Coordinated Management

Introduction

Dry eye syndrome (DES) is a complex, multifactorial condition that can escalate into an irreversible chronic inflammatory disease if not treated in its early stages. As discussed in the Overview section, tear film and ocular surface inflammation leads to morphological and functional changes, altering the expression profile of inflammatory cytokines and enzymes, including interleukins, TNF-α, and matrix metalloproteinase (MMPs). These changes activate adaptive immune pathways, with lymphocytes migrating to the conjunctiva and causing a chronic immune-mediated inflammatory response. The progression from acute to chronic disease is exacerbated by reduced aqueous tear flow, increased tear film evaporation, and repeated nerve stimulation, creating a self-perpetuating cycle of inflammation that can lead to treatment-resistant disease and permanent ocular surface damage. Healthcare providers of different specialties need to cooperate to tailor an individualized treatment for each patient early enough to prevent the inflammatory cascade and its consequences.