rita
Rubino, Pierangela
Cantera, Emilia
Rolando, Maurizio
author_sort Aragona, Pasquale
collection PubMed
description Dry eye disease (DED) is a growing public health concern affecting quality of life and visual function, with a significant socio-economic impact. It is characterised by the loss of homoeostasis, resulting in tear film instability, hyperosmolarity and inflammation of the ocular surface. If the innate immune response is unable to cope with internal bodily or environmental adverse conditions, the persistent, self-maintaining vicious circle of inflammation leads to the chronic form of the disease. Treatment of DED should be aimed at the restoration of the homoeostasis of the ocular surface system. A proper diagnostic approach is fundamental to define the relevance and importance of each of the DED main pathogenic factors, namely tear film instability, epithelial damage and inflammation. Consideration also needs to be given concerning two other pathogenic elements: lid margin changes and nerve damage. All the factors that maintain the vicious circle of DED in the patient’s clinical presentation have to be considered and possibly treated simultaneously. The treatment should be long-lasting and personalised since it has to be adapted to the different clinical conditions observed along the course of the disease. Since DED treatment is frequently unable to provide fast and complete relief from symptoms, empathy with patients and willingness to explain to them the natural history of the disease are mandatory to improve patients’ compliance. Furthermore, patients should be instructed about the possible need to increase the frequency and/or change the type of treatment according to the fluctuation of symptoms, following a preplanned rescue regimen.
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spelling pubmed-80058042021-04-16 Modern approach to the treatment of dry eye, a complex multifactorial disease: a P.I.C.A.S.S.O. board review Aragona, Pasquale Giannaccare, Giuseppe Mencucci, Rita Rubino, Pierangela Cantera, Emilia Rolando, Maurizio Br J Ophthalmol Review Dry eye disease (DED) is a growing public health concern affecting quality of life and visual function, with a significant socio-economic impact. It is characterised by the loss of homoeostasis, resulting in tear film instability, hyperosmolarity and inflammation of the ocular surface. If the innate immune response is unable to cope with internal bodily or environmental adverse conditions, the persistent, self-maintaining vicious circle of inflammation leads to the chronic form of the disease. Treatment of DED should be aimed at the restoration of the homoeostasis of the ocular surface system. A proper diagnostic approach is fundamental to define the relevance and importance of each of the DED main pathogenic factors, namely tear film instability, epithelial damage and inflammation. Consideration also needs to be given concerning two other pathogenic elements: lid margin changes and nerve damage. All the factors that maintain the vicious circle of DED in the patient’s clinical presentation have to be considered and possibly treated simultaneously. The treatment should be long-lasting and personalised since it has to be adapted to the different clinical conditions observed along the course of the disease. Since DED treatment is frequently unable to provide fast and complete relief from symptoms, empathy with patients and willingness to explain to them the natural history of the disease are mandatory to improve patients’ compliance. Furthermore, patients should be instructed about the possible need to increase the frequency and/or change the type of treatment according to the fluctuation of symptoms, following a preplanned rescue regimen. BMJ Publishing Group 2021-04 2020-07-23 /pmc/articles/PMC8005804/ /pubmed/32703782 http://dx.doi.org/10.1136/bjophthalmol-2019-315747 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Review
Aragona, Pasquale
Giannaccare, Giuseppe
Mencucci, Rita
Rubino, Pierangela
Cantera, Emilia
Rolando, Maurizio
Modern approach to the treatment of dry eye, a complex multifactorial disease: a P.I.C.A.S.S.O. board review
title Modern approach to the treatment of dry eye, a complex multifactorial disease: a P.I.C.A.S.S.O. board review
title_full Modern approach to the treatment of dry eye, a complex multifactorial disease: a P.I.C.A.S.S.O. board review
title_fullStr Modern approach to the treatment of dry eye, a complex multifactorial disease: a P.I.C.A.S.S.O. board review
title_full_unstemmed Modern approach to the treatment of dry eye, a complex multifactorial disease: a P.I.C.A.S.S.O. board review
title_short Modern approach to the treatment of dry eye, a complex multifactorial disease: a P.I.C.A.S.S.O. board review
title_sort modern approach to the treatment of dry eye, a complex multifactorial disease: a p.i.c.a.s.s.o. board review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005804/
https://www.ncbi.nlm.nih.gov/pubmed/32703782
http://dx.doi.org/10.1136/bjophthalmol-2019-315747
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