Interdisciplinary Management of DES

Roles of Primary Care Clinicians

Primary care clinicians often serve as the initial point of contact for patients with dry eye syndrome (DES), providing essential preliminary education about the nature of the disease. They play a vital role in screening for and diagnosing DES, initiating nonspecialized treatments and providing recommendations and advice to minimize symptoms and ocular surface damage. For instance, a primary care clinician might address underlying disorders contributing to DES or consider medication adjustments for agents that increase the risk of dry eye (see Comorbidities). They may also suggest conservative interventions such as ocular lubricants, warm eyelid compresses, or individualized environmental and lifestyle modifications, including dietary changes, to improve DES symptoms (see Treatment Options).

For moderate to severe cases of DES that are unresponsive to standard treatments or when a systemic disease is suspected, timely referral to an ophthalmologist experienced in managing these complex conditions is recommended. This ensures that patients receive specialized care that might involve advanced diagnostic techniques and therapeutic interventions not typically available in a primary care setting. Ophthalmologists can provide more targeted treatments such as prescription medications, punctal plugs, or intense pulsed light therapy, which are essential for managing severe cases (see Treatment Options).

When systemic immune dysfunction or the need for immunosuppressive therapy is suspected, referral to an internist or rheumatologist is appropriate. These specialists can assess for underlying systemic conditions, such as autoimmune diseases, which often contribute to DES (see Comorbidities). For instance, patients with primary Sjögren syndrome, secondary Sjögren syndrome (associated with connective tissue diseases), or rheumatoid arthritis should be managed by the relevant medical specialist. These systemic conditions require comprehensive care involving immunosuppressive or immunomodulatory therapies that can significantly impact the management of DES.