The Triple Classification of Dry Eye for Practical Clinical Use

Abstract

Clinicians need a practical classification to face diagnosis, prognosis, and treatment. Dry eyes have many etiologies and pathogenesis, different affectation of the various dacryoglands and ocular surface epithelium, and diverse grades of severity. The specialists in xero-dacryology must know these three parameters to evaluate any case of dry eye, and to establish an adequate treatment. To facilitate this, an open session in the VIII congress of the International Society of Dacryology and Dry Eye (Madrid, April, 2005) proposed modifying the Triple Classification of Dry Eye approved in the XIV congress of the European Society of Ophthalmology (Madrid, June 2003). The following classification has been established: first, a classification of the etiopathogenesis, distributed in 10 groups: age-related, hormonal, pharmacologic, immunopathic, hypo nutritional, dysgenic, infectious/inflammatory traumatic, neurologic, and tantalic; second, a classification of the affected glands and tissues, which under the acronym of ALMEN includes the aqueo-serous deficient, lipo deficient, mucin deficient, and epitheliopathic dry eyes, and the non-dacryologic affected exocrine glands (i.e., saliva, nasal secretion, tracheo-pharyngeal secretion); third, a classification of severity, in three grades: grade 1 or mild (symptoms without slit lamp signs), grade 2 or moderate (symptoms with reversible signs), and grade 3 or severe (symptoms with permanent signs).