TFOS DEWS II Definition and Classification Report

Jennifer P. Craig, Kelly K. Nichols, Jason J. Nichols, Barbara Caffery, Harminder S. Dua, Esen K. Akpek, Kazuo Tsubota, Choun Ki Joo, Zuguo Liu, Kazuo Tsubota, Fiona Stapleton

Research output: Contribution to journalArticle

342 Citations (Scopus)

Abstract

The goals of the TFOS DEWS II Definition and Classification Subcommittee were to create an evidence-based definition and a contemporary classification system for dry eye disease (DED). The new definition recognizes the multifactorial nature of dry eye as a disease where loss of homeostasis of the tear film is the central pathophysiological concept. Ocular symptoms, as a broader term that encompasses reports of discomfort or visual disturbance, feature in the definition and the key etiologies of tear film instability, hyperosmolarity, and ocular surface inflammation and damage were determined to be important for inclusion in the definition. In the light of new data, neurosensory abnormalities were also included in the definition for the first time. In the classification of DED, recent evidence supports a scheme based on the pathophysiology where aqueous deficient and evaporative dry eye exist as a continuum, such that elements of each are considered in diagnosis and management. Central to the scheme is a positive diagnosis of DED with signs and symptoms, and this is directed towards management to restore homeostasis. The scheme also allows consideration of various related manifestations, such as non-obvious disease involving ocular surface signs without related symptoms, including neurotrophic conditions where dysfunctional sensation exists, and cases where symptoms exist without demonstrable ocular surface signs, including neuropathic pain. This approach is not intended to override clinical assessment and judgment but should prove helpful in guiding clinical management and research.

Original languageEnglish
JournalOcular Surface
DOIs
Publication statusAccepted/In press - 2017

Fingerprint

Eye Diseases
Tears
Homeostasis
Neuralgia
Signs and Symptoms
Inflammation
Research

Keywords

  • Aqueous deficient
  • Classification
  • Definition
  • Dry eye disease
  • Evaporative
  • Mechanism

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Craig, J. P., Nichols, K. K., Nichols, J. J., Caffery, B., Dua, H. S., Akpek, E. K., ... Stapleton, F. (Accepted/In press). TFOS DEWS II Definition and Classification Report. Ocular Surface. https://doi.org/10.1016/j.jtos.2017.05.008

TFOS DEWS II Definition and Classification Report. / Craig, Jennifer P.; Nichols, Kelly K.; Nichols, Jason J.; Caffery, Barbara; Dua, Harminder S.; Akpek, Esen K.; Tsubota, Kazuo; Joo, Choun Ki; Liu, Zuguo; Tsubota, Kazuo; Stapleton, Fiona.

In: Ocular Surface, 2017.

Research output: Contribution to journalArticle

Craig, JP, Nichols, KK, Nichols, JJ, Caffery, B, Dua, HS, Akpek, EK, Tsubota, K, Joo, CK, Liu, Z, Tsubota, K & Stapleton, F 2017, 'TFOS DEWS II Definition and Classification Report', Ocular Surface. https://doi.org/10.1016/j.jtos.2017.05.008
Craig JP, Nichols KK, Nichols JJ, Caffery B, Dua HS, Akpek EK et al. TFOS DEWS II Definition and Classification Report. Ocular Surface. 2017. https://doi.org/10.1016/j.jtos.2017.05.008
Craig, Jennifer P. ; Nichols, Kelly K. ; Nichols, Jason J. ; Caffery, Barbara ; Dua, Harminder S. ; Akpek, Esen K. ; Tsubota, Kazuo ; Joo, Choun Ki ; Liu, Zuguo ; Tsubota, Kazuo ; Stapleton, Fiona. / TFOS DEWS II Definition and Classification Report. In: Ocular Surface. 2017.
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