Level III: Treatment: EVAPORATIVE DRY EYE

If symptoms are mild and sporadic, little-to-no staining, MGD Grede 1, normal meibography

• Patient education
• Lipid-based artificial tears (preserved) - if symptoms controlled with 4x/day administration.
• Lipid-based artificial tears (non-preserved) - if symptoms controlled with 4x/day is required.
• Warm compress therapy with heat-retention mask at least BID, PLUS

If symptoms are moderate or constant, (+) staining, MGD 2, normal meilbography, diminished lipid layer thickness:

• in-office lid margin debridement
• Proactive, in-office thermal lid therapy and/or intense pulse light treatment with simultaneous or subsequent expression
• Subsequent treatment with artificial tears and warm compress therapy (as above PULS)
• Systemic therapy to improve gland health
• Nutritional supplements (omega) at 2,000 mg daily
• Oral doxycycline, minocycline or azithromycin for at least 3 months

*In cases of sever meibomian gland atrophy, sympthomatic improvement may be challenging: however, aggressive proactive