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DEWS II Calls for Nutritional Intervention

Dry eye is one of the most common reasons patients go in to see their eye doctors.Dry eye is one of the most common reasons for patient visits to eye care professionals, and it affects nearly 30 million Americans. The Tear Film and Ocular Surface Society (TFOS) devised the Dry Eye Workshop (DEWS) in 2007 to help standardize the treatment, and a decade later, the research continued with DEWS II.

DEWS II at a Glance

  • Developed over 2 and a half years
  • Published in the Ocular Surface Journal, July 2017
  • Objectives:
    • Update the definition, classification, and identification of dry eye
    • Assess the etiology, mechanism, distribution, and impact
    • Address the management and therapy of dry eye

Mile Brujic, OD, FAAO, is excited about the report because it’s simple for practitioners to understand and utilize every day.


What’s New with DEWS II?

Updated definition:

“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.”

Updated protocol:

  1. Identification – suggested identification methods include:
  • 5-item Dry Eye Questionnaire (DEQ-5)
  • Ocular Surface Disease Index (OSDI)
  • Tear break-up time
  • Tear film osmolarity determination
  • Ocular surface staining with fluorescein and lissamine green (cornea, conjunctiva, lid margin)
  1. Management – Each patient’s individual needs dictate what kind of dry eye management they should have.

Determining the cause(s) of an individual’s dry eye, whether it’s an aqueous tear deficiency or evaporative causes or both, is imperative to selecting a management strategy. Another important change is that ocular nutrition is now included as a first step towards relief. This gives eye care professionals another avenue to alleviate patient suffering.

Having a consistent approach to identifying and managing dry eye will help improve both research and patient care in the years to come. While these advancements are great, eye care professionals will be continually challenged to offer management strategies that are simple enough that patients will stick to them.




  1. “DRY EYE REDEFINED: TFOS DEWS II REPORT.” TFOS – Tear Film & Ocular Surface Society, Tear Film & Ocular Surface Society, July 2017,
  2. Mastrota, Katherine M. “5 Things You Need to Know about TFOS DEWS II.” OptometryTimes, UBM Medica, LLC., 26 July 2017,
  3. “TFOS DEWS II – Introduction.” TFOS DEWS II REPORT – TFOS – Tear Film & Ocular Surface Society, Tear Film & Ocular Surface Society, July 2017,
  4. Wolffsohn, James. “Evidence-Based Understanding of Dry Eye Disease in Pharmacy: Overview of the TFOS DEWS II Report.” Pharmaceutical Journal, Royal Pharmaceutical Society, 12 Sept. 2017,