Medical Care
Artificial tears are used as the primary treatment modality as often as necessary to relieve ocular discomfort.
Severe cases necessitate more viscous preparations, such as gels and ointments.
Pay particular attention to preservatives and concomitant hypersensitivity.
Petrolatum gels may be used at night.
Progressive symptoms may require sustained-release ocular inserts.
Moisture chambers at night may be attempted, but compliance in children is often poor.
Blepharoconjunctivitis may be treated with hot compresses and antibiotic drops or ointments.
Some cases of keratoconjunctivitis sicca, especially with recurrent corneal erosion or ulceration, may be ameliorated with bandage contact lenses, aggressive topical lubrication, and antibiotics (as needed).
Cases of systemic autoimmune dysfunction have been treated with neostigmine (Prostigmin).
Corneal epithelial breakdown is more likely if the cornea is anesthetic.
Surgical Care
Attempt surgical interventions when conservative topical therapy does not relieve symptoms.
Temporary occlusion
Temporary punctal obliteration is difficult to quantitate and better achieved by punctal plugs.
If surgical obliteration is contemplated, it probably should be permanent.
Permanent occlusion
Permanent punctal occlusion should be attempted if all conservative means fail.
Inferior punctal occlusion and/or superior punctal occlusion may be attempted depending on the severity of the clinical findings.
Thermal, electrical, and laser modalities have been advocated, but the best permanent results occur when the punctum and the vertical limb of the canaliculus are obliterated.
Tarsorrhaphy
Temporary or permanent tarsorrhaphy is indicated with prolonged symptoms or evidence of ocular compromise characterized by corneal breakdown.
