Treatment schema proposed from P.I.C.A.S.S.O. board for different clinical conditions
| ~Month 1 | ~Month 2 | ~Month 3 | |
|---|---|---|---|
| Tx for dry eye and inflammation | |||
| Lid hygiene (at home) | Warm/hot compresses + medicated wipes (two times per day) | ||
| Anti-inflammatory | Mild corticosteroids for 2 weeks | ||
| Tear substitutes | Use fluid tear substitutes two to four times a day in order to restore tear film stability (ie, semifluorinated alkane eye drops) and break DE vicious circle (ie, sodium hyaluronate/trehalose, other MATS) | ||
| Tx for MGD with blepharitis | |||
| Lid hygiene (at home) | Warm/hot compresses + medicated wipes (two times per day) | ||
| Anti-inflammatory | Potent corticosteroids at decreasing doses + other anti-inflammatory molecules (ie, omega3 supplementation) | Milder corticosteroids at decreasing doses; continue other anti-inflammatory molecules (ie, omega3 supplementation) | Stop corticosteroids; continue other anti-inflammatory molecules (ie, omega3 supplementation) |
| Antibiotics | Treat with courses of ointments based on drugs with anti-inflammatory activity once daily or two times per day (ie, 20 days with tetracyclines, macrolides, fluoroquinolones) | Reduce ointment application: once daily for 10 days | Continue ointment application: once daily for 10 days |
| Tear substitutes | Use fluid tear substitutes five to six times a day in order to favour tear film dilution and clearance (based on low viscosity formulations of sodium hyaluronate) | ||
| Tx for dry eye with severe epithelial damage | |||
| Lid hygiene (at home) | Warm/hot compresses + medicated wipes (two times per day) | ||
| Anti-inflammatory | Potent corticosteroids at decreasing doses + cyclosporine once daily | Milder corticosteroids at decreasing doses + cyclosporine once daily | Stop corticosteroids; cyclosporine once daily |
| Antibiotics | Systemic doxycycline 100 mg two times per day | Systemic doxycycline 100 mg once daily | Stop doxycycline (consider to continue its use, at lower concentrations that is, 40 mg/day if necessary) |
| Tear substitutes | High-mean viscosity (sodium hyaluronate, linear or cross-linked; other polymers) + molecules helping epithelial healing (vitamins, antioxidants and bioprotectors) one drop five to six times a day | ||
The treatment should be given for a 3-month course followed by a further evaluation of patients’ conditions.
DE, dry eye; MATS, multiple action tear substitute; MGD, meibomian gland dysfunction; Tx, therapy.