Dysfunctional Tear Syndrome (DTS)

Last edited 09/2019 and last reviewed 11/2020

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.