Table 1.

Summary of conventional treatment options of SSDE.

Accepted Treatment Options of SSDE
	Mechanism of Action	Advantages & Considerations
Artificial lubricants	Tear replacement via artificial tears, ointments, inserts to reduce epithelial damage [5]	High frequency of dosing Preservatives may induce toxicity [5] Ointments may induce blur [7]
Biologic Tear Substitutes Autologous Serum (AT) Platelet rich preparations (PRP)	Tear replacement and wound repair through epitheliotropic and neurotrophic factors [8,9]	PRP may be superior to AT [10,11] Cost, preparation, and storage requirements are limitations [12] High frequency of dosing [8]
Topical Corticosteroids	Immunosuppression through NF-κB suppression and phospholipase A inhibition [14]	Fast acting [14] Risk of ocular hypertension, glaucoma, cataract, infection [15]
Topical Cyclosporine A	Immunomodulation and anti-inflammation via calcineurin inhibition [16]	Long term safety, site specific side effects Delayed onset up to 3 months [19]
Topical Lifitegrast	Immunomodulation and anti-inflammation through LFA-1/ICAM inhibition [23]	Systemic side effects including dysgeusia, headaches [23] Delayed onset up to 1 month [23]
Topical Diquafosol Sodium	Tear volume stimulation through P2Y2 stimulation [25]	May have added benefit with meibomian gland dysfunction [25] Not available in the USA [25]
Pilocarpine and Cevimeline	Secretagogues by cholinergic agonists [4,27]	Effective for both oral and ocular symptoms [4]. Off label for dry eye. Common systemic side effects include sweating, increased urinary frequency, and flushing [4,27]
Punctal Occlusion	Improve aqueous retention by reducing tear drainage [30]	May be less effective in Sjogren’s dry eye [31]. Surface inflammation may exacerbate signs [30] Spontaneous extrusion, inflammation, and infection [30]
Amniotic Membrane Graft	Promote wound healing by mechanical support, growth factor delivery, and anti-inflammation [32]	Foreign body sensation, blurred vision, discomfort [32]
Extranasal iTear Stimulator	Tear volume stimulator by electromechanical nasolacrimal stimulation through exterior of nose [35]	Highly effective with low side effects including dizziness and headaches [35,36]
Intranasal Varencicline	Tear volume stimulator by chemical nicotinic acetylcholine receptor neurostimulation at the nasociliary nerve [36,37]	Bypasses topical administration Nonserious side effects such as transient sneezing, cough [36,37]
Not utilized
Hydroxychloroquine	Immunomodulation, anti-inflammation [28]	Retinal and multisystem toxicity [29]
Submandibular Salivary Gland Transplant	Tear volume restoration [40,41]	Contraindicated in glandular disease such as Sjogren’s [41,42]