What are the recommended first-line treatments for patients diagnosed with dry eye syndrome in primary care?

For patients diagnosed with dry eye syndrome in primary care, the recommended first-line treatments involve a stepped approach, beginning with lifestyle measures, followed by the use of tear substitutes if symptoms persist NICE CKS.

• Lifestyle Measures: Patients should be advised on lifestyle modifications for symptom relief NICE CKS. This includes using warm compresses, practicing lid hygiene, and performing lid massage, particularly if blepharitis or Meibomian gland dysfunction is present NICE CKS. Other recommendations include modifying contact lens wear, using moisture chamber eyewear (such as wrap-around glasses or specialist goggles), and adjusting environmental factors like increasing humidity, avoiding prolonged digital device use, and lowering computer screens NICE CKS.
• Tear Substitutes ('Artificial Tears'): If lifestyle measures are insufficient for symptom relief, tear substitutes are advised NICE CKS. People with mild-to-moderate dry eye symptoms should self-manage using over-the-counter topical preparations NICE CKS. A wide range of tear substitutes are available over-the-counter in various formulations, including eye drops, gels, ointments, and sprays NICE CKS. Low-viscosity drops are typically recommended for daytime use to reduce the risk of adverse effects like blurred vision, while increased viscosity ointments or gels may be needed for overnight use NICE CKS. Examples of options include hypromellose and carbomers NICE CKS. Where possible, preservative-free topical formulations should be advised, especially if the person is intolerant of preservatives, has moderate-to-severe dry eye requiring topical preparations more than four times per day, is using multiple topical eye preparations, or uses soft or hybrid contact lenses NICE CKS.