Table 2.

Step therapy management for dry eye disease

Step 1	Step 2	Step 3	Step 4
Patient education regarding DED condition, management and prognosis Review of risk factors and medications that worsen DED Local environment modifications Dietary modifications and oral supplementation of essential fatty acids Ocular lubricants Treatment of pre-existing conditions: MGD: Eyelid compression during the warm showers producing the drainage of meibomian glands Bacterial blepharitis: Topical antibiotic or antibiotic/steroid combination Demodex mite: tea tree oil	MGD: In-office expression of the meibomian glands Pulsed light treatments for drainage of meibomian glands Oral macrolide or tetracyclines Moisture chamber goggles overnight Punctal plugs Prescription options: Topical corticosteroids (short-term use) Topical non-glucocorticoid immunomodulatory drugs, such as cyclosporine A or lifitegrast (long-term use) Topical secretagogues	Oral secretagogues (pilocarpine or cevimeline) Autologous serum eye drops Contact lens therapy: Soft bandage lenses Scleral lenses	Surgical options: Amniotic membrane grafts Surgical punctal occlusion Salivary gland transplant Tarsorrhaphy

Note: Data from Jones et al.¹⁵

Abbreviations: DED, dry eye disease; MGD, meibomian gland dysfunction.