This is the Management and Therapy Report from TFOS DEWS III (2025), the latest international consensus on Dry Eye Disease (DED). Led by experts including Lyndon Jones, it was published in the American Journal of Ophthalmology. It provides a major update to the 2017 DEWS II report, based on a review of over 1,000 recent publications, offering evidence-based clinical guidelines for DED management.

Core Content Summary

1. Personalized, Etiology-Driven Treatment Moves beyond the simple binary classification of aqueous-deficient vs. evaporative dry eye. Instead, it organizes treatment around three main etiological domains: tear film deficiencies, eyelid anomalies, and ocular surface abnormalities. Strongly emphasizes combination therapy to address multiple contributing factors simultaneously.

2.Staged Treatment Categories The report classifies treatments into 10 major categories based on their mechanisms of action:

First-line foundational care: Lifestyle modifications (environment, screen time, blink habits), artificial tears, and tear film stabilizers (still the cornerstone).

Eyelid therapies (especially for Meibomian Gland Dysfunction – MGD): Warm compresses, lid hygiene, IPL (Intense Pulsed Light), radiofrequency (RF), low-level light therapy (LLLT), and in-office device-assisted treatments.

Anti-inflammatory and immunomodulatory agents: Cyclosporine, lifitegrast, etc.

Antimicrobial and Demodex treatments: Tea tree oil, lotilaner, etc.

Neuromodulation for neurosensory abnormalities.

Regenerative and biologics: Autologous serum, platelet-rich plasma, amniotic membrane, lubricin, etc.

Nutritional and alternative therapies: Omega-3 fatty acids (modest benefit), acupuncture, etc.

Surgical and advanced options: Punctal plugs, scleral lenses, and surgery (as last resort).

Key Updates and Highlights

1.Procedural treatments (e.g., IPL, RF) are now considered mainstream options, not just for refractory cases.

2.Strong focus on patient education, lifestyle interventions, and long-term adherence.

3.Includes three detailed prescribing algorithms to help clinicians match therapies to the patient’s specific etiological drivers.

Clinical Significance

This report shifts dry eye management from symptom-based to precision, etiology-based care, greatly improving systematic and effective treatment. It is currently the most authoritative global reference guideline for Dry Eye Disease management.