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Dysfunctional Tear Syndrome (DTS)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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DTS (Dysfunctional Tear Syndrome) is a disorder of the tear film in quality and/or quantity, which is caused by a range of aetiologies and involves abnormalities in one or more components of the tear film, resulting in a constellation of signs and symptoms affecting the ocular surface

  • any alteration in the quantity and/or quality of the tear film can result in DTS, a chronic condition with multiple subtypes that include dry eye disease (DED) and associated tear film disorders

    • possible symptoms of DTS are:
    • ocular discomfort
    • dryness
    • burning/stinging
    • grittiness/foreign body sensation
    • photophobia
    • blurred/fluctuating vision

  • overlap and frequent comorbidity of DED and other conditions affecting the quantity or quality of the tear film require careful examination of patients with DTS

  • four main subtype classifications used by the DTS Panel approach are as follows:
    • aqueous deficiency;
    • blepharitis/Meibomian Gland Dysfunction (MGD) (evaporative and nonevaporative);
    • goblet cell deficiency/ mucin deficiency;
    • exposure-related DTS

  • following the clinical assessment and evaluation of a patient with DTS, each patient can be classified into one or more of the disease-state subtypes (the presence of multiple subtypes within a patient is common)

Management options include:

  • artificial tears, gels, ointments, and inserts are used to replenish the tear film
    • tears can be conserved via punctal plugs, cautery, and moisture chamber eyewear
  • alterations in environmental conditions may benefit patients with DTS through increases in relative humidity
  • adjustments in lid hygiene, warm compresses, and massage may also be necessary for patients with blepharitis/MGD
  • anti-inflammatory and immunomodulatory agent options include:
    • cyclosporine, lifitegrast, steroids, and nutritional supplements, such as omega-3 fatty acids

Reference:

  • Behrens A, Doyle JJ, Stern L, et al., Dysfunctional Tear Syndrome Study Group. Dysfunctional tear syndrome: a Delphi approach to treatment recommendations. Cornea 2006; 25:900-907.
  • American Academy of Ophthalmology Cornea/External Disease Panel. Preferred practice pattern guidelines. Dry eye syndrome. San Francisco, CA: American Academy of Ophthalmology; 2013.

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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