DEWS Details

DEWS, stands for Dry Eye Workshop – it is a way of describing a systematic review of all that is known about dry eye disease (DED) from published scientific papers.

It provides clear guidance for a
o Standardized Diagnostic Protocol
o Treatment Algorithm

DEWS was first published in 2007. This original DEWS report reviewed all that was known about dry eye at that time, and highlighted some key messages which we have referred to ever since…
o prevalence of dry eye
o preservatives should be avoided
o the vicious circle of dry eye
o the importance of eyelid inflammation in dry eye
o risk factors for dry eye – to name just a few…

DEWS II, published in 2017, further highlighted all of the contributing factors of Dry Eye and classed it as a multifactorial disease with contributions from meibomian gland dysfunction, tear osmolarity, inflammation and much more.

The following definition of Dry Eye was determined from the DEWS II workshop: Dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.

Key Points
1. Every kind of dry eye, however initiated, enters a final common pathway in which tear hyperosmolarity and a chain of inflammatory events create a vicious circle that perpetuates the DED state
2. The vicious circle is an accepted central mechanism in DED that explains how ocular surface damage is initiated and perpetuated.
3. Patient education regarding the condition, its management, treatment and prognosis, as well as specific environmental and dietary modification, including oral essential FA supplementation, are all part of the staged management and treatment recommendations for DED.
4. Lid hygiene is widely considered an effective mainstream therapy for MGD and blepharitis, and remains an important part of the Dry Eye management.