At the 2025 Optometric Management Symposium, Nona Kalfayan, OD, delivered "Dry Eye Updates in Diagnosis and Treatment," a practical update on dry eye disease (DED), emphasizing the importance of accurate diagnosis, a stepwise approach, and following evidence-based algorithms. 

Accurate Diagnosis

To identify the type of DED (aqueous deficient or evaporative), Dr. Kalfayan recommended combining validated patient surveys—such as the Ocular Surface Disease Index (OSDI-6) and the Dry Eye Questionnaire (DEQ-5)—with objective tools, such as meibography and lipid interferometry.

Stepwise Approach

Additionally, she outlined a stepwise approach to DED management designed to help clinicians navigate the growing array of available therapies. First-line care includes patient education, lifestyle and environmental modifications, lid hygiene, and artificial tears. For patients with persistent symptoms, treatment escalates to topical anti-inflammatories, with short-term corticosteroids reserved for acute flares, she explained. Also, a nasal spray is available to stimulate natural tear production through the nasolacrimal reflex.

In-office treatments offer the next tier of care, targeting meibomian gland dysfunction and ocular surface inflammation. For severe or refractory cases, advanced interventions, such as autologous serum or platelet-rich plasma tears, and amniotic membrane grafts may be considered.

Evidence-Based Algorithms

Dr. Kalfayan stressed that while the abundance of therapies is encouraging, it can also create clinical complexity. Therrefore, she urged optometrists to follow evidence-based algorithms, such as those outlined in the Tear Film & Ocular Surface Society Dry Eye Workshop III report, to guide treatment selection and deliver more personalized, effective care.

“As optometrists, our responsibility is not only to recognize dry eye disease early but also to match the right treatment to the right patient,” Dr. Kalfayan stressed. “By applying evidence-based protocols and tailoring care to the root cause, we can simplify complex decisions and provide patients with lasting relief.” OM