The vicious circle scheme7 allows us to understand why, once the cycle is initiated, the continuous environmental challenge acting on a compromised ocular surface allows the vicious circle to perpetuate, even if the initial cause has been removed or reduced. The vicious circle scheme may also promote the development of therapeutic strategies that can simultaneously target the multiple mechanisms underlying the pathophysiology of DED8. For example, tear substitutes with osmoprotective properties9-11 may act on multiple points to break the vicious circle of DED.9,11,12 Topical anti-inflammatory strategies, such as those containing steroids or cyclosporine, target inflammation and help halt the cycle.13,14
Thus, a better understanding of the vicious circle may improve DED management with existing therapies and could also aid in the development of new therapies.
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4. Craig JP, Nelson JD, Azar DT, et al. TFOS DEWS II report executive summary. Ocul Surf. 2017;15:802-812.
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6. International Dry Eye Workshop. Report of the International Dry Eye Workshop (DEWS). Ocul Surf 2007;5:61–204.
7. Baudouin et al, Role Of Hyperosmolarity In The Pathogenesis And Management Of Dry Eye Disease: Proceedings Of The Ocean Group Meeting, The Ocular Surface / October 2013, VOL. 11 NO. 4 / www.theocularsurface.com
8. Labetoulle M, Baudouin C. From pathogenic considerations to a simplified decision-making schema in dry eye disease. J Fr Ophtalmol 2013;36:543–7.
9. Baudouin C, Aragona P, Messmer EM, et al. Role of hyperosmolarity in the pathogenesis and management of dry eye disease:
10. Hamano T, Horimoto K, Lee M, et al. Sodium hyaluronate eyedrops enhance tear film stability. Jpn J Ophthalmol 1996;40:62–5.
11. Simmons PA, Chang-Lin J-E, Chung Q, et al. Effect of compatible solutes on transepithelial electrical resistance and uptake in primary rabbit corneal epithelial cell layers model. Presented at the Association for Research in Vision and Ophthalmology (ARVO), 2007.
12. Bayhan SA, Bayhan HA, Muhafiz E, et al. Effects of osmoprotective eye drops on tear osmolarity in contact lens wearers. Can J Ophthalmol 2015;50:283–9.
13. Geerling G, Tauber J, Baudouin C, et al. The International Workshop on Meibomian Gland Dysfunction: report of the Subcommittee on Management and Treatment of Meibomian Gland Dysfunction. Invest Ophthalmol Vis Sci 2011;52:2050–64
14. Qiao J, Yan X. Emerging treatment options for meibomian gland dysfunction. Clin Ophthalmol 2013;7:1797–803
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