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f
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f
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f
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h
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f
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f
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h
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f
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f
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h
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f
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f
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244.541 545.0724 243.631 543.525 242.07 543.7174 c
f
255.09 545.8624 m
254.967 546.8384 254.087 547.4694 253.752 547.5425 c
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254.034 543.0533 255.256 544.5806 255.09 545.8624 c
h
252.543 536.1006 m
251.428 535.9347 250.764 536.9176 v
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253.181 542.0709 253.081 541.9908 v
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252.178 537.5748 251.988 537.0967 252.277 536.8112 c
252.417 536.6652 252.732 536.5723 252.732 536.5524 c
252.742 536.5456 252.851 536.4595 252.818 536.34 c
252.782 536.174 252.562 536.0807 252.543 536.1006 c
f
256.85 531.3326 m
256.823 531.3395 256.079 532.1496 255.571 532.6212 c
255.014 533.1456 254.08 533.9162 y
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255.559 534.2414 255.863 534.6666 255.873 534.673 c
260.94 540.0983 l
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261.213 542.2169 261.946 541.42 262.454 540.942 c
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257.152 533.4777 l
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257.089 531.1802 256.906 531.2798 256.85 531.3326 c
f
261.236 526.6779 m
259.25 528.816 259.951 531.7178 262.049 533.6505 c
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271.881 530.9009 271.864 530.8345 271.81 530.7682 c
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262.006 531.2067 261.093 528.4307 262.693 526.7111 c
263.663 525.6686 265.33 525.6021 266.329 525.6749 c
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266.538 525.3497 266.449 525.3033 266.369 525.2633 c
265.316 524.7321 263.144 524.6193 261.236 526.6779 c
f
273.226 520.6813 m
274.816 523.3576 l
274.859 523.4371 274.929 523.5103 274.883 523.57 c
274.836 523.6295 274.75 523.6099 274.666 523.5768 c
271.559 522.7067 l
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272.75 520.4953 l
272.791 520.442 272.844 520.3755 272.924 520.3893 c
273.049 520.4088 273.143 520.5553 273.226 520.6813 c
h
271.725 514.1071 m
270.98 515.1232 270.486 515.7604 v
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269.274 517.3345 269.287 517.4274 269.357 517.4806 c
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268.182 521.611 267.986 521.4782 267.793 521.1993 c
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267.726 519.3864 267.607 519.4528 267.551 519.5192 c
267.508 519.5323 266.917 520.4821 266.462 521.0464 c
266.17 521.4249 265.644 521.9894 y
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267.512 522.2549 267.893 522.421 268.514 522.6002 c
277.184 524.918 l
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271.711 514.7047 272.315 514.3262 271.95 514.0939 c
271.874 514.0338 271.777 514.0406 271.725 514.1071 c
f
287.204 508.854 m
286.493 509.233 285.541 508.4625 285.518 508.4493 c
278.282 503.9537 l
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281.273 514.3795 l
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276.157 511.5372 l
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282.316 517.9254 282.426 517.7994 y
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287.453 509.6178 288.027 508.7746 y
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287.676 508.3961 287.479 508.7018 287.204 508.854 c
f
286.869 485.9909 m
286.842 486.0172 286.363 487.2457 286.016 488.0226 c
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283.727 493.149 283.582 493.3483 283.545 493.4283 c
283.516 493.4479 283.094 494.6901 282.744 495.4668 c
282.366 496.3102 281.679 497.5982 y
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293.466 503.4821 293.918 502.2736 294.256 501.5099 c
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286.799 486.8937 287.738 486.0372 287.23 485.8047 c
287.031 485.7184 286.905 485.9108 286.869 485.9909 c
f
289.927 477.2716 m
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299.725 481.7472 300.236 480.3394 y
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292.779 477.2052 292.835 476.9928 v
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292.702 476.8068 291.035 476.1559 289.927 477.2716 c
f
297.172 469.821 m
299.708 471.627 l
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296.089 472.2379 296.089 472.172 296.102 472.1119 c
296.66 469.8399 l
296.677 469.781 296.697 469.694 296.773 469.674 c
296.899 469.641 297.045 469.741 297.172 469.821 c
h
293.137 464.4149 m
292.865 465.644 292.676 466.4269 v
292.514 467.151 292.185 468.254 292.221 468.287 c
292.201 468.36 292.254 468.4399 292.334 468.46 c
292.695 468.572 292.871 467.796 293.359 467.7489 c
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293.269 472.6899 l
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291.617 470.857 291.533 470.969 291.514 471.056 c
291.476 471.0829 291.321 472.185 291.135 472.895 c
291.019 473.354 290.769 474.0841 y
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292.58 473.573 292.998 473.5659 293.639 473.48 c
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293.363 464.966 293.765 464.376 293.336 464.309 c
293.24 464.2889 293.157 464.3289 293.137 464.4149 c
f
294.642 455.802 m
294.478 456.035 294.429 456.42 294.416 456.493 c
294.412 456.52 294.186 458.5379 293.967 459.813 c
293.848 460.57 293.586 461.753 y
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294.12 462.045 294.186 461.547 294.469 461.3739 c
294.94 461.0949 295.438 461.248 295.451 461.248 c
302.766 462.43 l
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304.184 464.196 304.268 464.03 304.277 463.957 c
304.297 463.937 304.387 462.855 304.496 462.171 c
304.605 461.387 304.891 460.1589 y
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303.637 460.823 303.018 460.696 303.006 460.696 c
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295.129 457.097 295.69 456.334 v
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297.457 455.304 297.464 455.072 v
297.467 454.985 297.334 454.913 297.317 454.926 c
297.305 454.9059 295.555 454.5339 294.642 455.802 c
f
303.851 446.692 m
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303.998 447.037 304.775 447.2889 305.09 447.641 c
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295.389 447.986 295.322 449.3409 295.239 450.1979 c
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296.338 451.294 296.906 451.36 296.933 451.366 c
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304.008 455.105 303.168 455.212 y
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306.455 447.203 306.418 447.1429 306.372 447.057 c
306.336 447.0039 306.185 446.95 y
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304.181 446.512 303.941 446.472 303.851 446.692 c
f
295.943 432.553 m
295.93 432.58 295.97 433.67 295.959 434.3799 c
295.946 435.1429 295.873 436.352 295.887 436.365 c
295.887 436.379 295.913 436.5309 296.066 436.5309 c
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297.115 435.502 297.55 435.575 297.576 435.575 c
300.697 435.615 l
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301.209 435.761 301.279 435.867 301.279 435.994 c
301.216 440.183 l
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301 440.595 300.887 440.6289 300.761 440.6289 c
297.586 440.5819 l
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296.115 440.017 296.534 439.054 296.072 439.035 c
295.89 439.035 295.847 439.2339 295.844 439.3069 c
295.83 439.334 295.913 440.423 295.903 441.127 c
295.893 441.89 295.787 443.099 y
295.787 443.112 295.856 443.265 296.01 443.278 c
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297.059 442.2489 297.576 442.315 297.606 442.315 c
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305.098 442.4279 305.35 442.408 305.668 442.574 c
306.266 442.9 306.053 444.028 306.502 443.995 c
306.684 443.989 306.687 443.836 306.687 443.75 c
306.704 443.723 306.647 442.6539 306.658 441.957 c
306.671 441.153 306.744 439.884 y
306.744 439.872 306.734 439.6849 306.564 439.692 c
306.16 439.6989 306.375 440.183 306.023 440.456 c
305.685 440.728 305.067 440.688 305.041 440.688 c
302.607 440.655 l
302.437 440.6479 302.311 440.662 302.219 440.562 c
302.122 440.469 302.096 440.396 302.096 440.27 c
302.158 435.966 l
302.158 435.854 302.201 435.774 302.301 435.714 c
302.4 435.641 302.5 435.641 302.641 435.6479 c
305.113 435.681 l
305.141 435.681 305.409 435.662 305.725 435.8279 c
306.309 436.139 306.123 437.261 306.588 437.235 c
306.754 437.228 306.787 437.062 306.787 436.99 c
306.816 436.963 306.761 435.881 306.77 435.176 c
306.78 434.4 306.844 433.138 y
306.844 433.125 306.791 432.925 306.621 432.925 c
306.229 432.9319 306.405 433.423 306.053 433.709 c
305.711 433.981 305.08 433.941 305.067 433.941 c
297.673 433.836 l
297.646 433.836 297.338 433.855 297.006 433.689 c
296.185 433.257 296.62 432.301 296.158 432.295 c
295.976 432.2879 295.943 432.474 295.943 432.553 c
f
295.361 425.834 m
295.578 428.742 298.187 430.2029 301.029 429.97 c
303.984 429.7239 306.668 427.58 306.462 424.864 c
306.355 423.449 305.934 422.699 305.442 421.942 c
305.333 421.783 305.226 421.676 305.24 421.5039 c
305.264 421.245 305.781 421.231 305.718 420.972 c
305.685 420.886 305.629 420.853 305.542 420.8459 c
302.444 420.853 l
302.331 420.853 302.225 420.92 302.188 421.0249 c
302.145 421.152 302.278 421.271 302.437 421.318 c
303.673 421.736 305.642 422.692 305.801 424.817 c
305.943 426.697 304.144 427.9709 301.747 428.151 c
299.21 428.343 296.551 427.1289 296.375 424.784 c
296.268 423.3629 297.348 422.094 298.081 421.4109 c
298.174 421.344 298.207 421.2379 298.088 421.131 c
297.981 421.039 297.889 421.072 297.806 421.105 c
296.703 421.5169 295.149 423.0309 295.361 425.834 c
f
299.207 413.216 m
302.242 413.8999 l
302.331 413.926 302.431 413.92 302.441 414 c
302.454 414.073 302.375 414.119 302.298 414.159 c
299.529 415.8189 l
299.423 415.873 299.29 415.932 299.2 415.8919 c
299.141 415.866 299.117 415.806 299.107 415.746 c
298.745 413.428 l
298.732 413.369 298.719 413.283 298.781 413.236 c
298.885 413.156 299.06 413.189 299.207 413.216 c
h
293.402 409.7899 m
293.625 411.025 293.748 411.822 v
293.878 412.552 294 413.694 294.047 413.7079 c
294.057 413.787 294.137 413.834 294.22 413.8199 c
294.598 413.787 294.459 413.0099 294.891 412.771 c
295.269 412.5789 295.581 412.5789 295.989 412.6649 c
297.221 412.918 l
297.234 412.918 297.5 412.99 297.646 413.11 c
297.76 413.189 297.785 413.289 297.809 413.435 c
298.221 416.058 l
298.258 416.271 298.234 416.31 298.131 416.457 c
297.992 416.67 297.652 416.862 297.627 416.869 c
296.717 417.3669 l
296.414 417.512 296.179 417.566 295.847 417.512 c
295.08 417.42 295.05 416.138 294.605 416.2839 c
294.485 416.317 294.449 416.45 294.462 416.537 c
294.439 416.576 294.721 417.6519 294.82 418.376 c
294.896 418.854 294.947 419.618 y
294.947 419.631 294.99 419.896 295.156 419.877 c
295.588 419.8369 295.392 419.305 295.934 418.8669 c
296.418 418.442 296.803 418.283 297.361 417.958 c
305.001 413.25 l
305.09 413.196 305.164 413.123 305.146 413.023 c
305.134 412.9229 305.054 412.871 304.954 412.864 c
295.228 410.713 l
295.203 410.713 294.781 410.6389 294.322 410.433 c
293.821 410.201 293.967 409.5039 293.543 409.61 c
293.446 409.6239 293.39 409.697 293.402 409.7899 c
f
301.06 399.988 m
301.893 400.506 302.101 401.5679 302.025 401.8999 c
301.916 402.2719 301.129 402.405 301.116 402.412 c
298.46 403.0829 l
298.297 403.123 298.178 403.169 298.018 403.116 c
297.803 403.049 297.716 402.658 297.723 402.618 c
297.6 402.405 297.262 400.998 297.652 400.42 c
298.068 399.769 299.967 399.298 301.06 399.988 c
h
291.122 398.214 m
290.508 399.1649 291.122 400.1729 v
291.407 400.685 292.154 400.97 292.427 401.017 c
295.79 401.7339 l
296.129 401.821 296.398 401.8669 296.637 402.073 c
296.889 402.279 296.976 402.8029 296.969 402.83 c
296.973 402.843 297.142 403.228 296.996 403.408 c
296.886 403.541 296.76 403.5479 296.594 403.588 c
293.961 404.2379 l
293.934 404.245 293.586 404.3439 293.221 404.271 c
292.324 404.0789 292.583 403.1559 292.045 403.256 c
291.905 403.275 291.905 403.4409 291.912 403.467 c
291.879 403.5139 292.294 404.769 292.49 405.619 c
292.652 406.2769 292.851 407.306 292.868 407.312 c
292.871 407.326 292.912 407.499 293.088 407.4449 c
293.439 407.352 293.283 406.781 293.582 406.3699 c
293.798 406.071 294.376 405.905 294.389 405.898 c
301.581 404.112 l
301.607 404.1049 301.836 404.098 302.188 404.1779 c
302.832 404.331 302.902 405.36 303.327 405.22 c
303.5 405.161 303.537 405.021 303.519 404.9489 c
303.543 404.9279 303.211 403.886 303.045 403.215 c
302.779 402.213 302.52 400.6989 302.447 400.6379 c
302.076 399.085 301.172 397.597 299.157 397.903 c
297.201 398.209 296.909 399.815 296.896 399.815 c
296.816 400.134 296.7 400.187 v
296.674 400.194 296.643 400.187 296.613 400.187 c
292.353 399.172 l
292.31 399.1649 291.799 399.1379 291.66 398.759 c
291.587 398.567 291.633 398.248 291.62 398.235 c
291.617 398.2209 291.584 398.0889 291.461 398.069 c
291.295 398.0289 291.119 398.188 291.122 398.214 c
f
288.067 390.06 m
288.023 390.3329 288.127 390.7239 288.15 390.798 c
288.143 390.824 288.834 392.664 289.303 393.9639 c
289.545 394.6949 289.837 395.871 289.85 395.871 c
289.853 395.884 289.967 396.0039 290.119 395.964 c
290.465 395.864 290.311 395.392 290.48 395.114 c
290.767 394.642 291.277 394.543 291.305 394.5359 c
298.334 392.1779 l
298.36 392.172 298.59 392.066 298.958 392.112 c
299.615 392.2249 299.81 393.34 300.239 393.162 c
300.393 393.095 300.369 392.929 300.339 392.849 c
300.346 392.816 299.648 390.824 299.197 389.5219 c
298.586 387.743 298.15 386.308 y
298.141 386.282 298.084 386.116 297.972 386.0889 c
297.882 386.036 297.785 386.0559 297.68 386.0889 c
295.943 386.633 l
295.916 386.64 295.591 386.726 295.697 387.046 c
295.76 387.224 296.109 387.131 296.129 387.1379 c
296.143 387.1379 296.653 386.953 297.165 387.1519 c
297.955 387.4839 298.436 389.41 298.43 389.4359 c
298.436 389.4489 298.623 389.875 298.38 390.12 c
298.25 390.266 298.061 390.3589 298.048 390.3589 c
295.412 391.256 l
295.256 391.308 295.08 391.369 294.976 391.322 c
294.9 391.269 294.808 391.17 294.805 391.1559 c
294.429 390.087 l
294.322 389.761 294.376 389.5219 294.485 389.19 c
294.631 388.798 295.116 388.4729 295.123 388.4599 c
295.226 388.36 295.339 388.3069 295.289 388.154 c
295.256 388.015 295.08 387.9749 294.934 388.021 c
291.908 388.938 l
291.723 389.0049 291.54 389.078 291.557 389.256 c
291.57 389.429 291.76 389.469 291.926 389.476 c
291.945 389.489 292.639 389.356 293.004 389.529 c
293.387 389.695 293.535 389.961 293.662 390.345 c
294.004 391.3549 l
294.041 391.4739 294.03 391.574 293.964 391.687 c
293.891 391.8199 293.771 391.86 293.612 391.913 c
290.724 392.882 l
290.697 392.8889 290.368 393.055 290.029 392.929 c
289.628 392.783 289.472 392.052 y
289.09 390.957 289.223 390.041 v
289.372 389.111 290.09 388.486 290.086 388.4729 c
290.302 388.287 290.219 388.088 v
290.192 388.002 290.023 388.021 y
290.003 388.015 288.279 388.5 288.067 390.06 c
f
0.25 0.12 0 0.1 k
138.0488 401.728 m
138.0488 427.473 l
138.0488 431.0399 140.9506 433.941 144.5165 433.941 c
163.868 433.941 l
167.437 433.941 170.339 431.0399 170.339 427.473 c
170.339 401.728 l
170.339 399.742 169.094 398.347 167.31 398.347 c
165.501 398.347 164.137 399.802 164.137 401.728 c
164.137 419.545 l
164.106 419.664 163.791 420.448 163.11 420.448 c
162.44 420.448 162.108 419.7509 162.095 419.7169 c
162.075 365.729 162.075 365.2839 v
161.669 365.2839 156.241 365.2839 155.839 365.2839 c
155.839 365.722 155.839 391.806 y
152.545 391.806 l
152.545 365.722 152.545 365.2839 v
152.143 365.2839 146.7148 365.2839 146.3129 365.2839 c
146.3129 365.729 146.3129 419.625 y
146.2797 419.744 145.9609 420.448 145.2905 420.448 c
144.6132 420.448 144.2812 419.664 144.2675 419.631 c
144.248 401.728 l
144.248 399.802 142.8998 398.347 141.1069 398.347 c
139.3368 398.347 138.0488 399.775 138.0488 401.728 c
f
146.4623 442.8329 m
146.4623 447.0959 149.9286 450.563 154.192 450.563 c
158.455 450.563 161.922 447.0959 161.922 442.8329 c
161.922 438.5699 158.455 435.103 154.192 435.103 c
149.9286 435.103 146.4623 438.5699 146.4623 442.8329 c
f
199.551 437.521 m
199.551 441.452 202.745 444.646 206.673 444.646 c
210.601 444.646 213.798 441.452 213.798 437.521 c
213.798 433.5959 210.601 430.395 206.673 430.395 c
202.745 430.395 199.551 433.5959 199.551 437.521 c
f
198.588 425.03 m
199.787 427.2209 202.682 429.2139 204.661 429.2139 c
208.506 429.2139 l
210.485 429.2139 213.377 427.2209 214.579 425.037 c
214.579 425.03 224.261 406.655 y
224.287 406.582 225.064 404.384 222.876 403.3549 c
220.685 402.3189 219.453 404.112 219.403 404.1909 c
213.536 415.5339 l
213.533 415.5339 212.726 416.184 y
211.733 415.992 l
211.394 415.779 211.285 415.48 211.285 415.202 c
211.285 414.943 211.371 414.7039 211.461 414.545 c
224.121 389.814 224.447 389.1769 v
223.756 389.1769 211.839 389.183 y
211.839 365.775 211.839 365.338 v
211.468 365.338 208.821 365.338 208.449 365.338 c
208.449 365.775 208.449 389.084 y
204.714 389.084 l
204.714 365.775 204.714 365.338 v
204.342 365.338 201.699 365.338 201.327 365.338 c
201.327 365.775 201.327 389.183 y
189.407 389.1769 188.717 389.1769 v
189.039 389.814 201.712 414.5569 y
201.795 414.7039 201.878 414.943 201.878 415.1949 c
201.878 415.48 201.772 415.779 201.437 415.992 c
201.434 415.992 200.441 416.184 y
199.634 415.5339 l
193.75 404.172 l
193.714 404.119 192.482 402.3189 190.287 403.3549 c
188.102 404.384 188.883 406.582 188.916 406.675 c
188.906 406.655 198.588 425.03 y
f
174.565 420.839 m
174.565 423.835 177.006 426.271 180.001 426.271 c
182.999 426.271 185.439 423.835 185.439 420.839 c
185.439 417.838 182.999 415.401 180.001 415.401 c
177.006 415.401 174.565 417.838 174.565 420.839 c
f
166.371 397.059 m
166.374 397.059 173.818 411.191 y
174.735 412.864 176.943 414.384 178.45 414.384 c
181.412 414.384 l
182.923 414.384 185.131 412.864 186.047 411.191 c
193.505 397.033 l
193.521 396.993 194.099 395.3329 192.462 394.562 c
190.815 393.7859 189.886 395.1329 189.849 395.1929 c
185.337 403.92 l
185.333 403.925 184.676 404.451 y
183.872 404.2979 l
183.594 404.125 183.504 403.8799 183.504 403.64 c
183.504 403.434 183.574 403.242 183.646 403.116 c
193.289 384.276 193.611 383.652 v
192.934 383.652 183.932 383.652 y
183.932 365.722 183.932 365.2839 v
183.58 365.2839 181.774 365.2839 181.425 365.2839 c
181.425 365.722 181.425 383.572 y
178.444 383.572 l
178.444 365.722 178.444 365.2839 v
178.092 365.2839 176.286 365.2839 175.937 365.2839 c
175.937 365.722 175.937 383.652 y
166.932 383.652 166.255 383.652 v
166.577 384.283 176.226 403.123 y
176.295 403.242 176.365 403.434 176.365 403.64 c
176.365 403.873 176.275 404.125 175.997 404.2979 c
175.19 404.451 l
174.536 403.925 l
170.003 395.173 l
169.977 395.1329 169.051 393.7859 167.404 394.562 c
166.457 395.007 166.251 395.752 166.251 396.309 c
166.251 396.72 166.361 397.033 166.371 397.059 c
f
BT
/F12 1 Tf
18 0 0 18 108.1523 274.631 Tm
0.14 0.1 0.11 0.09 k
<7F>Tj
1.02499 0 Td
(Ma)Tj
(naged Care &)Tj
-4.17945 -1 TD
(He)Tj
(althcare )Tj
4.88697 0 Td
(Communicat)Tj
5.38888 0 Td
(ions, LLC)Tj
ET
Q
Q
/GS1 gs
47.52 28.7999 480.528 16 re
f
Q
/GS1 gs
q
BT
/F13 1 Tf
11 0 0 11 48.52 35.6064 Tm
0.95 0.44 0 0.32 k
(S88)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
5 0 0 5 255.3009 35.6064 Tm
0.95 0.44 0 0.32 k
(n)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9 0 0 9 262.8558 35.6064 Tm
0 0 0 1 k
(www)Tj
1.927 0.00001 TD
(.ajmc.com)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
5 0 0 5 321.4342 35.6064 Tm
0.95 0.44 0 0.32 k
(n)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
7.5 0 0 7.5 488.315 35.6064 Tm
0 0 0 1 k
0.025 Tw
(APRIL 2008)Tj
ET
0.25 w
0 0 0 1 K
47.52 54 m
526.226 54 l
S
Q
/GS2 gs
q
BT
/F15 1 Tf
9 0 0 9 47.52 572.9417 Tm
0.95 0.44 0 0.32 k
0.028 Tw
[(T)150(r)30(eatment options)]TJ
ET
Q
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 59.52 559.9417 Tm
0 0 0 1 k
-0.005 Tc
0.079 Tw
(There is a wide variety of pharmacologic and nonpharmacologic)Tj
-1.26316 -1.36842 TD
0.229 Tw
(approaches to the management of dry eye disease (DED). These)Tj
T*
0.109 Tw
(approaches are best described within categories that include avoid-)Tj
T*
0.141 Tw
(ance of exacerbating factors, eyelid hygiene, tear supplementation,)Tj
T*
0.025 Tw
(tear retention, tear stimulation, and anti-inflammatory agents. )Tj
ET
Q
/GS2 gs
q
BT
/F15 1 Tf
9 0 0 9 47.52 481.9417 Tm
0.95 0.44 0 0.32 k
0.028 Tw
[(A)55(v)20(oidance of exacerbating f)40(act)19(ors )]TJ
ET
Q
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 59.52 468.9417 Tm
0 0 0 1 k
-0.005 Tc
0.145 Tw
[(Environmental mo)-10(difications such as humidification, avoidance)]TJ
-1.26316 -1.36842 TD
-0.012 Tw
(of wind or drafts, and avoidance of dusty or smoky environments may)Tj
T*
0.01 Tw
(ameliorate DED symptoms. Lifestyle or workplace mo)Tj
21.44962 0 TD
(difications may)Tj
-21.44962 -1.36842 TD
0.092 Tw
(be helpful, for example, taking regular breaks from reading or com-)Tj
T*
-0.011 Tw
(puter use, and lowering the computer monitor below eye level so that)Tj
T*
0.078 Tw
(the gaze is directed downward.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 165.9012 407.1018 Tm
0 0 0 1 k
(1-4)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 176.9669 403.9417 Tm
0 0 0 1 k
-0.005 Tc
0.078 Tw
(Increasing blink frequency)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 279.0255 407.1018 Tm
0 0 0 1 k
(1)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 285.0946 403.9417 Tm
0 0 0 1 k
-0.005 Tc
0.078 Tw
(or fast)Tj
-25.00785 -1.36842 TD
0.014 Tw
(blinking exercises)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 115.1069 394.1018 Tm
0 0 0 1 k
(4)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 120.5644 390.9417 Tm
0 0 0 1 k
-0.005 Tc
0.014 Tw
(have also been recommended. If feasible, medica)Tj
19.50423 0 TD
0 Tc
(-)Tj
-27.19312 -1.36842 TD
-0.005 Tc
0.047 Tw
(tions that exacerbate DED should be discontinued.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 243.348 381.1018 Tm
0 0 0 1 k
(1)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 249.1257 377.9417 Tm
0 0 0 1 k
-0.005 Tc
0.047 Tw
(In an accompa)Tj
5.97147 0 TD
0 Tc
(-)Tj
-27.19313 -1.36842 TD
-0.005 Tc
0.304 Tw
(nying article in this supplement, Perry discusses mo)Tj
22.58946 0 TD
(difiable risk)Tj
-22.58946 -1.36843 TD
0.025 Tw
(factors for DED, including exacerbating medications.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 249.5962 355.1018 Tm
0 0 0 1 k
(5)Tj
ET
Q
/GS2 gs
q
BT
/F15 1 Tf
9 0 0 9 47.52 325.9417 Tm
0.95 0.44 0 0.32 k
(Ey)Tj
1.14698 0 TD
0.028 Tw
[(elid h)40(y)19(giene )]TJ
ET
Q
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 59.52 312.9417 Tm
0 0 0 1 k
-0.015 Tc
0.121 Tw
[(W)55(ashing the eyelid margin with a gentle soap decreases bacterial)]TJ
-1.26316 -1.36842 TD
0.038 Tw
(colonization. Bacterial colonization is believed to inhibit conjunctival)Tj
T*
0.036 Tw
(goblet cell proliferation)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 134.845 290.1018 Tm
0 0 0 1 k
(6)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 140.3607 286.9417 Tm
0 0 0 1 k
-0.015 Tc
0.036 Tw
(and may also increase the breakdown of mei)Tj
17.42042 0 TD
0 Tc
(-)Tj
-27.19313 -1.36843 TD
-0.015 Tc
-0.016 Tw
(bomian lipid.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 96.7068 277.1017 Tm
0 0 0 1 k
(2)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 101.7239 273.9417 Tm
0 0 0 1 k
-0.015 Tc
-0.016 Tw
(Reducing colonization, therefore, may improve both the)Tj
-5.70567 -1.36842 TD
0.029 Tw
(mucous and lipid layers of the tear film. W)Tj
16.72294 0.00001 TD
(arm compresses may reduce)Tj
-16.72294 -1.36843 TD
0.203 Tw
[(evaporative loss by temporarily thickening the lipid layer)55(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 273.109 251.1018 Tm
0 0 0 1 k
(6)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 280.1801 247.9417 Tm
0 0 0 1 k
-0.015 Tc
(Manual)Tj
-24.49054 -1.36842 TD
0.075 Tw
(expression of the meibomian glands has been shown to increase lipid)Tj
T*
0.025 Tw
(layer thickness and tear film stability in normal subjects.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 257.0169 225.1018 Tm
0 0 0 1 k
(7)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 59.52 208.9417 Tm
0 0 0 1 k
-0.005 Tc
-0.013 Tw
(In a small nonrandomized study of patients with meibomian gland)Tj
-1.26316 -1.36842 TD
0.112 Tw
(dysfunction (MGD), a daily regimen of eyelid scrubbing and warm)Tj
T*
0.056 Tw
(compresses, plus meibomian gland expression performed as an office)Tj
T*
0.037 Tw
(procedure every 6 weeks, resulted in less-solidified meibomian secre-)Tj
T*
0.128 Tw
(tions and significantly increased lipid layer thickness. Patients also)Tj
T*
0.025 Tw
(reported improvement of DED symptoms.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 206.8267 147.1018 Tm
0 0 0 1 k
(8)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
9 0 0 9 47.52 117.9417 Tm
0.95 0.44 0 0.32 k
0.028 Tw
[(T)150(ear supplementation)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F16 1 Tf
9.5 0 0 9.5 59.52 104.9417 Tm
0 0 0 1 k
-0.006 Tc
-0.007 Tw
(Artificial tears)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 118.9172 104.9417 Tm
0 0 0 1 k
-0.005 Tc
-0.006 Tw
(are the mainstay of DED treatment. They are used)Tj
-7.51549 -1.36842 TD
0.024 Tw
[(in all stages of DED, either alone \(in mild to mo)-10(derate disease\) or in)]TJ
T*
0.037 Tw
[(combination with other treatments \(in mo)-10(derate to severe disease\).)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 306.0159 82.1018 Tm
0 0 0 1 k
(9)Tj
ET
4 w
0.22 0 0.1 0.19 K
229.434 663.769 m
346.086 663.769 l
S
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
18 0 0 18 169.4337 683.7692 Tm
0 0 0 1 k
0.025 Tw
(Management of Dry Eye Disease)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F17 1 Tf
10 0 0 10 239.4253 639.7692 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(Mic)50(hael )24(A. L)20(emp, MD)]TJ
ET
0.065 0 0.045 0.06 k
324 73.757 204 505.673 re
f
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
9 0 0 9 348 548.9417 Tm
0 0 0 1 k
[(Abstr)20(act)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
8 0 0 8 348 534.9417 Tm
0 0 0 1 k
0.011 Tc
(T)Tj
0.62198 0.00001 TD
0.028 Tw
(he management of dry eye disease)Tj
-0.62198 -1.375 TD
((DED) encompasses both pharmacolog-)Tj
T*
[(ic and nonpharmacologic approac)50(hes,)]TJ
T*
[(including av)15(oidance of exacerbating)]TJ
T*
[(factor)-20(s, eyelid h)20(ygiene, tear supplemen-)]TJ
T*
(tation, tear retention, tear stimulation,)Tj
T*
[(and anti-inflammatory agents. )50(Ar)24(tificial)]TJ
T*
[(tear)-20(s are the mainstay of DED therapy)]TJ
T*
(but, although they impro)Tj
12.10933 0 TD
(ve symptoms)Tj
-12.10933 -1.375 TD
[(and objecti)-20(ve findings, there is no evi-)]TJ
T*
(dence that they can resolve the under)Tj
18.35496 0 TD
0 Tc
(-)Tj
-18.35496 -1.375 TD
0.011 Tc
(lying inflammation in DED. )Tj
13.22806 0 TD
0 Tc
(T)Tj
0.50696 0 TD
0.011 Tc
0 Tw
(opical)Tj
-13.73502 -1.37501 TD
0.028 Tw
[(cor)25(ticosteroids are ef)25(fecti)-20(ve anti-inflam)-1(-)]TJ
0 -1.375 TD
(matory agents, but are not recommend)Tj
19.09096 0 TD
0 Tc
(-)Tj
-19.09096 -1.375 TD
0.011 Tc
(ed for long-term use because of their)Tj
T*
[(adver)-20(se-ef)25(fect profiles. )180(T)115(opical)]TJ
T*
[(cyclosporine\321cur)25(rently the only phar-)]TJ
T*
[(macologic treatment appro)15(ved by the)]TJ
T*
[(US F)20(ood and Drug )49(Administration)]TJ
T*
(specifically for DED\321is safe for long-)Tj
T*
(term use and is disease-modifying)Tj
T*
[(rather than merely palliati)-20(ve. )180(T)95(reatment)]TJ
T*
(selection is guided primarily by DED)Tj
T*
[(severity)55(. R)19(ecently published guidelines)]TJ
T*
(propose a severity classification based)Tj
T*
(on clinical signs and symptoms, with)Tj
T*
(treatment recommendations according)Tj
T*
(to severity level.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7 0 0 7 377.545 225.9417 Tm
0 0 0 1 k
0.028 Tw
[(\(Am J Manag Care. 20)-40(08;1)35(4:S88-S1)55(0)55(1\))]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
8.5 0 0 8.5 348 117.9417 Tm
0 0 0 1 k
-0.017 Tc
0.028 Tw
[(F)20(or author information and disclosures,)]TJ
0 -1.41176 TD
(see end of text.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
7 0 0 7 254.9889 720.7515 Tm
0.13 0 0.09 0.12 k
(n)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F13 1 Tf
10 0 0 10 265.319 720.564 Tm
0.95 0.44 0 0.32 k
-0.0002 Tc
(R)Tj
0.72184 0.00001 TD
0 Tc
[(EPOR)74(TS)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
7 0 0 7 317.4058 720.7515 Tm
0.13 0 0.09 0.12 k
(n)Tj
ET
Q
endstream
endobj
6 0 obj
<<
/Length 13599
>>
stream
/GS0 gs
1 g
0 774 0 0 re
f
q
/GS1 gs
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47.52 713.378 480.528 17.322 re
f
Q
/GS1 gs
q
BT
/F14 1 Tf
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0 0 0 1 k
-0.0051 Tc
(M)Tj
0.88387 0.00001 TD
-0.005 Tc
0.025 Tw
(anagement of Dry Eye Disease)Tj
ET
0 0 0 0 k
47.52 28.7999 480.528 16 re
f
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
7.5 0 0 7.5 48.52 35.6064 Tm
0 0 0 1 k
(V)Tj
0.71216 0.00001 TD
0.025 Tw
(OL. 14, NO. 3)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
5 0 0 5 195.3852 35.6064 Tm
0.95 0.44 0 0.32 k
(n)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
7.5 0 0 7.5 202.9401 35.6064 Tm
0 0 0 1 k
0.025 Tw
(THE AMERICAN JOURNAL OF MANAGED CARE)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
5 0 0 5 377.8499 35.6064 Tm
0.95 0.44 0 0.32 k
(n)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F13 1 Tf
11 0 0 11 508.703 35.6064 Tm
0.95 0.44 0 0.32 k
(S89)Tj
ET
0.25 w
0 0 0 1 K
47.52 54 m
526.226 54 l
S
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 47.52 705.4657 Tm
0 0 0 1 k
-0.004 Tc
0.374 Tw
(Most tear supplements act as lubricants; other)Tj
0 -1.36842 TD
-0.005 Tc
0.147 Tw
(actions may include replacement of deficient tear)Tj
T*
0.011 Tc
0.359 Tw
(constituents, dilution of proinflammatory sub-)Tj
T*
-0.005 Tc
0.066 Tw
[(stances, reduction of tear osmolarity)74(,)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 188.3498 669.6257 Tm
0 0 0 1 k
(2,9)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 198.8062 666.4657 Tm
0 0 0 1 k
-0.005 Tc
0.066 Tw
(and protec-)Tj
-15.92486 -1.36842 TD
0.025 Tw
(tion against osmotic stress.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 149.2186 656.6258 Tm
0 0 0 1 k
(10 )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 59.52 640.4657 Tm
0 0 0 1 k
-0.0051 Tc
(A)Tj
1.0691 0 Td
-0.005 Tc
0.051 Tw
[(wide variety of over)37(-the-counter (OTC) arti-)]TJ
-2.33226 -1.36842 TD
0.048 Tw
[(ficial tear pro)-10(ducts is available. These pro)-10(ducts dif-)]TJ
T*
0.338 Tw
(fer with respect to a number of variables that)Tj
T*
0.202 Tw
(include electrolyte composition, osmolarity/osmo-)Tj
T*
-0.003 Tw
[(lality)74(, viscosity)74(, the presence or absence of preserva)-1(-)]TJ
T*
0 Tw
(tives,)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 67.5386 578.6258 Tm
0 0 0 1 k
(2)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 74.233 575.4656 Tm
0 0 0 1 k
-0.005 Tc
0.144 Tw
(and the presence or absence of compatible)Tj
-2.81189 -1.36841 TD
0 Tw
(solutes.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 75.355 565.6258 Tm
0 0 0 1 k
(10)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 59.52 540.4656 Tm
0 0 0 1 k
Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F21 1 Tf
9.5 0 0 9.5 69.52 540.4656 Tm
0 0 0 1 k
-0.005 Tc
0.244 Tw
(Electrolyte composition.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 161.0468 540.4656 Tm
0 0 0 1 k
-0.005 Tc
0.244 Tw
[(Pro)-10(ducts that mimic)]TJ
-9.6344 -1.15789 TD
0.214 Tw
(the electrolyte composition of natural tears)Tj
0 -1.1579 TD
0.182 Tw
(are available. Of the electrolytes, potassium)Tj
0 -1.15789 TD
0.002 Tw
(and bicarbonate appear to be the most impor-)Tj
T*
0 Tw
(tant.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 87.4778 499.6258 Tm
0 0 0 1 k
(2)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 59.52 485.4657 Tm
0 0 0 1 k
Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F21 1 Tf
9.5 0 0 9.5 69.52 485.4657 Tm
0 0 0 1 k
0.015 Tc
(Osmolarity/osmolality)Tj
8.54816 0 TD
0 Tc
(.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 160.3394 485.4657 Tm
0 0 0 1 k
0.015 Tc
0.399 Tw
(DED patients have)Tj
-9.55994 -1.1579 TD
-0.005 Tc
0.179 Tw
[(higher)37(-than-normal tear film osmolarity \(ie,)]TJ
0 -1.15789 TD
0.279 Tw
(crystalloid osmolarity)Tj
8.72763 0 TD
-0.0051 Tc
(,)Tj
0.76848 0 Td
-0.005 Tc
(which relates to the)Tj
-9.49611 -1.1579 TD
-0.003 Tc
0.373 Tw
(concentration of small dissolved particles,)Tj
T*
-0.005 Tc
0.086 Tw
(such as ions\). Although some studies suggest)Tj
0 -1.15789 TD
0.138 Tw
(that artificial tears ideally should mimic the)Tj
0 -1.1579 TD
-0.004 Tw
(osmolarity of normal tears, others suggest that)Tj
T*
0.003 Tc
0.367 Tw
(hypo-osmolar artificial tears are optimal.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 239.999 411.6258 Tm
0 0 0 1 k
(9)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 69.52 397.4657 Tm
0 0 0 1 k
-0.005 Tc
(Pro)Tj
1.38344 0 TD
0.077 Tw
(ducts with varying degrees of hypo-osmo)Tj
16.54483 0.00001 TD
0 Tc
(-)Tj
-17.92827 -1.1579 TD
-0.005 Tc
0.025 Tw
(larity have been developed.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 174.4528 389.6258 Tm
0 0 0 1 k
(2)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 59.52 360.4657 Tm
0 0 0 1 k
-0.005 Tc
-0.017 Tw
(Colloid osmolality \(which relates to macromole-)Tj
-1.26316 -1.36842 TD
0.003 Tw
(cule concentration\) also varies among artificial tear)Tj
T*
0.179 Tw
[(pro)-10(ducts, and may be important because it influ-)]TJ
T*
0.368 Tw
(ences water transport across the ocular surface)Tj
T*
0.198 Tw
[(epithelium. Theoretically)74(, high colloid osmolality)]TJ
T*
0.082 Tw
(may be beneficial in reducing swelling of damaged)Tj
T*
0.025 Tw
(epithelial cells.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 104.9734 285.6258 Tm
0 0 0 1 k
(2)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 59.52 260.4657 Tm
0 0 0 1 k
Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F21 1 Tf
9.5 0 0 9.5 69.52 260.4657 Tm
0 0 0 1 k
-0.005 Tc
[(V)18(iscosity)37(. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 108.0368 260.4657 Tm
0 0 0 1 k
-0.005 Tc
0.25 Tw
(Higher artificial tear viscosity in-)Tj
-4.0544 -1.1579 TD
0.027 Tw
(creases tear retention time and may help pro-)Tj
0 -1.15789 TD
0.106 Tw
[(tect the ocular surface. V)55(iscosity agents used)]TJ
T*
0.028 Tw
(in artificial tears include carboxymethylcellu)Tj
17.92829 0.00001 TD
0 Tc
(-)Tj
-17.92829 -1.15791 TD
-0.005 Tc
0.078 Tw
(lose (CMC), polyvinyl alcohol, polyethylene)Tj
0 -1.15789 TD
0.19 Tw
(glycol, propylene glycol, hydroxypropyl-guar)Tj
T*
0.006 Tw
((HP-guar), and lipids such as those that make)Tj
0 -1.1579 TD
0.025 Tw
(up castor oil or mineral oil.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 173.2604 186.6258 Tm
0 0 0 1 k
(2)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 59.52 157.4657 Tm
0 0 0 1 k
-0.005 Tc
0.094 Tw
[(Lipid-containing artificial tear pro)-10(ducts such as)]TJ
-1.26316 -1.36842 TD
0.206 Tw
(Refresh Endura (with castor oil) and Soothe XP)Tj
T*
0.241 Tw
((with mineral oil) are intended to decrease tear)Tj
T*
0.092 Tw
(evaporation by restoring the lipid layer of the tear)Tj
T*
0 Tw
(film)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 62.6377 108.6258 Tm
0 0 0 1 k
(2,11-13)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 81.1343 105.4657 Tm
0 0 0 1 k
-0.0051 Tc
(;)Tj
0.51215 0 Td
-0.005 Tc
0.022 Tw
(this may be particularly useful in patients)Tj
-4.0505 -1.36842 TD
-0.031 Tw
(with MGD.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 91.6609 95.6258 Tm
0 0 0 1 k
(11)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 99.6959 92.4657 Tm
0 0 0 1 k
-0.005 Tc
-0.031 Tw
(HP-guar \(in pro)Tj
6.31562 0.00001 TD
(ducts such as Systane\))Tj
-11.80782 -1.36843 TD
0.034 Tw
(is believed to form a bioadhesive gel when exposed)Tj
22.47158 65.89474 TD
-0.007 Tw
(to ocular pH, increasing aqueous retention and pro-)Tj
0 -1.36842 TD
-0.004 Tw
(tecting the ocular surface by mimicking the mucous)Tj
T*
0.025 Tw
(layer of the tear film.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 341.2951 682.6258 Tm
0 0 0 1 k
(14,15)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 273 666.4657 Tm
0 0 0 1 k
-0.005 Tc
0.313 Tw
(Hyaluronic acid is a naturally occurring vis-)Tj
-1.26316 -1.36842 TD
0.002 Tc
0.368 Tw
(coelastic substance)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 337.3105 656.6258 Tm
0 0 0 1 k
0.007 Tc
(16)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 349.2807 653.4656 Tm
0 0 0 1 k
0.002 Tc
0.368 Tw
(that may also have anti-)Tj
-9.2927 -1.36842 TD
-0.005 Tc
0.072 Tw
[(inflammatory activity)74(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 345.3841 643.6258 Tm
0 0 0 1 k
(17)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 354.3915 640.4657 Tm
0 0 0 1 k
-0.005 Tc
0.072 Tw
(In small randomized trials,)Tj
-9.83068 -1.36842 TD
0.015 Tw
[(artificial tears containing so)-10(dium hyaluronate (SH))]TJ
T*
0.222 Tw
(have demonstrated greater improvement of DED)Tj
T*
0.007 Tc
0.363 Tw
(signs and/or symptoms compared with normal)Tj
T*
-0.005 Tc
0 Tw
(saline)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 282.8695 591.6257 Tm
0 0 0 1 k
(18)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 293.892 588.4657 Tm
0 0 0 1 k
-0.005 Tc
0.284 Tw
(and with other viscosity agents such as)Tj
-3.46231 -1.36842 TD
0.015 Tc
0 Tw
(CMC)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 283.5888 578.6258 Tm
0 0 0 1 k
0.02 Tc
(19)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 297.6027 575.4656 Tm
0 0 0 1 k
0.015 Tc
0.553 Tw
(or hydroxypropyl-methylcellulose/dex-)Tj
-3.85291 -1.36841 TD
-0.005 Tc
0 Tw
(tran.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 278.9578 565.6258 Tm
0 0 0 1 k
(16)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 287.4507 562.4657 Tm
0 0 0 1 k
-0.005 Tc
0.017 Tw
[(However)55(, in another report, an SH-contain-)]TJ
-2.78429 -1.36842 TD
0.104 Tw
(ing tear supplement was significantly less effective)Tj
T*
-0.034 Tw
(than topical cyclosporine in improving tear film sta-)Tj
T*
0.051 Tw
[(bility and goblet cell density)74(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 371.8069 526.6258 Tm
0 0 0 1 k
(17)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 380.6196 523.4657 Tm
0 0 0 1 k
-0.005 Tc
0.051 Tw
(SH-containing arti-)Tj
-12.59154 -1.36842 TD
0.202 Tw
[(ficial tear pro)-10(ducts are commercially available in)]TJ
T*
0.023 Tw
(some countries, but have not been approved by the)Tj
T*
0.109 Tw
[(US Foo)-10(d and Drug Administration (FDA) for use)]TJ
T*
0.025 Tw
(in the United States.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 341.4309 474.6258 Tm
0 0 0 1 k
(2)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 273 458.4657 Tm
0 0 0 1 k
-0.005 Tc
0.093 Tw
(High-viscosity agents tend to cause visual blur)Tj
18.9809 0 TD
0 Tc
(-)Tj
-20.24406 -1.36842 TD
-0.005 Tc
0.083 Tw
(ring; therefore, lower)Tj
8.51526 0 TD
(-viscosity agents are generally)Tj
-8.51526 -1.36843 TD
0.135 Tw
[(preferred for mild to mo)-10(derate DED. However)55(, in)]TJ
0 -1.36842 TD
0.29 Tw
(more severe cases, high-viscosity agents may be)Tj
T*
0.032 Tw
(needed for symptom control.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 370.8943 409.6258 Tm
0 0 0 1 k
(9)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 376.5275 406.4657 Tm
0 0 0 1 k
-0.005 Tc
0.032 Tw
(Ophthalmic gels and)Tj
-12.16079 -1.36842 TD
0.106 Tw
(ointments have higher viscosity than liquids; they)Tj
T*
0.131 Tw
(are also associated with more visual blurring than)Tj
T*
0.002 Tc
0.368 Tw
(liquids and, therefore, are usually reserved for)Tj
T*
-0.005 Tc
0.255 Tw
(overnight use.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 317.092 357.6258 Tm
0 0 0 1 k
(9)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 324.8411 354.4657 Tm
0 0 0 1 k
-0.005 Tc
0.255 Tw
(Gels containing carbomers cause)Tj
-6.72011 -1.36842 TD
-0.002 Tc
0.372 Tw
(less blurring than petrolatum-based ointments,)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 453.4788 344.6258 Tm
0 0 0 1 k
(2)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 261 328.4657 Tm
0 0 0 1 k
-0.005 Tc
0.008 Tw
(perhaps because carbomer viscosity decreases rapid)Tj
20.24407 0 TD
0 Tc
(-)Tj
-20.24407 -1.36843 TD
-0.005 Tc
0.025 Tw
(ly on exposure to tear salts.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 364.7102 318.6258 Tm
0 0 0 1 k
(20)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 273 292.4657 Tm
0 0 0 1 k
Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F21 1 Tf
9.5 0 0 9.5 283 292.4657 Tm
0 0 0 1 k
-0.005 Tc
(Preservatives.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 334.3147 292.4657 Tm
0 0 0 1 k
-0.005 Tc
0.009 Tw
(Preservatives are added to artifi)Tj
12.52674 0 TD
0 Tc
(-)Tj
-17.92829 -1.1579 TD
-0.005 Tc
0.098 Tw
(cial tears to reduce the risk of bacterial con)Tj
17.92829 0.00001 TD
0 Tc
(-)Tj
-17.92829 -1.15791 TD
-0.005 Tc
0.228 Tw
(tamination in multidose containers, and to)Tj
0 -1.15789 TD
0.113 Tw
(prolong shelf life. There are 2 main types of)Tj
T*
0.025 Tw
(preservatives: detergent and oxidative.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 429.8001 251.6258 Tm
0 0 0 1 k
(9)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 273 222.4657 Tm
0 0 0 1 k
-0.01 Tc
0.101 Tw
(Detergent preservatives act by altering bacterial)Tj
-1.26316 -1.36842 TD
0.033 Tw
(cell membrane permeability)Tj
11.00328 0.00001 TD
0 Tc
(.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 367.8113 212.6258 Tm
0 0 0 1 k
(9)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 373.3732 209.4657 Tm
0 0 0 1 k
-0.01 Tc
0.033 Tw
(Detergents have toxic)Tj
-11.82876 -1.36842 TD
0.162 Tw
(effects on the ocular surface epithelium and, with)Tj
T*
-0.031 Tw
(frequent use, can cause epithelial irritation and dam-)Tj
T*
0.172 Tw
(age. Patients with a compromised tear film are at)Tj
T*
0.005 Tw
(higher risk. Benzalkonium chloride, the most widely)Tj
T*
0.306 Tw
(used preservative in topical ophthalmic prepara-)Tj
T*
0.025 Tw
(tions, is an example of a detergent preservative.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 440.2424 134.6258 Tm
0 0 0 1 k
-0.005 Tc
(2,9)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 273 118.4657 Tm
0 0 0 1 k
-0.005 Tc
0.153 Tw
(Oxidative preservatives penetrate the bacterial)Tj
-1.26316 -1.36842 TD
0.02 Tw
(cell membrane and act by interfering with intracel-)Tj
T*
0.151 Tw
(lular processes. They are sometimes referred to as)Tj
T*
0.051 Tw
(\322vanishing\323 preservatives because they dissipate on)Tj
ET
Q
endstream
endobj
7 0 obj
<<
/Length 13443
>>
stream
/GS0 gs
1 g
0 774 0 0 re
f
/GS1 gs
q
BT
/F14 1 Tf
11 0 0 11 39.943 721.2969 Tm
0 0 0 1 k
0.01 Tc
(Reports)Tj
ET
0 0 0 0 k
38.949 28.7999 480.531 16 re
f
Q
/GS2 gs
/GS1 gs
q
BT
/F13 1 Tf
11 0 0 11 39.9489 35.6064 Tm
0.95 0.44 0 0.32 k
(S90)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
5 0 0 5 246.7298 35.6064 Tm
0.95 0.44 0 0.32 k
(n)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9 0 0 9 254.2847 35.6064 Tm
0 0 0 1 k
(www)Tj
1.927 0.00001 TD
(.ajmc.com)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
5 0 0 5 312.8631 35.6064 Tm
0.95 0.44 0 0.32 k
(n)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
7.5 0 0 7.5 479.7469 35.6064 Tm
0 0 0 1 k
0.025 Tw
(APRIL 2008)Tj
ET
0.25 w
0 0 0 1 K
40.774 54 m
519.48 54 l
S
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 110.52 706.0912 Tm
0 0 0 1 k
-0.005 Tc
0.099 Tw
(contact with the eye and, therefore, are less likely)Tj
0 -1.36842 TD
0.048 Tw
(than detergents to cause ocular damage.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 263.8783 696.2513 Tm
0 0 0 1 k
(9)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 269.659 693.0912 Tm
0 0 0 1 k
-0.005 Tc
[(However)55(,)]TJ
-16.75147 -1.36842 TD
0.129 Tw
(they may not always dissipate completely in DED)Tj
T*
0.015 Tc
0.518 Tw
(patients because of decreased tear volume.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 303.0002 670.2512 Tm
0 0 0 1 k
(2)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 110.52 654.0912 Tm
0 0 0 1 k
-0.005 Tc
0.121 Tw
(Stabilized oxychloro complex is an example of an)Tj
0 -1.36842 TD
0.025 Tw
(oxidative preservative.)Tj
1.26316 -1.36842 TD
0.014 Tw
(Preserved tears are usually well tolerated in mild)Tj
-1.26316 -1.36842 TD
0.063 Tw
[(DED, when used no more than 4 to 6 times daily)74(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 303 618.2513 Tm
0 0 0 1 k
(2)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 110.52 602.0912 Tm
0 0 0 1 k
-0.005 Tc
0.257 Tw
(\(Exposure to preservatives in other topical oph-)Tj
0 -1.36842 TD
0.042 Tw
(thalmic agents [eg, glaucoma medications] must al-)Tj
T*
0.117 Tw
(so be taken into account.\) If more frequent use is)Tj
T*
0.275 Tw
[(necessary)74(, unpreserved tears are recommended.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 298.4999 566.2513 Tm
0 0 0 1 k
(2,9)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 110.52 550.0912 Tm
0 0 0 1 k
-0.005 Tc
0.036 Tw
[(Until recently)74(, the FDA required unpreserved tears)]TJ
0 -1.36842 TD
0.009 Tw
(to be packaged in single-dose vials to avoid bacteri-)Tj
T*
0.03 Tw
(al contamination; this makes them more expensive)Tj
0 -1.36841 TD
0.193 Tw
(and less convenient to use.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 219.7242 514.2513 Tm
0 0 0 1 k
(2)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 226.8897 511.0913 Tm
0 0 0 1 k
-0.005 Tc
0.193 Tw
[(However)55(, an unpre-)]TJ
-12.24944 -1.36842 TD
0.017 Tw
[(served pro)-10(duct \(V)55(isine Pure-T)111(ears\) is now available)]TJ
T*
0.207 Tw
(in a multidose vial with a dispensing system de-)Tj
T*
0.025 Tw
(signed to prevent contamination.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 237.9102 475.2513 Tm
0 0 0 1 k
(2,9)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 122.52 449.0913 Tm
0 0 0 1 k
Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F21 1 Tf
9.5 0 0 9.5 132.52 449.0913 Tm
0 0 0 1 k
-0.01 Tc
-0.005 Tw
(Compatible solutes.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 203.2973 449.0913 Tm
0 0 0 1 k
-0.01 Tc
-0.005 Tw
(Osmotic stress occurs when)Tj
-7.45024 -1.1579 TD
-0.011 Tw
(the concentration of molecules and/or ions in)Tj
17.92328 0 TD
0 Tc
(-)Tj
-17.92328 -1.1579 TD
-0.005 Tc
0.049 Tw
(side a cell differs from that outside the cell\321)Tj
0 -1.15789 TD
0.124 Tw
(as is the case in DED, in which the )Tj
15.32297 0 TD
-0.01 Tc
0 Tw
(corneal)Tj
-15.32297 -1.1579 TD
0.156 Tw
[(epithelium is exposed to hyperosmolar)-402(t)-5(e)-5(a)-5(r)-5(s)-5(.)]TJ
T*
-0.005 Tc
0.186 Tw
(Under osmotic stress, the corneal epithelial)Tj
0 -1.15789 TD
0.054 Tw
(cells tend to lose water)Tj
9.2554 0 TD
-0.0051 Tc
(,)Tj
0.54333 0 Td
-0.005 Tc
(and may compensate)Tj
-9.79873 -1.1579 TD
0.182 Tw
(by increasing their internal electrolyte con-)Tj
0 -1.15789 TD
-0.018 Tw
(centration to stabilize their volume. However)Tj
18.01104 0 TD
0 Tc
(,)Tj
-18.01104 -1.1579 TD
-0.005 Tc
0.012 Tw
(elevated electrolyte concentrations can even-)Tj
T*
0.025 Tw
(tually lead to cellular damage.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 246.7152 342.2513 Tm
0 0 0 1 k
(10,21)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 122.52 314.0913 Tm
0 0 0 1 k
-0.005 Tc
0.29 Tw
(Compatible solutes are small nonionic mole-)Tj
-1.26316 -1.36842 TD
0.127 Tw
(cules (eg, glycerin) that can be taken up by cells,)Tj
T*
0.072 Tw
(increasing intracellular osmolarity without disrupt)Tj
20.24407 0 TD
0 Tc
(-)Tj
-20.24407 -1.36842 TD
-0.005 Tc
0.08 Tw
(ing cellular metabolism. Artificial tears containing)Tj
T*
0.335 Tw
(compatible solutes may thus provide protection)Tj
0 -1.36841 TD
-0.033 Tw
(against osmotic stress.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 192.9178 252.2513 Tm
0 0 0 1 k
(10,21)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 208.436 249.0913 Tm
0 0 0 1 k
-0.005 Tc
(Pro)Tj
1.38344 0.00001 TD
-0.033 Tw
(ducts containing com-)Tj
-11.69039 -1.36843 TD
0.091 Tw
(patible solutes include Optive and Refresh Endura)Tj
0 -1.36842 TD
0.025 Tw
((with 0.9% and 1% glycerin, respectively).)Tj
1.26316 -1.36842 TD
0.028 Tw
(Large, randomized, masked comparative trials of)Tj
-1.26316 -1.36842 TD
0.052 Tw
[(different artificial tear pro)-10(ducts have not been per-)]TJ
T*
0 Tw
(formed.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 139.4693 187.2513 Tm
0 0 0 1 k
(2)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 146.1279 184.0913 Tm
0 0 0 1 k
-0.005 Tc
0.14 Tw
[(However)55(, limited data suggest that there)]TJ
-3.7482 -1.36842 TD
0.025 Tw
[(may be differences in pro)-10(duct efficacy)74(, for example:)]TJ
1.26316 -2.42106 TD
0.274 Tw
[-452(In small, randomized, comparative trials, a)]TJ
1.05263 -1.15789 TD
0 Tw
(pro)Tj
1.32754 0.00001 TD
-0.01 Tc
0.162 Tw
(duct containing polyethylene glycol, pro)Tj
16.60076 0.00001 TD
0 Tc
(-)Tj
-17.9283 -1.15791 TD
-0.01 Tc
-0.028 Tw
[(pylene glycol, and HP-guar)55(, with the detergent)]TJ
0 -1.1579 TD
-0.005 Tc
0.014 Tw
(preservative polyquaternium-1 (Systane), was)Tj
0 -1.15789 TD
0.002 Tc
0.368 Tw
(significantly more effective than a CMC)Tj
T*
-0.005 Tc
0 Tw
(pro)Tj
1.32754 0.00001 TD
0.229 Tw
(duct preserved with stabilized oxychloro)Tj
-1.32754 -1.15791 TD
0.089 Tw
[(complex \(Refresh T)111(ears\) in improving symp)-1(-)]TJ
22.47158 65.68421 TD
0 Tw
(toms,)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 366.5996 709.2512 Tm
0 0 0 1 k
(22,23)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 383.1274 706.0912 Tm
0 0 0 1 k
-0.005 Tc
0.074 Tw
(ocular surface staining,)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 471.2058 709.2512 Tm
0 0 0 1 k
(22,23)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 487.7337 706.0912 Tm
0 0 0 1 k
-0.005 Tc
0.074 Tw
(and tear)Tj
-14.91934 -1.15789 TD
-0.02 Tc
-0.016 Tw
(breakup time (TBUT).)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 430.2752 698.2513 Tm
0 0 0 1 k
-0.015 Tc
(24)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 438.1272 695.0913 Tm
0 0 0 1 k
-0.02 Tc
-0.016 Tw
(Systane also improved)Tj
-9.6976 -1.1579 TD
-0.01 Tc
-0.012 Tw
(TBUT significantly more than an unpreserved)Tj
0 -1.15789 TD
0 Tc
0.107 Tw
[(pro)-10(duct containing glycerin, polysorbate 80,)]TJ
T*
-0.005 Tc
0.025 Tw
(and castor oil (Refresh Endura).)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 468.0914 665.2513 Tm
0 0 0 1 k
(24 )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 336 651.0912 Tm
0 0 0 1 k
-0.005 Tc
0.184 Tw
[-452(A randomized, internally paired study com-)]TJ
1.05263 -1.15789 TD
-0.03 Tc
-0.022 Tw
[(pared a mineral oil\320containing pro)-10(duct (Soothe))]TJ
0 -1.1579 TD
-0.005 Tc
0.088 Tw
(versus Systane. Forty patients received a sin-)Tj
0 -1.15789 TD
-0.0051 Tc
(g)Tj
0.43891 -0.00001 TD
-0.005 Tc
0.179 Tw
(le drop of Soothe in one eye and a single)Tj
-0.43891 -1.15789 TD
0.106 Tw
(drop of Systane in the other eye \(the eye in)Tj
0 -1.1579 TD
0.014 Tw
(which each treatment was used was randomly)Tj
0 -1.15789 TD
0.267 Tw
(assigned\). Both treatments significantly in-)Tj
T*
0.025 Tw
(creased tear film lipid layer thickness, but the)Tj
0 -1.1579 TD
0.016 Tw
(increase was significantly greater with Soothe)Tj
0 -1.15789 TD
0.163 Tw
(than with Systane.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 420.2684 555.2513 Tm
0 0 0 1 k
(2)Tj
0.5 -0.00001 TD
(5)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 430.1485 552.0912 Tm
0 0 0 1 k
-0.005 Tc
0.163 Tw
(In a similarly designed)Tj
-8.85774 -1.15789 TD
0.173 Tw
(trial (N = 41), Soothe increased lipid layer)Tj
0 -1.1579 TD
0.004 Tw
(thickness significantly more than Refresh Dry)Tj
0 -1.15789 TD
0.262 Tw
[(Eye Therapy \(a pro)-10(duct similar to Refresh)]TJ
T*
0.317 Tw
(Endura, but preserved with stabilized oxy-)Tj
T*
0.025 Tw
(chloro complex\).)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 411.4329 500.2513 Tm
0 0 0 1 k
(26)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 336 472.0913 Tm
0 0 0 1 k
-0.005 Tc
0.06 Tw
(Although artificial tears can improve symptoms)Tj
-1.26316 -1.36842 TD
0.189 Tw
(and objective findings, there is no evidence that)Tj
T*
0.145 Tw
(they can resolve the inflammation that accompa-)Tj
T*
0.025 Tw
(nies DED.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 362.8563 436.2513 Tm
0 0 0 1 k
(2)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F16 1 Tf
9.5 0 0 9.5 336 420.0913 Tm
0 0 0 1 k
-0.006 Tc
0.366 Tw
(Autologous serum tears,)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 443.2022 420.0913 Tm
0 0 0 1 k
-0.005 Tc
0.329 Tw
[(pro)-10(duced from the)]TJ
-12.5476 -1.36842 TD
0 Tw
(patient\325)Tj
3.01398 0 TD
-0.0051 Tc
(s)Tj
0.56503 0 Td
-0.005 Tc
-0.008 Tw
(serum, have been used in severe DED. Au)Tj
16.66005 0.00001 TD
0 Tc
(-)Tj
-20.23907 -1.36843 TD
0.079 Tw
(tologous serum tears have biochemical and mech-)Tj
0 -1.36842 TD
-0.007 Tw
[(anical properties similar)55(, but not identical, to those)]TJ
T*
0.201 Tw
(of normal aqueous tears.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 422.5669 371.2513 Tm
0 0 0 1 k
(27)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 432.8514 368.0913 Tm
0 0 0 1 k
0.201 Tw
(They are unpreserved)Tj
-11.45804 -1.36842 TD
0.228 Tw
(but can be stored frozen for 3 to 6 months,)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 505.9798 358.2513 Tm
0 0 0 1 k
(27,28)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 324 342.0913 Tm
0 0 0 1 k
0.124 Tw
[(so that bloo)-10(d donation is required 2 to 4 times a)]TJ
0 -1.36842 TD
0 Tw
(year)Tj
1.60938 0 TD
(.)Tj
-0.34622 -1.36842 TD
-0.005 Tc
0.145 Tw
(Several small, randomized studies investigating)Tj
-1.26316 -1.36842 TD
0.26 Tw
(autologous serum tears versus unpreserved saline)Tj
T*
0 Tw
(drops,)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 346.6627 293.2513 Tm
0 0 0 1 k
(29)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 356.3286 290.0913 Tm
0 0 0 1 k
-0.005 Tc
0.141 Tw
(unpreserved artificial tears,)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 461.2543 293.2513 Tm
0 0 0 1 k
(30)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 470.9202 290.0913 Tm
0 0 0 1 k
-0.005 Tc
0.141 Tw
(and/or other)Tj
-15.46528 -1.36842 TD
0.24 Tw
(conventional treatment)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 416.7588 280.2513 Tm
0 0 0 1 k
(28)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 427.3661 277.0912 Tm
0 0 0 1 k
-0.005 Tc
0.24 Tw
(suggest that autologous)Tj
-10.88064 -1.36842 TD
0.229 Tw
(serum tears are effective in improving symptoms)Tj
T*
-0.008 Tw
(and signs of severe or refractory DED\321although, in)Tj
T*
-0.036 Tw
[(one of these studies, only nonsignificant trends w)5(e)5(r)5(e)]TJ
T*
-0.01 Tc
0 Tw
(observed.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 359.276 228.2513 Tm
0 0 0 1 k
-0.005 Tc
(29)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 368.1125 225.0913 Tm
0 0 0 1 k
-0.0101 Tc
(A)Tj
1.07264 0 Td
-0.01 Tc
0.065 Tw
[(randomized study in post\320laser)37(-assist)-1(-)]TJ
-5.71606 -1.36842 TD
-0.016 Tw
[(ed in situ keratomileusis \(L)-5(A)-5(S)-5(I)-5(K)-5(\))-5( )-5(D)-5(E)-5(D)-5( )-5(d)-5(e)-5(m)-5(o)-5(n)-5(s)-5(t)-5(r)-5(a)-5(t)-5(-)]TJ
T*
-0.005 Tc
0.064 Tw
(ed significant improvement in rose bengal staining)Tj
T*
0.103 Tw
(and TBUT)Tj
4.4252 0.00001 TD
-0.0051 Tc
(,)Tj
0.5924 0 Td
-0.005 Tc
(but not in the Schirmer test or symp-)Tj
-5.0176 -1.36843 TD
0.114 Tw
(tom scores, with autologous serum tears compared)Tj
0 -1.36842 TD
0.205 Tw
(with artificial tears.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 401.4804 163.2513 Tm
0 0 0 1 k
(31)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 411.7557 160.0913 Tm
0 0 0 1 k
-0.005 Tc
0.205 Tw
(Differences in efficacy may)Tj
-9.23744 -1.36842 TD
0.129 Tw
(result from differences in pro)Tj
11.97958 0.00001 TD
(duction, storage, and)Tj
-11.97958 -1.36843 TD
0.041 Tw
[(treatment protocols. An optimized pro)-10(duction pro-)]TJ
0 -1.36842 TD
0.025 Tw
(tocol has recently been published.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 453.8985 124.2513 Tm
0 0 0 1 k
(2)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 336 108.0913 Tm
0 0 0 1 k
-0.005 Tc
0.375 Tw
(Few complications have been reported with)Tj
-1.26316 -1.36842 TD
0.161 Tw
[(autologous serum tears; however)55(, circulating anti-)]TJ
T*
-0.02 Tw
[(bo)-10(dies in serum could theoretically cause an inflam-)]TJ
ET
Q
endstream
endobj
8 0 obj
<<
/Length 14017
>>
stream
/GS0 gs
1 g
0 774 0 0 re
f
q
/GS1 gs
0 0 0 0 k
47.52 713.378 480.528 17.322 re
f
Q
/GS1 gs
q
BT
/F14 1 Tf
10 0 0 10 396.9735 722.2516 Tm
0 0 0 1 k
-0.0051 Tc
(M)Tj
0.88387 0.00001 TD
-0.005 Tc
0.025 Tw
(anagement of Dry Eye Disease)Tj
ET
0 0 0 0 k
47.52 28.7999 480.528 16 re
f
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
7.5 0 0 7.5 48.52 35.6064 Tm
0 0 0 1 k
(V)Tj
0.71216 0.00001 TD
0.025 Tw
(OL. 14, NO. 3)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
5 0 0 5 195.3852 35.6064 Tm
0.95 0.44 0 0.32 k
(n)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
7.5 0 0 7.5 202.9401 35.6064 Tm
0 0 0 1 k
0.025 Tw
(THE AMERICAN JOURNAL OF MANAGED CARE)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
5 0 0 5 377.8499 35.6064 Tm
0.95 0.44 0 0.32 k
(n)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F13 1 Tf
11 0 0 11 508.703 35.6064 Tm
0.95 0.44 0 0.32 k
(S91)Tj
ET
0.25 w
0 0 0 1 K
47.52 54 m
526.226 54 l
S
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 47.52 705.4658 Tm
0 0 0 1 k
-0.005 Tc
0.15 Tw
(matory response.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 112.5275 708.626 Tm
0 0 0 1 k
(27)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 122.279 705.4658 Tm
0 0 0 1 k
-0.005 Tc
0.15 Tw
(Other potential adverse effects)Tj
-7.86937 -1.36842 TD
-0.035 Tw
((AEs) from prolonged exposure of the ocular surface)Tj
T*
0.025 Tw
(to serum components have not been ruled out.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 225.9403 682.626 Tm
0 0 0 1 k
(28)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
9 0 0 9 47.52 653.4659 Tm
0.95 0.44 0 0.32 k
(T)Tj
0.46093 0.00001 TD
0.028 Tw
[(ear r)30(et)19(ention)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 59.52 640.4659 Tm
0 0 0 1 k
-0.005 Tc
0.023 Tw
(Lacrimal outflow occlusion slows tear clearance,)Tj
-1.26316 -1.36842 TD
0.074 Tw
(and is indicated in patients with aqueous-deficient)Tj
T*
0 Tw
(DED.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 68.7028 617.626 Tm
0 0 0 1 k
(2)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 75.1014 614.4659 Tm
0 0 0 1 k
-0.005 Tc
0.113 Tw
[(However)55(, it is relatively contraindicated in)]TJ
-2.90331 -1.36842 TD
0.187 Tw
(the presence of clinically apparent inflammation.)Tj
T*
0.086 Tw
(When inflammation is present, occlusion prolongs)Tj
T*
0.084 Tw
(ocular surface exposure to abnormal tears contain-)Tj
T*
-0.004 Tc
0.374 Tw
(ing proinflammatory cytokines; therefore, treat-)Tj
T*
0.001 Tc
0.369 Tw
(ment of inflammation before plug insertion is)Tj
T*
-0.005 Tc
0.025 Tw
(usually recommended.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 132.2687 539.626 Tm
0 0 0 1 k
(2,32,33)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F21 1 Tf
9.5 0 0 9.5 59.52 523.4659 Tm
0 0 0 1 k
-0.005 Tc
-0.013 Tw
(Punctal plugs)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 108.7277 523.4659 Tm
0 0 0 1 k
-0.005 Tc
-0.013 Tw
(are the most commonly used means)Tj
-6.44292 -1.36842 TD
-0.026 Tw
(of occlusion, and have been shown to improve DED)Tj
T*
0.031 Tw
(symptoms and signs in a number of clinical studies.)Tj
T*
0.018 Tw
(There are 2 main types of punctal plugs: absorbable)Tj
T*
0.141 Tw
(and nonabsorbable. Absorbable plugs are made of)Tj
T*
0.06 Tw
(collagen or various polymers, and may last for days)Tj
T*
0.087 Tw
(to months.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 89.5592 448.626 Tm
0 0 0 1 k
(2)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 95.7153 445.4659 Tm
0 0 0 1 k
-0.005 Tc
0.087 Tw
(Some newer absorbable materials may)Tj
-5.07319 -1.36842 TD
0.212 Tw
(last as long as 6 months.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 149.2474 435.626 Tm
0 0 0 1 k
(33)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 159.5887 432.4659 Tm
0 0 0 1 k
-0.005 Tc
0.212 Tw
(Nonabsorbable plugs,)Tj
-11.7967 -1.36842 TD
0.182 Tw
(often made of silicone or hydrophilic acrylic, are)Tj
T*
0.025 Tw
(intended to be permanent. )Tj
1.26316 -1.36842 TD
-0.0051 Tc
(A)Tj
1.32641 0 Td
-0.005 Tc
0.309 Tw
(common complication of punctal plugs is)Tj
-2.58957 -1.36842 TD
0.15 Tw
(epiphora (tear overflow). Mild epiphora has been)Tj
T*
0.056 Tw
(reported in up to 36% of patients. Epiphora is usu)Tj
20.24408 0 TD
0 Tc
(-)Tj
-20.24408 -1.36842 TD
-0.005 Tc
0.13 Tw
(ally well tolerated, but as many as 5% of patients)Tj
T*
0.375 Tw
(request plug removal.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 135.6801 344.626 Tm
0 0 0 1 k
-0.005 Tc
(33)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 147.5109 341.4659 Tm
0 0 0 1 k
-0.005 Tc
0.375 Tw
(Other AEs include in-)Tj
-10.52536 -1.36842 TD
0 Tw
(fection)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 74.092 331.626 Tm
0 0 0 1 k
(2)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 81.802 328.4659 Tm
0 0 0 1 k
-0.005 Tc
0.254 Tw
(and conjunctival irritation.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 190.0227 331.626 Tm
0 0 0 1 k
-0.005 Tc
(33)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 200.7026 328.4659 Tm
0 0 0 1 k
-0.005 Tc
(Short-term)Tj
-16.12448 -1.36842 TD
0.217 Tw
(absorbable plugs may be used initially to predict)Tj
T*
0.056 Tw
(which patients are likely to tolerate nonabsorbable)Tj
T*
-0.016 Tw
[(plugs; however)55(, this test is not completely reliable.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 237.03 292.626 Tm
0 0 0 1 k
-0.005 Tc
(33)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 59.52 276.4659 Tm
0 0 0 1 k
-0.005 Tc
0.106 Tw
(Spontaneous extrusion of plugs occurs in up to)Tj
-1.26316 -1.36842 TD
-0.016 Tw
(50% of patients within 3 months, requiring replace-)Tj
T*
0.026 Tw
(ment. In contrast, internal migration is uncommon)Tj
T*
0.27 Tw
(but troublesome, because removal of a migrated)Tj
T*
0.059 Tw
(plug may require surgery)Tj
9.78026 0.00001 TD
-0.0051 Tc
(.)Tj
0.54847 0 Td
-0.005 Tc
(If not removed, a migrat)Tj
9.91535 0.00001 TD
0 Tc
(-)Tj
-20.24408 -1.36844 TD
-0.005 Tc
0.116 Tw
(ed plug can cause complete occlusion, which may)Tj
0 -1.36842 TD
0.088 Tw
(lead to epiphora, infection, or fistulas. Newer plug)Tj
T*
0.064 Tw
(designs minimize the risk of spontaneous extrusion)Tj
T*
0.025 Tw
(or migration.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 97.2566 175.6259 Tm
0 0 0 1 k
(33)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F21 1 Tf
9.5 0 0 9.5 59.52 159.4658 Tm
0 0 0 1 k
-0.005 Tc
0.068 Tw
(Intracanalicular plugs)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 139.3458 159.4658 Tm
0 0 0 1 k
-0.005 Tc
0.068 Tw
(are an alternative to punc-)Tj
-9.66587 -1.36842 TD
0.071 Tw
(tal plugs with less risk of extrusion or conjunctival)Tj
T*
0.316 Tw
(irritation. However)Tj
7.99562 0.00001 TD
-0.0051 Tc
(,)Tj
0.80564 0 Td
-0.005 Tc
(canalicular inflammation or)Tj
-8.80126 -1.36843 TD
0.054 Tw
[(infection may occur)55(. Furthermore, removal is more)]TJ
0 -1.36842 TD
0.225 Tw
(difficult than with punctal plugs, requiring more)Tj
T*
0.025 Tw
(invasive procedures.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 124.3458 97.6259 Tm
0 0 0 1 k
(33)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F21 1 Tf
9.5 0 0 9.5 59.52 81.4658 Tm
0 0 0 1 k
-0.005 Tc
0.065 Tw
(Surgical occlusion)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 125.7802 81.4658 Tm
0 0 0 1 k
-0.005 Tc
0.065 Tw
[(\(eg, using electrocautery)74(, laser)55(,)]TJ
14.23367 65.68421 TD
0.023 Tw
(or glue\) is an option for patients who tolerate plugs)Tj
0 -1.36842 TD
0.219 Tw
[(but repeatedly extrude them. However)55(, the wide)]TJ
T*
0.076 Tw
(choice of reversible devices currently available has)Tj
T*
0.025 Tw
[(decreased the need for occlusive surgery)74(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 414.5908 669.626 Tm
0 0 0 1 k
(33)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F16 1 Tf
9.5 0 0 9.5 273 653.4659 Tm
0 0 0 1 k
-0.017 Tc
0.059 Tw
(Moisture spectacles/goggles)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 380.1412 653.4659 Tm
0 0 0 1 k
-0.015 Tc
0.053 Tw
(reduce tear evapora-)Tj
-12.54118 -1.36842 TD
0.246 Tw
(tion by increasing humidity around the eye. The)Tj
T*
0.057 Tw
[(patient\325)55(s glasses can be mo)-10(dified using commercially)]TJ
T*
0.145 Tw
(available top and side shields or swimming goggles)Tj
T*
0.015 Tw
(can be used.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 306.2617 604.626 Tm
0 0 0 1 k
-0.01 Tc
(34)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 314.5184 601.4659 Tm
0 0 0 1 k
-0.015 Tc
0.015 Tw
[(However)55(, evidence of efficacy is limit-)]TJ
-5.63351 -1.36842 TD
0 Tw
(ed)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 269.6815 591.626 Tm
0 0 0 1 k
(2)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 274.6128 588.4658 Tm
0 0 0 1 k
-0.015 Tc
-0.025 Tw
(and adherence may be poor for cosmetic reasons.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 453.4799 591.626 Tm
0 0 0 1 k
(1)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F16 1 Tf
9.5 0 0 9.5 273 575.4659 Tm
0 0 0 1 k
-0.006 Tc
-0.027 Tw
(Therapeutic contact lenses)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 380.3043 575.4659 Tm
0 0 0 1 k
-0.005 Tc
-0.024 Tw
(\(also called bandage)Tj
-12.55835 -1.36842 TD
-0.031 Tw
(contact lenses\) may be used in severe DED, or when)Tj
T*
0.008 Tw
(other therapy has failed, to help retain the tear film)Tj
T*
0.055 Tw
(and/or promote ocular surface healing.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 408.7195 539.626 Tm
0 0 0 1 k
(35)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 417.5684 536.4659 Tm
0 0 0 1 k
-0.005 Tc
0.055 Tw
(For exam-)Tj
-16.48088 -1.36842 TD
0.026 Tw
(ple, therapeutic contact lenses may be useful in the)Tj
T*
0.083 Tw
(management of filamentary keratitis.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 403.0236 513.626 Tm
0 0 0 1 k
(35-37)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 420.1389 510.4659 Tm
0 0 0 1 k
-0.005 Tc
[(However)55(,)]TJ
-16.75146 -1.36842 TD
0.197 Tw
(because contact lenses can also exacerbate DED,)Tj
T*
0.198 Tw
(patients using them for DED must be monitored)Tj
T*
0 Tw
(closely)Tj
2.61102 0.00001 TD
0 Tc
(.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 288.1322 474.626 Tm
0 0 0 1 k
(35)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 273 458.4659 Tm
0 0 0 1 k
-0.005 Tc
0.014 Tw
(Silicone hydrogel lenses have been recommend-)Tj
-1.26316 -1.36842 TD
0 Tw
(ed for use in DED because of their high oxygen per-)Tj
T*
-0.024 Tw
(meability and relatively low water content. The low)Tj
T*
0.001 Tw
(water content makes them less likely to dehydrate)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 450.4801 422.626 Tm
0 0 0 1 k
(35)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 261 406.4659 Tm
0 0 0 1 k
-0.005 Tc
0.025 Tw
(in the presence of a hyperosmolar tear film.)Tj
1.26316 -1.36842 TD
0.06 Tw
(The Boston scleral lens is a therapeutic contact)Tj
-1.26316 -1.36842 TD
-0.003 Tw
[(lens that is custom-manufactured using a computer)37(-)]TJ
T*
0.082 Tw
(assisted design program.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 352.93 370.626 Tm
0 0 0 1 k
(38,39)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 369.541 367.4659 Tm
0 0 0 1 k
-0.005 Tc
0.082 Tw
(It is a rigid gas-perme)Tj
8.8187 0 TD
0 Tc
(-)Tj
-20.24406 -1.36842 TD
-0.005 Tc
-0.025 Tw
(able lens that vaults the cornea and rests entirely on)Tj
T*
-0.015 Tc
-0.003 Tw
[(t)-10(he sclera, creating a fluid-filled precorneal space.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 443.2199 344.626 Tm
0 0 0 1 k
-0.01 Tc
(38,40)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 261 328.4659 Tm
0 0 0 1 k
-0.005 Tc
0.126 Tw
[(In this way)74(, it provides a \322liquid bandage\323 for the)]TJ
0 -1.36842 TD
0.266 Tw
(corneal surface, reducing or eliminating desicca-)Tj
T*
0.233 Tw
[(tion, hyperosmolarity)74(, and friction with the eye-)]TJ
T*
0 Tw
(lids.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 276.3277 292.626 Tm
0 0 0 1 k
(39)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 288.1696 289.4659 Tm
0 0 0 1 k
-0.005 Tc
0.37 Tw
(It is also fluid-ventilated\321designed with)Tj
-2.85995 -1.36842 TD
0.289 Tw
(channels that allow tears to flow into the pre-)Tj
T*
0.132 Tw
(corneal space, avoiding the development of nega-)Tj
T*
0.025 Tw
(tive pressure.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 310.6683 253.6259 Tm
0 0 0 1 k
(38,40)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 273 237.4658 Tm
0 0 0 1 k
-0.005 Tc
0.028 Tw
(The Boston scleral lens is indicated for manage-)Tj
-1.26316 -1.36842 TD
0.023 Tw
(ment of severe, refractory ocular surface disease, for)Tj
T*
0.013 Tw
(example, to relieve disabling pain and photophobia)Tj
T*
0.187 Tw
(or treat persistent epithelial defects.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 403.62 201.626 Tm
0 0 0 1 k
(38-40)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 421.7183 198.4658 Tm
0 0 0 1 k
-0.005 Tc
0.187 Tw
(It is also)Tj
-16.91771 -1.36842 TD
0.163 Tw
(used to improve visual acuity when conventional)Tj
T*
0.015 Tc
0.406 Tw
(lenses are inadequate or are not tolerated.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 450.3601 175.6259 Tm
0 0 0 1 k
0.02 Tc
(38)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 261 159.4658 Tm
0 0 0 1 k
-0.005 Tc
0.015 Tw
(Successful use has been reported in DED, including)Tj
0 -1.36842 TD
0.027 Tw
(DED with filamentary keratitis)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 378.7766 149.6259 Tm
0 0 0 1 k
(38,40)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 394.8626 146.4659 Tm
0 0 0 1 k
-0.005 Tc
0.027 Tw
(and severe DED)Tj
-14.0908 -1.36842 TD
0.19 Tw
(secondary to graft-versus-host disease,)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 409.5841 136.6259 Tm
0 0 0 1 k
(38,39)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 427.2187 133.4659 Tm
0 0 0 1 k
-0.005 Tc
(Sj\232gren)Tj
-17.4967 -1.36842 TD
(syndrome,)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 299.8739 123.626 Tm
0 0 0 1 k
(38)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 309.0984 120.4658 Tm
0 0 0 1 k
-0.005 Tc
0.094 Tw
(or radiation.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 356.855 123.626 Tm
0 0 0 1 k
(38)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 366.0794 120.4658 Tm
0 0 0 1 k
-0.005 Tc
0.094 Tw
(Additional information)Tj
-11.06099 -1.36842 TD
0.048 Tw
(about the Boston scleral lens can be obtained from)Tj
T*
0.286 Tw
[(the Boston Foundation for Sight at http://www)74(.)]TJ
T*
0.025 Tw
(bostonsight.org or (781) 726-7337.)Tj
ET
Q
endstream
endobj
9 0 obj
<<
/Length 11915
>>
stream
/GS0 gs
1 g
0 774 0 0 re
f
/GS1 gs
q
BT
/F16 1 Tf
9.5 0 0 9.5 122.52 705.0912 Tm
0 0 0 1 k
-0.006 Tc
[(T)91(arsorrhaphy)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 178.2168 705.0912 Tm
0 0 0 1 k
-0.005 Tc
-0.001 Tw
((closure of the eyelids) is reserved)Tj
-7.12598 -1.36842 TD
0.025 Tw
(for severe or refractory DED.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 220.0508 695.2513 Tm
0 0 0 1 k
(1,34)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 233.1159 692.0913 Tm
0 0 0 1 k
-0.005 Tc
0.025 Tw
[(Metho)-10(ds include:)]TJ
-11.64167 -2.84211 TD
0.19 Tw
[-452(Short-term tarsorrhaphy using, for example,)]TJ
1.05263 -1.1579 TD
0.008 Tw
(tape, adhesive glue (lasts a few days), or botu-)Tj
0 -1.15789 TD
0.025 Tw
(linum toxin (lasts an average of 16 days).)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 289.9246 646.2512 Tm
0 0 0 1 k
(41)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 122.52 632.0912 Tm
0 0 0 1 k
-0.005 Tc
0.136 Tw
[-452(T)111(emporary suture tarsorrhaphy \(lasts as long)]TJ
1.05263 -1.15789 TD
0.025 Tw
(as 4-6 weeks\).)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 185.87 624.2513 Tm
0 0 0 1 k
(41)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 122.52 610.0912 Tm
0 0 0 1 k
-0.01 Tc
-0.032 Tw
[-457(\322Permanent\323 tarsorrhaphy)74(. The lid margins are)]TJ
1.05263 -1.1579 TD
0.001 Tw
[(excised and sutured so that they heal together)55(.)]TJ
0 -1.15789 TD
0.025 Tw
[(The procedure can be reversed later)55(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 269.5328 591.2513 Tm
0 0 0 1 k
-0.005 Tc
(41)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 122.52 561.0912 Tm
0 0 0 1 k
-0.005 Tc
-0.028 Tw
(In most cases, only the lateral portions of the lids)Tj
-1.26316 -1.36842 TD
-0.029 Tw
(are closed to narrow the palpebral aperture, decreas-)Tj
T*
0 Tc
0.226 Tw
(ing evaporation.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 175.4504 538.2512 Tm
0 0 0 1 k
(34,41)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 193.4759 535.0912 Tm
0 0 0 1 k
-0.0001 Tc
(A)Tj
1.25415 0 Td
0 Tc
0.226 Tw
(partially open eye allows)Tj
-9.98635 -1.36842 TD
-0.005 Tc
0.058 Tw
[(p)-15(a)-15(r)-15(tial vision, administration of drops, and corneal)]TJ
T*
0.149 Tw
(examination; it also allows more oxygen to reach)Tj
T*
0.053 Tw
(the cornea.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 153.7533 499.2513 Tm
0 0 0 1 k
(41)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 162.5852 496.0913 Tm
0 0 0 1 k
-0.005 Tc
0.053 Tw
[(However)55(, if partial closure fails, com-)]TJ
-5.48055 -1.36842 TD
0.025 Tw
(plete closure may be indicated.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 228.4122 486.2513 Tm
0 0 0 1 k
(34)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 122.52 470.0913 Tm
0 0 0 1 k
-0.005 Tc
0.321 Tw
(In a retrospective review of 77 tarsorrhaphy)Tj
-1.26316 -1.36842 TD
-0.033 Tw
(patients, complications included trichiasis \(ingrown)Tj
T*
0.254 Tw
(eyelashes\) in 18.2%; adhesion of the upper and)Tj
T*
0.044 Tw
(lower lids after tarsorrhaphy removal in 2.6%; pyo-)Tj
T*
0.089 Tw
(genic granuloma in 1.3%; and keloid formation in)Tj
T*
0.008 Tc
0.362 Tw
(1.3%. All of these complications occurred in)Tj
T*
0.006 Tc
0.364 Tw
(patients with permanent tarsorrhaphies. Other)Tj
T*
-0.005 Tc
0.235 Tw
(reported complications have included lid margin)Tj
T*
0.048 Tw
(deformities, suture granulomas, focal cellulitis, skin)Tj
T*
0.025 Tw
(breakdown, and distichiasis.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 217.2923 356.2513 Tm
0 0 0 1 k
(41)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
9 0 0 9 110.52 327.0913 Tm
0.95 0.44 0 0.32 k
0.028 Tw
[(T)150(ear stimulation:)-281(secr)30(etag)20(ogues)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F16 1 Tf
9.5 0 0 9.5 122.52 314.0913 Tm
0 0 0 1 k
-0.006 Tc
-0.027 Tw
(Cholinergic agents)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 196.7493 314.0913 Tm
0 0 0 1 k
-0.005 Tc
-0.024 Tw
(\(ie, muscarinic acetylcholine)Tj
-9.07677 -1.36842 TD
0.267 Tw
(receptor agonists\) are sometimes given orally to)Tj
T*
-0.004 Tc
0.374 Tw
(treat aqueous-deficient DED. T)Tj
13.53101 0 TD
(wo agents, pilo-)Tj
-13.53101 -1.36842 TD
-0.005 Tc
0.085 Tw
(carpine and cevimeline, have FDA-approved indi)Tj
20.24391 0.00001 TD
0 Tc
(-)Tj
-20.24391 -1.36843 TD
-0.005 Tc
0.067 Tw
(cations for treatment of dry mouth associated with)Tj
0 -1.36841 TD
0.165 Tw
(Sj\232gren syndrome; however)Tj
11.34118 0.00001 TD
-0.0051 Tc
(,)Tj
0.65506 0 Td
-0.005 Tc
(they are off-label for)Tj
-11.99624 -1.36843 TD
0.025 Tw
(treatment of dry eye.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 189.8678 239.2512 Tm
0 0 0 1 k
(42,43)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F21 1 Tf
9.5 0 0 9.5 122.52 223.0913 Tm
0 0 0 1 k
-0.005 Tc
(Pilocarpine.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 167.8073 223.0913 Tm
0 0 0 1 k
-0.005 Tc
0.085 Tw
[(T)129(wo multicenter)55(, 12-week, random-)]TJ
-6.03024 -1.36842 TD
0.256 Tw
(ized, placebo-controlled trials of oral pilocarpine)Tj
T*
0.313 Tw
(have been conducted, involving a total of 629)Tj
T*
0.294 Tw
(patients with Sj\232gren syndrome. In these trials,)Tj
T*
0.373 Tw
(pilocarpine significantly improved global assess-)Tj
T*
-0.028 Tw
(ment of DED symptoms)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 200.3241 161.2512 Tm
0 0 0 1 k
(44-46)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 216.3862 158.0913 Tm
0 0 0 1 k
-0.005 Tc
-0.028 Tw
(at doses of 5.0 to 7.5 mg)Tj
-11.14381 -1.36842 TD
0 Tw
(QID.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 130.1141 148.2513 Tm
0 0 0 1 k
(46)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 139.447 145.0913 Tm
0 0 0 1 k
-0.005 Tc
0.106 Tw
(Pilocarpine also significantly decreased the)Tj
-3.04495 -1.36842 TD
0.234 Tw
(use of artificial tears and improved salivary flow)Tj
T*
0.025 Tw
((measured by 5-minute saliva sample collection).)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 297.7521 122.2512 Tm
0 0 0 1 k
(44)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 122.52 106.0913 Tm
0 0 0 1 k
-0.0052 Tc
(A)Tj
1.10692 0 Td
-0.005 Tc
0.089 Tw
[(single-center)55(, randomized trial of pilocarpine)]TJ
-2.37008 -1.36842 TD
-0.034 Tw
((5 mg BID) versus punctal occlusion versus artificial)Tj
T*
0.032 Tw
(tears alone involved 85 Sj\232gren syndrome patients.)Tj
22.47141 65.78947 TD
0.148 Tw
((All patients received artificial tears.) Pilocarpine)Tj
0 -1.36842 TD
0.15 Tw
(significantly improved global symptom assessment)Tj
T*
0.156 Tw
(compared with the other 2 groups; it also signifi-)Tj
T*
0.001 Tc
0.368 Tw
(cantly improved rose bengal staining, but not)Tj
T*
-0.005 Tc
0.025 Tw
(Schirmer scores or goblet cell numbers.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 473.6648 656.2513 Tm
0 0 0 1 k
(47)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 335.9984 640.0912 Tm
0 0 0 1 k
-0.005 Tc
0.106 Tw
(In the placebo-controlled trials, the most com-)Tj
-1.26316 -1.36842 TD
0.077 Tw
(mon drug-related AE was sweating.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 460.6581 630.2513 Tm
0 0 0 1 k
(44-46)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 477.7113 627.0912 Tm
0 0 0 1 k
-0.005 Tc
0.077 Tw
(Other AEs)Tj
-16.18031 -1.36842 TD
-0.016 Tw
(probably related to pilocarpine included urinary fre-)Tj
T*
0.093 Tw
[(quency)74(, flushing, and hypersalivation.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 469.7653 604.2512 Tm
0 0 0 1 k
(46)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 478.9783 601.0912 Tm
0 0 0 1 k
-0.005 Tc
(Headache,)Tj
-16.31367 -1.36842 TD
0.17 Tw
(nausea, rhinitis, and dizziness were also common,)Tj
T*
0.24 Tw
(but occurred with similar frequency in the pilo-)Tj
T*
0.201 Tw
(carpine and placebo groups.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 435.011 565.2512 Tm
0 0 0 1 k
(46)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 445.2508 562.0912 Tm
0 0 0 1 k
-0.005 Tc
0.201 Tw
(AEs were typically)Tj
-12.76341 -1.36842 TD
0.13 Tw
[(mild to mo)-10(derate, and were roughly dose-depend-)]TJ
T*
0 Tw
(ent.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 338.8425 539.2513 Tm
0 0 0 1 k
(46)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 349.2932 536.0912 Tm
0 0 0 1 k
-0.005 Tc
0.223 Tw
(No serious AEs were reported.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 472.193 539.2513 Tm
0 0 0 1 k
(44-46)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 490.6404 536.0912 Tm
0 0 0 1 k
-0.005 Tc
(Among)Tj
-17.54126 -1.36842 TD
0.134 Tw
(patients receiving pilocarpine 5.0 to 7.5 mg QID,)Tj
T*
0.076 Tw
(3.9% to 8.6% withdrew because of AEs, compared)Tj
T*
0.025 Tw
(with 4.0% to 4.7% of those receiving placebo.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 500.263 500.2513 Tm
0 0 0 1 k
(44)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F21 1 Tf
9.5 0 0 9.5 335.9984 484.0913 Tm
0 0 0 1 k
-0.005 Tc
(Cevimeline.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 382.7277 484.0913 Tm
0 0 0 1 k
-0.005 Tc
0.176 Tw
[(T)129(wo multicenter)55(, randomized trials)]TJ
-6.18203 -1.36842 TD
0.049 Tw
(of oral cevimeline have been conducted, involving)Tj
-0.0051 Tc
(a)'
0.81112 0 Td
-0.005 Tc
0.127 Tw
(total of 257 patients with Sj\232gren syndrome. In)Tj
-0.81112 -1.36842 TD
0.308 Tw
(the first trial, 197 patients were randomized to)Tj
T*
0.167 Tw
(cevimeline (15 or 30 mg TID) or placebo for 12)Tj
T*
0.003 Tw
(weeks. The 30-mg dose significantly improved both)Tj
T*
0.325 Tw
(Schirmer scores and global symptom self-assess-)Tj
T*
0.002 Tw
(ment, compared with placebo. The 15-mg dose also)Tj
T*
0.243 Tw
(relieved some symptoms and improved Schirmer)Tj
T*
0.116 Tw
(scores, but less so than the higher dose. Common)Tj
T*
0.148 Tw
(drug-related AEs included increased sweating and)Tj
T*
0.034 Tw
(nausea. Headache and diarrhea were also common,)Tj
T*
0.051 Tw
(but occurred with similar frequency in the cevime-)Tj
T*
0.092 Tw
(line and placebo groups. AEs led to withdrawal in)Tj
T*
-0.012 Tw
(16.1% of the cevimeline 30-mg group, 13.8% of the)Tj
T*
0.025 Tw
(15-mg group, and 4.3% of the placebo group.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 496.139 292.2513 Tm
0 0 0 1 k
(48)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
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T*
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0.166 Tw
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T*
-0.016 Tw
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0 -1.1579 TD
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0.362 Tw
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0.109 Tw
(improved symptom scores on days 15 and 30,)Tj
T*
-0.034 Tw
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T*
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T*
0.025 Tw
(with the other 2 treatments.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
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0 0 0 1 k
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(50)Tj
ET
Q
/GS2 gs
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BT
/F14 1 Tf
9.5 0 0 9.5 59.52 427.5521 Tm
0 0 0 1 k
Tj
1.05263 0 TD
-0.005 Tc
0.003 Tw
(In a double-blind, placebo-controlled trial, 64)Tj
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0.133 Tw
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T*
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T*
0.231 Tw
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0.412 Tw
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T*
0.061 Tw
(inflammation are more likely to show signifi-)Tj
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(cant benefits with loteprednol.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
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/F14 1 Tf
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0 0 0 1 k
(51)Tj
ET
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(In a double-blind trial, 41 DED patients each)Tj
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0.358 Tw
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(52)Tj
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T*
0.313 Tw
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T*
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T*
0.025 Tw
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T*
0.025 Tw
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0.454 Tw
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ET
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(55)Tj
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-0.01 Tc
0.078 Tw
(It has been suggested that reduction of bacterial)Tj
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0.042 Tw
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T*
-0.01 Tc
0.089 Tw
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(-)Tj
-20.28865 -1.36843 TD
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0.198 Tw
(terial actions. Mechanisms may include decreased)Tj
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0.34 Tw
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13.87665 0.00001 TD
-0.0051 Tc
(,)Tj
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-0.005 Tc
(and decreased)Tj
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0.231 Tw
[(pro)-10(duction of proinflammatory cytokines such as)]TJ
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0.01 Tw
(interleukin (IL)-1 and tumor necrosis factor)Tj
17.53643 0.00001 TD
0 Tw
(-alpha.)Tj
ET
Q
/GS2 gs
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/F14 1 Tf
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(2)Tj
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0.101 Tw
(Several small, randomized clinical trials, mostly in)Tj
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0.022 Tw
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1.26316 -2.31579 TD
0 Tc
Tj
1.05263 0.00001 TD
-0.005 Tc
0.037 Tw
(Oral oxytetracycline, topical fusidic acid, and)Tj
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0.134 Tw
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-0.017 Tw
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0.182 Tw
(double-blind, partial crossover study involv)Tj
17.97289 0.00001 TD
0 Tc
(-)Tj
-17.97289 -1.15791 TD
-0.005 Tc
0.043 Tw
(ing 43 patients with long-term blepharitis \(of)Tj
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T*
0.284 Tw
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(-)Tj
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/GS2 gs
/GS1 gs
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(58)Tj
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/GS2 gs
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/F14 1 Tf
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0 0 0 1 k
-0.005 Tc
0.208 Tw
(No randomized trials of doxycycline or mino-)Tj
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0.02 Tc
0.268 Tw
(cycline for ocular rosacea or DED have been)Tj
T*
-0.005 Tc
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[(p)-25(u)-25(b)-25(lished.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F16 1 Tf
9.5 0 0 9.5 122.52 432.0913 Tm
0 0 0 1 k
-0.006 Tc
0.089 Tw
[(T)91(opical cyclosporine)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 205.2373 432.0913 Tm
0 0 0 1 k
-0.005 Tc
0.08 Tw
(was approved by the FDA)Tj
-9.97024 -1.36842 TD
0.072 Tw
[(in December 2002. According to pro)-10(duct informa-)]TJ
T*
0.007 Tc
0.363 Tw
(tion, cyclosporine ophthalmic emulsion 0.05%)Tj
T*
-0.005 Tc
0.091 Tw
[((Restasis) is indicated \322to increase tear pro)-10(duction)]TJ
T*
0.012 Tw
(in patients whose tear pro)Tj
10.36578 0 TD
(duction is presumed to be)Tj
-10.36578 -1.36842 TD
0.212 Tw
(suppressed due to ocular inflammation associated)Tj
T*
0.078 Tw
(with keratoconjunctivitis sicca. Increased tear pro-)Tj
T*
0.16 Tw
(duction was not seen in patients currently taking)Tj
T*
0.268 Tw
(topical anti-inflammatory drugs or using punctal)Tj
T*
0 Tw
(plugs.\323)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 135.7746 318.2513 Tm
0 0 0 1 k
(59)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 122.52 302.0913 Tm
0 0 0 1 k
(T)Tj
0.55116 0 TD
-0.005 Tc
0.082 Tw
(opical cyclosporine is currently the only phar-)Tj
-1.81432 -1.36842 TD
0.062 Tw
(macologic treatment that is FDA approved specifi)Tj
20.28866 0 TD
0 Tc
(-)Tj
-20.28866 -1.36842 TD
0.015 Tc
0.444 Tw
(cally for DED. As previously noted, topical)Tj
T*
0.007 Tc
0.363 Tw
(corticosteroids are approved for corticosteroid-)Tj
T*
-0.005 Tc
0.212 Tw
(responsive inflammatory conditions of the ocular)Tj
T*
0.003 Tc
0.367 Tw
(surface (which presumably include DED); oral)Tj
T*
0.366 Tw
(doxycycline is approved for inflammatory skin)Tj
T*
-0.005 Tc
0.08 Tw
(lesions of rosacea (but not for ocular rosacea); and)Tj
T*
0.255 Tw
(pilocarpine and cevimeline are approved for dry)Tj
T*
0.064 Tw
(mouth (but not dry eye) symptoms associated with)Tj
T*
0.025 Tw
(Sj\232gren syndrome.)Tj
1.26316 -1.36842 TD
0.204 Tw
(Evidence suggests that cyclosporine is disease-)Tj
-1.26316 -1.36842 TD
0 Tw
(mo)Tj
1.2776 0.00001 TD
0.104 Tw
(difying rather than merely palliative. In studies)Tj
-1.2776 -1.36843 TD
0.009 Tw
(of DED patients, cyclosporine reduced conjunctival)Tj
0 -1.36842 TD
0.246 Tw
(IL-6 levels,)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 155.0187 123.2513 Tm
0 0 0 1 k
(60)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 165.6879 120.0913 Tm
0 0 0 1 k
-0.005 Tc
0.246 Tw
(decreased activated lymphocytes in)Tj
-5.80715 -1.36842 TD
0.091 Tw
(the conjunctiva,)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 173.9405 110.2512 Tm
0 0 0 1 k
(61)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 183.1372 107.0913 Tm
0 0 0 1 k
-0.005 Tc
0.091 Tw
(reduced conjunctival inflamma-)Tj
-7.64392 -1.36842 TD
0.077 Tw
(tory and apoptotic markers,)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 216.9318 97.2513 Tm
0 0 0 1 k
(62,63)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 233.4945 94.0913 Tm
0 0 0 1 k
-0.005 Tc
0.077 Tw
(and increased con-)Tj
-12.94469 -1.36842 TD
0.025 Tw
(junctival goblet cell numbers.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 223.7574 84.2513 Tm
0 0 0 1 k
(64)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F21 1 Tf
9.5 0 0 9.5 336.4237 705.0912 Tm
0 0 0 1 k
-0.005 Tc
0.172 Tw
(Pivotal clinical trials.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 417.3953 705.0912 Tm
0 0 0 1 k
-0.005 Tc
0.172 Tw
(The efficacy and safety of)Tj
-9.78648 -1.36842 TD
0.015 Tc
0.413 Tw
(cyclosporine ophthalmic emulsion \(0.1% and)Tj
T*
-0.005 Tc
0.167 Tw
[(0.05%\) in mo)-10(derate to severe DED were demon-)]TJ
T*
0.184 Tw
[(strated in two 6-month, multicenter)55(, randomized,)]TJ
T*
0.006 Tc
0.364 Tw
(double-blind, vehicle-controlled phase 3 trials.)Tj
T*
-0.005 Tc
0.299 Tw
(Although both cyclosporine and vehicle signifi-)Tj
T*
-0.001 Tc
0.371 Tw
(cantly decreased symptoms and objective signs)Tj
T*
-0.005 Tc
0.207 Tw
(compared with baseline, cyclosporine was signifi-)Tj
T*
0.254 Tw
(cantly more effective than vehicle in improving)Tj
T*
0.013 Tc
0.357 Tw
[(several efficacy outcomes. T)129(wo objective out-)]TJ
T*
0.015 Tc
0.518 Tw
(comes\321corneal fluorescein staining and the)Tj
T*
-0.005 Tc
0.217 Tw
(Schirmer test with anesthesia\321were significantly)Tj
T*
0.036 Tw
(more improved with cyclosporine \(both 0.05% and)Tj
T*
0.3 Tw
(0.1%\) than with vehicle. Three subjective out-)Tj
T*
0.037 Tw
(comes\321blurred vision, need for artificial tears, and)Tj
T*
0.015 Tw
[(physician\325)55(s evaluation of global response\321were sig-)]TJ
T*
0.139 Tw
(nificantly improved with cyclosporine 0.05% \(but)Tj
T*
0.126 Tw
(not 0.1%\) compared with vehicle. There were no)Tj
T*
0.033 Tw
(between-group differences in conjunctival staining,)Tj
T*
-0.001 Tc
0.371 Tw
(Schirmer test without anesthesia, or symptoms)Tj
T*
-0.005 Tc
0.025 Tw
(other than blurred vision.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 422.5619 448.2513 Tm
0 0 0 1 k
(65)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 336.4237 432.0913 Tm
0 0 0 1 k
0.255 Tw
(Most AEs reported during the phase 3 trials)Tj
-1.26316 -1.36842 TD
0.224 Tw
[(were mild to mo)-10(derate and transient. The most)]TJ
T*
0.088 Tw
(common treatment-related AEs were ocular burn-)Tj
T*
0.221 Tw
(ing and stinging, occurring in 16.1% and 4.5%,)Tj
T*
0 Tw
(respectively)Tj
4.69921 0 TD
-0.0001 Tc
(,)Tj
0.46938 0 Td
0 Tc
-0.03 Tw
(of the cyclosporine 0.1% group; 14.7%)Tj
-5.16859 -1.36842 TD
0.217 Tw
(and 3.4% of the cyclosporine 0.05% group; and)Tj
T*
0.336 Tw
(6.5% and 1.4% of the vehicle group. Burning)Tj
T*
0.129 Tw
(and/or stinging led to discontinuation in 3.1% of)Tj
T*
0.02 Tc
0.526 Tw
(the cyclosporine 0.1% group, 1.7% of the)Tj
T*
0 Tc
0.011 Tw
(cyclosporine 0.05% group, and 1.7% of the vehicle)Tj
T*
(group. The investigators noted that only 2 patients)Tj
T*
-0.017 Tw
((both in the vehicle group) developed ocular infec)Tj
20.28867 0 TD
(-)Tj
-20.28867 -1.36842 TD
0.025 Tw
(tion during treatment.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 410.619 279.2513 Tm
0 0 0 1 k
0.005 Tc
(65)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 336.4237 263.0913 Tm
0 0 0 1 k
-0.0152 Tc
(A)Tj
1.0045 0 Td
-0.015 Tc
(multicenter)Tj
4.49946 0.00001 TD
-0.0151 Tc
(,)Tj
0.47663 0 Td
-0.015 Tc
0.007 Tw
(nonrandomized, open-label, phase)Tj
-7.24375 -1.36843 TD
-0.0101 Tc
(3)Tj
0.81618 0 Td
-0.01 Tc
0.086 Tw
(extension trial was conducted to further evaluate)Tj
-0.81618 -1.36842 TD
0 Tw
(safety)Tj
2.14095 0.00001 TD
-0.0101 Tc
(.)Tj
0.509 0 Td
-0.01 Tc
0.029 Tw
(Four hundred twelve patients who had previ)Tj
17.63872 0.00001 TD
0 Tc
(-)Tj
-20.28867 -1.36844 TD
-0.002 Tc
0.367 Tw
(ously been treated with cyclosporine \(0.1% or)Tj
0 -1.36842 TD
-0.01 Tc
0.187 Tw
(0.05%\) for 6 to 12 months subsequently received)Tj
T*
-0.023 Tw
(cyclosporine 0.1% for an additional 1 to 3 years. The)Tj
T*
0.087 Tw
(most common AEs were burning (10.9%), stinging)Tj
T*
0.145 Tw
((3.9%), and conjunctival hyperemia (3.4%). Most)Tj
T*
0.01 Tc
0.396 Tw
(AEs were mild to mo)Tj
10.28304 0.00001 TD
(derate; no serious AEs)Tj
-10.28304 -1.36843 TD
-0.01 Tc
0.055 Tw
(occurred. Efficacy evaluation \(for the first year only)Tj
0 -1.36842 TD
-0.007 Tc
0.372 Tw
(of the extension studies\) showed that previous)Tj
T*
-0.01 Tc
0.028 Tw
(improvements in objective and subjective outcomes)Tj
T*
0.03 Tw
(were maintained. More than 95% of responding pa-)Tj
T*
0.19 Tw
(tients said they would continue cyclosporine, and)Tj
T*
-0.02 Tc
-0.009 Tw
(nearly 98% said they would recommend it to others.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 514.4172 84.2513 Tm
0 0 0 1 k
-0.015 Tc
(66)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
11 0 0 11 39.943 721.2969 Tm
0 0 0 1 k
0.01 Tc
(Reports)Tj
ET
0 0 0 0 k
38.949 28.7999 480.531 16 re
f
Q
/GS2 gs
/GS1 gs
q
BT
/F13 1 Tf
11 0 0 11 39.9489 35.6064 Tm
0.95 0.44 0 0.32 k
(S94)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
5 0 0 5 246.7298 35.6064 Tm
0.95 0.44 0 0.32 k
(n)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9 0 0 9 254.2847 35.6064 Tm
0 0 0 1 k
(www)Tj
1.927 0.00001 TD
(.ajmc.com)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
5 0 0 5 312.8631 35.6064 Tm
0.95 0.44 0 0.32 k
(n)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
7.5 0 0 7.5 479.7469 35.6064 Tm
0 0 0 1 k
0.025 Tw
(APRIL 2008)Tj
ET
0.25 w
0 0 0 1 K
40.774 54 m
519.48 54 l
S
Q
endstream
endobj
12 0 obj
<<
/Length 12510
>>
stream
/GS0 gs
1 g
0 774 0 0 re
f
/GS1 gs
q
BT
/F21 1 Tf
9.5 0 0 9.5 59.52 705.3012 Tm
0 0 0 1 k
-0.02 Tc
0.276 Tw
(Systemic exposure.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 131.3012 705.3012 Tm
0 0 0 1 k
-0.02 Tc
0.276 Tw
(In the phase 3 trials, cyclo-)Tj
-8.81907 -1.36842 TD
0.122 Tw
[(sporine bloo)-10(d levels were measured in 128 patients.)]TJ
T*
0.014 Tw
(Even after 9 to 12 months of treatment, trough levels)Tj
T*
0.102 Tw
[(were below the quantification limit of 0.1 ng/mL i)-15(n)]TJ
T*
-0.005 Tc
0.103 Tw
[(100% of samples collected from patients receivi)5(n)5(g)]TJ
T*
-0.01 Tc
0.072 Tw
[(0.05% cyclosporine, and in all but 5.5% of samp)10(l)10(e)10(s)]TJ
T*
-0.02 Tc
0.094 Tw
(collected from patients receiving 0.1% cyclosporine.)Tj
T*
0.025 Tw
(Among the 5.5%, none had levels >0.3 ng/mL.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 221.6994 617.4612 Tm
0 0 0 1 k
-0.015 Tc
(67)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 59.52 601.3011 Tm
0 0 0 1 k
-0.005 Tc
0.029 Tw
(Serial postdose samples were also collected from)Tj
-1.26316 -1.36842 TD
0.006 Tw
(26 patients after 9 to 12 months of treatment. Only)Tj
T*
0.072 Tw
(1.4% of samples\321all from patients receiving 0.1%)Tj
T*
0.061 Tw
(cyclosporine\321were above the quantification limit,)Tj
T*
0.025 Tw
(and those were barely detectable.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 174.2722 552.4612 Tm
0 0 0 1 k
(67)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 59.52 536.3011 Tm
0 0 0 1 k
-0.005 Tc
-0.021 Tw
[(These bloo)-10(d levels are orders of magnitude lower)]TJ
-1.26316 -1.36842 TD
0.169 Tw
(than those occurring during oral immunosuppres-)Tj
T*
0.209 Tw
(sive therapy with cyclosporine.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 170.695 513.4612 Tm
0 0 0 1 k
(67)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 181.009 510.3012 Tm
0 0 0 1 k
-0.005 Tc
0.209 Tw
(Furthermore, in)Tj
-14.05147 -1.36842 TD
0.16 Tw
(the extension studies, nonocular AEs occurred in)Tj
T*
0.023 Tw
[(only 1% of patients \(2 cases of mo)-10(derate headache,)]TJ
-0.0051 Tc
(1)'
0.95604 0 Td
-0.005 Tc
0.216 Tw
[(mo)-10(derate allergic reaction, and 1 mild case of)]TJ
-0.95603 -1.36842 TD
0 Tw
(alopecia\).)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 84.76 461.4613 Tm
0 0 0 1 k
(66)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 93.4556 458.3012 Tm
0 0 0 1 k
-0.005 Tc
0.039 Tw
(Thus, it can be concluded that the risk)Tj
-4.83533 -1.36842 TD
0.025 Tw
(of systemic toxicity is minimal.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F16 1 Tf
9.5 0 0 9.5 59.52 432.3012 Tm
0 0 0 1 k
(T)Tj
0.62457 0 TD
-0.006 Tc
0.28 Tw
(opical NSAIDs)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 131.778 432.3012 Tm
0 0 0 1 k
-0.005 Tc
0.252 Tw
(have been used off-label in)Tj
-8.86926 -1.36842 TD
0.107 Tw
[(DED. T)129(wo small randomized trials provide limited)]TJ
T*
0.025 Tw
[(evidence of efficacy)74(.)]TJ
1.26316 -2.10526 TD
-0.031 Tw
[-452(In a 28-day open-label trial, topical diclofenac)]TJ
1.05263 -1.15789 TD
0.011 Tw
(0.1% QID was compared with saline 5% QID)Tj
0 -1.1579 TD
0.218 Tw
(in 32 patients with secondary Sj\232gren syn-)Tj
T*
0.164 Tw
(drome and filamentary keratitis. Both treat-)Tj
0 -1.15789 TD
0.125 Tw
(ments resulted in disappearance of filaments)Tj
0 -1.1579 TD
0.327 Tw
(by day 28; however)Tj
8.61104 0 TD
-0.0051 Tc
(,)Tj
0.8168 0 Td
-0.005 Tc
(the diclofenac group)Tj
-9.42784 -1.1579 TD
0.005 Tc
0.166 Tw
(improved significantly more rapidly)Tj
14.95445 0 TD
0.0049 Tc
(.)Tj
0.6761 0 Td
0.005 Tc
0 Tw
(Symp)Tj
2.29774 0 TD
0 Tc
(-)Tj
-17.92829 -1.1579 TD
0.005 Tc
(to)Tj
0.84276 0 TD
-0.005 Tc
0.239 Tw
(matic improvement was also significantly)Tj
-0.84276 -1.1579 TD
0.025 Tw
(faster with diclofenac.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 153.5683 301.4613 Tm
0 0 0 1 k
(68)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 59.52 287.3012 Tm
0 0 0 1 k
Tj
1.05263 0 TD
-0.005 Tc
0.149 Tw
(In a 6-week open-label trial in 52 DED pa-)Tj
0 -1.1579 TD
0.007 Tw
(tients, topical ketorolac 0.4% significantly re-)Tj
0 -1.15789 TD
0.176 Tw
(duced symptoms and corneal staining when)Tj
0 -1.1579 TD
0.07 Tw
(used adjunctively during induction of topical)Tj
0 -1.15789 TD
0.242 Tw
(cyclosporine therapy)Tj
8.42322 0.00001 TD
-0.0051 Tc
(,)Tj
0.73146 0 Td
-0.005 Tc
(compared with cyclo)Tj
8.77361 0.00001 TD
0 Tc
(-)Tj
-17.92829 -1.15791 TD
-0.005 Tc
0.025 Tw
(sporine alone.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 122.9062 235.4613 Tm
0 0 0 1 k
(69)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.405 0 0 9.5 59.52 210.3012 Tm
0 0 0 1 k
-0.015 Tc
0.168 Tw
[(Despite some evidence of efficacy)74(, serious safety)]TJ
-1.27592 -1.36842 TD
-0.03 Tc
0.076 Tw
(concerns have been raised regarding the use of topical)Tj
T*
-0.015 Tc
0.257 Tw
(NSAIDs in DED. NSAIDs (especially diclofenac))Tj
T*
0.025 Tw
(reduce corneal sensitivity)Tj
9.8567 0.00001 TD
-0.0151 Tc
(,)Tj
0.49488 0 Td
-0.015 Tc
(potentially contributing to)Tj
-10.35158 -1.36843 TD
0.218 Tw
(corneal damage in DED by interfering with reflex)Tj
0 -1.36842 TD
0.102 Tw
(tearing and blinking. Cases of corneal melting have)Tj
T*
-0.025 Tw
(been reported, especially in postoperative settings.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
5.94 0 0 6 229.8727 135.4613 Tm
0 0 0 1 k
-0.01 Tc
(70,71)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.405 0 0 9.5 47.52 119.3012 Tm
0 0 0 1 k
-0.015 Tc
0.084 Tw
(Because topical NSAIDs can promote corneal melt-)Tj
0 -1.36842 TD
0.179 Tw
(ing in patients with a compromised ocular surface,)Tj
T*
0.094 Tw
(their use in DED is controversial. Some experts feel)Tj
T*
0.025 Tw
(that they have no role in the treatment of DED.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
9 0 0 9 261 705.889 Tm
0.95 0.44 0 0.32 k
0.028 Tw
[(Nutr)40(itional supplements)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F16 1 Tf
9.5 0 0 9.5 273 692.889 Tm
0 0 0 1 k
-0.006 Tc
0.03 Tw
[(Essential fatty acids \(EF)34(As\))]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 387.0222 692.889 Tm
0 0 0 1 k
-0.005 Tc
0.027 Tw
[(may)74(, theoretically)73(,)]TJ
-13.26549 -1.36842 TD
0.116 Tw
(benefit DED in 2 ways: by reducing inflammation)Tj
T*
0.346 Tw
(and by altering the composition of meibomian)Tj
T*
0 Tw
(lipids.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 283.6222 657.049 Tm
0 0 0 1 k
(72)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 291.8652 653.889 Tm
0 0 0 1 k
-0.005 Tc
-0.009 Tw
[(There are at least 2 EF)25(A nutritional supple-)]TJ
-3.24897 -1.36842 TD
0.059 Tw
(ments marketed specifically for DED: one contain-)Tj
T*
0.037 Tw
(ing omega-3 fatty acids from flaxseed and fish oil,)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 450.48 631.049 Tm
0 0 0 1 k
(73)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 261 614.889 Tm
0 0 0 1 k
-0.005 Tc
0.222 Tw
(and another containing a blend of omega-3 and)Tj
0 -1.36842 TD
-0.015 Tc
0.258 Tw
(omega-6 fatty acids \(docosahexaenoic acid/eicosa-)Tj
T*
-0.005 Tc
0.035 Tw
[(pentaenoic acid [DHA/EP)74(A] from co)-10(d liver oil and)]TJ
T*
0.277 Tw
(gamma-linolenic acid [GLA] from black currant)Tj
T*
-0.023 Tw
(seed oil, respectively\).)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 344.34 566.049 Tm
0 0 0 1 k
(74)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 352.4506 562.889 Tm
0 0 0 1 k
-0.005 Tc
-0.023 Tw
[(However)55(, evidence for EF)25(A)]TJ
-9.62638 -1.36842 TD
0.025 Tw
(efficacy is limited and conflicting. )Tj
1.26316 -1.36842 TD
0.199 Tw
[(Epidemiologic data from the W)55(omen\325)55(s Health)]TJ
-1.26316 -1.36842 TD
-0.022 Tw
(Study (WHS) showed an association between high-)Tj
T*
-0.007 Tw
(er dietary omega-3 fatty acid intake and a lower risk)Tj
T*
0.133 Tw
(of DED. Omega-6 fatty acid intake was not inde-)Tj
T*
0.072 Tw
[(pendently associated with DED; however)55(, a higher)]TJ
T*
0.089 Tw
(omega-6:omega-3 ratio was associated with signifi-)Tj
T*
0.015 Tw
(cantly greater DED risk.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 352.5678 462.049 Tm
0 0 0 1 k
(75)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 361.034 458.889 Tm
0 0 0 1 k
-0.005 Tc
0.015 Tw
(Several small clinical tri)Tj
9.71417 0 TD
0 Tc
(-)Tj
-20.24406 -1.36842 TD
-0.005 Tc
0.086 Tw
(als of EF)Tj
3.48943 0 TD
-0.0051 Tc
(A)Tj
1.10332 0 Td
-0.005 Tc
(nutritional supplements have also been)Tj
-4.59275 -1.36842 TD
0.025 Tw
(conducted (described below). )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F21 1 Tf
9.5 0 0 9.5 273 419.889 Tm
0 0 0 1 k
-0.005 Tc
0.215 Tw
(Omega-3 fatty acids.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 355.9415 419.889 Tm
0 0 0 1 k
-0.005 Tc
0.215 Tw
(In a randomized, double-)Tj
-9.99384 -1.36842 TD
-0.031 Tw
(blind, placebo-controlled trial involving 41 patients)Tj
T*
0.271 Tw
(with Sj\232gren syndrome, an omega-3 supplement)Tj
T*
0.018 Tw
(improved DED symptoms more than placebo; how-)Tj
T*
0 Tw
(ever)Tj
1.64553 0 TD
-0.0051 Tc
(,)Tj
0.54101 0 Td
-0.005 Tc
0.051 Tw
(the difference did not reach statistical signifi)Tj
18.05754 0 TD
0 Tc
(-)Tj
-20.24408 -1.36843 TD
-0.005 Tc
0.025 Tw
(cance \()Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F21 1 Tf
9.5 0 0 9.5 289.1223 354.889 Tm
0 0 0 1 k
(P)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 296.921 354.889 Tm
0 0 0 1 k
-0.005 Tc
(=)Tj
0.87096 0 Td
(.082\).)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 327.605 358.049 Tm
0 0 0 1 k
(76)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F21 1 Tf
9.5 0 0 9.5 273 341.889 Tm
0 0 0 1 k
-0.005 Tc
0.019 Tw
(Omega-6 fatty acids.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 350.3446 341.889 Tm
0 0 0 1 k
-0.005 Tc
0.019 Tw
(The WHS data suggest that)Tj
-9.40469 -1.36842 TD
0.356 Tw
(omega-6 fatty acid supplementation should not)Tj
T*
0.173 Tw
[(improve DED; however)55(, small clinical trials have)]TJ
T*
0.025 Tw
(given conflicting results:)Tj
1.26316 -2.52632 TD
-0.015 Tc
-0.007 Tw
[-462(T)129(wo randomized trials of omega-6 fatty acids in)]TJ
1.05263 -1.15789 TD
0.124 Tw
(Sj\232gren syndrome patients \(N = 28 and N =)Tj
0 -1.1579 TD
0.331 Tw
(90\) showed no significant improvement in)Tj
0 -1.15789 TD
0.064 Tw
(DED signs or symptoms compared with place)Tj
17.92827 0.00001 TD
0 Tc
(-)Tj
-17.92827 -1.15791 TD
-0.015 Tc
0 Tw
(bo.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 294.4475 238.049 Tm
0 0 0 1 k
-0.015 Tc
(77,78)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 309.8935 234.8889 Tm
0 0 0 1 k
-0.015 Tc
0.017 Tw
[(In one of the trials, however)55(, the active)]TJ
-2.8309 -1.15789 TD
0.114 Tw
(treatment group had significant improvement)Tj
T*
0.169 Tw
(versus baseline, whereas improvement in the)Tj
0 -1.1579 TD
-0.031 Tw
(placebo group versus baseline did not reach sta-)Tj
0 -1.15789 TD
0.025 Tw
(tistical significance.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 356.0514 194.049 Tm
0 0 0 1 k
-0.015 Tc
(77)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 273 179.889 Tm
0 0 0 1 k
-0.02 Tc
0.081 Tw
[-467(In contrast, 2 other randomized trials \(N = 26)]TJ
1.05263 -1.1579 TD
-0.002 Tw
(and N = 40\) demonstrated significant improve-)Tj
0 -1.15789 TD
0.227 Tw
(ment of DED symptoms and some objective)Tj
T*
0.05 Tw
(signs with the omega-6 fatty acids linoleic acid)Tj
0 -1.1579 TD
0.025 Tw
((LA) plus GLA, compared with placebo.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 433.6118 139.049 Tm
0 0 0 1 k
-0.02 Tc
(79,80)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 273 124.8889 Tm
0 0 0 1 k
-0.005 Tc
0.181 Tw
[-452(A randomized trial of prophylactic LA plus)]TJ
1.05263 -1.15789 TD
0.105 Tw
(GLA versus no omega-6 treatment was con-)Tj
0 -1.1579 TD
-0.019 Tw
(ducted in 60 patients undergoing photorefrac-)Tj
0 -1.15789 TD
0.37 Tw
(tive keratectomy)Tj
7.01631 0.00001 TD
-0.0051 Tc
(.)Tj
0.86018 0 Td
-0.005 Tc
(Significant postoperative)Tj
-7.8765 -1.1579 TD
0.014 Tw
(differences were found in DED symptoms and)Tj
ET
0 0 0 0 k
47.52 713.378 480.528 17.322 re
f
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
10 0 0 10 396.9735 722.2516 Tm
0 0 0 1 k
-0.0051 Tc
(M)Tj
0.88387 0.00001 TD
-0.005 Tc
0.025 Tw
(anagement of Dry Eye Disease)Tj
ET
0 0 0 0 k
47.52 28.7999 480.528 16 re
f
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
7.5 0 0 7.5 48.52 35.6064 Tm
0 0 0 1 k
(V)Tj
0.71216 0.00001 TD
0.025 Tw
(OL. 14, NO. 3)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
5 0 0 5 195.3852 35.6064 Tm
0.95 0.44 0 0.32 k
(n)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
7.5 0 0 7.5 202.9401 35.6064 Tm
0 0 0 1 k
0.025 Tw
(THE AMERICAN JOURNAL OF MANAGED CARE)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
5 0 0 5 377.8499 35.6064 Tm
0.95 0.44 0 0.32 k
(n)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F13 1 Tf
11 0 0 11 508.703 35.6064 Tm
0.95 0.44 0 0.32 k
(S95)Tj
ET
0.25 w
0 0 0 1 K
47.52 54 m
526.226 54 l
S
Q
endstream
endobj
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<<
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/GS1 gs
q
BT
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0 0 0 1 k
0.01 Tc
(Reports)Tj
ET
0 0 0 0 k
38.949 28.7999 480.531 16 re
f
Q
/GS2 gs
/GS1 gs
q
BT
/F13 1 Tf
11 0 0 11 39.9489 35.6064 Tm
0.95 0.44 0 0.32 k
(S96)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
5 0 0 5 246.7298 35.6064 Tm
0.95 0.44 0 0.32 k
(n)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9 0 0 9 254.2847 35.6064 Tm
0 0 0 1 k
(www)Tj
1.927 0.00001 TD
(.ajmc.com)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
5 0 0 5 312.8631 35.6064 Tm
0.95 0.44 0 0.32 k
(n)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
7.5 0 0 7.5 479.7469 35.6064 Tm
0 0 0 1 k
0.025 Tw
(APRIL 2008)Tj
ET
0.25 w
0 0 0 1 K
40.774 54 m
519.48 54 l
S
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 132.52 706.0912 Tm
0 0 0 1 k
-0.005 Tc
0.305 Tw
(some objective signs, in favor of LA plus)Tj
0 -1.15789 TD
0 Tw
(GLA.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 154.7651 698.2513 Tm
0 0 0 1 k
(81)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 122.52 684.0912 Tm
0 0 0 1 k
-0.005 Tc
0.005 Tw
[-452(A randomized trial of LA plus GLA versus lid)]TJ
1.05263 -1.15789 TD
0.017 Tw
(hygiene versus both treatments in 57 patients)Tj
T*
0.013 Tc
0.357 Tw
(with MGD demonstrated that combined)Tj
0 -1.1579 TD
-0.002 Tc
0.371 Tw
(treatment was more effective than either)Tj
0 -1.15789 TD
-0.005 Tc
0.025 Tw
(treatment alone.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 195.8168 643.2512 Tm
0 0 0 1 k
(72)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 122.52 616.0912 Tm
0 0 0 1 k
-0.005 Tc
-0.009 Tw
(The positive clinical trials of omega-6 fatty acids)Tj
-1.26316 -1.36842 TD
0.161 Tw
[(were all conducted in Italy)74(, whereas the negative)]TJ
T*
0.009 Tc
0.361 Tw
(trials were conducted in North America, the)Tj
0 -1.36841 TD
-0.005 Tc
0.081 Tw
(United Kingdom, and Scandinavia. In light of the)Tj
0 -1.36842 TD
0.076 Tw
(WHS findings described above, one may speculate)Tj
T*
0.154 Tw
(that the conflicting results could be explained by)Tj
T*
0.199 Tw
(differences in dietary omega-6:omega-3 fatty acid)Tj
T*
0.134 Tw
(ratios among these countries. Differences in study)Tj
T*
0.074 Tw
(design, as well as limitations caused by small study)Tj
T*
0.025 Tw
(size, may also account for the discrepant results.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
9 0 0 9 110.52 473.0913 Tm
0.95 0.44 0 0.32 k
(Mucolytics)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 122.52 460.0913 Tm
0 0 0 1 k
-0.005 Tc
0.028 Tw
[(T)111(opical acetylcysteine was mentioned in the lit-)]TJ
-1.26316 -1.36842 TD
0.054 Tw
(erature as a DED treatment as early as the 1960s,)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 300.0002 450.2513 Tm
0 0 0 1 k
(82)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 110.52 434.0913 Tm
0 0 0 1 k
-0.005 Tc
0.165 Tw
(and is still sometimes used in DED patients with)Tj
0 -1.36842 TD
0.151 Tw
(dense mucus accumulation,)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 217.4439 424.2513 Tm
0 0 0 1 k
(83)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 227.2045 421.0913 Tm
0 0 0 1 k
-0.005 Tc
0.151 Tw
(for example, in fila-)Tj
10.189 30 TD
0.244 Tw
(mentary keratitis.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 392.9671 709.2512 Tm
0 0 0 1 k
(37,84)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 411.1166 706.0912 Tm
0 0 0 1 k
-0.005 Tc
0.244 Tw
(Acetylcysteine is not com-)Tj
-9.17017 -1.36842 TD
0.039 Tw
(mercially available as a topical ophthalmic agent.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 513.48 696.2513 Tm
0 0 0 1 k
(83)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 324 680.0913 Tm
0 0 0 1 k
-0.005 Tc
0.082 Tw
(Inhalational acetylcysteine \(FDA approved for use)Tj
0 -1.36842 TD
0.091 Tw
(as a bronchial mucolytic\) has been diluted for off-)Tj
T*
0.025 Tw
(label use as a topical ophthalmic agent.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
9 0 0 9 324 628.0912 Tm
0.95 0.44 0 0.32 k
0.028 Tw
[(T)150(opical vitamin )80(A \(r)29(etinol\))]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 336 615.0912 Tm
0 0 0 1 k
-0.001 Tc
0.371 Tw
[(V)55(itamin A deficiency is a known cause of)]TJ
-1.26316 -1.36842 TD
-0.005 Tc
0.267 Tw
[(xerophthalmia; however)55(, most DED patients are)]TJ
T*
0.033 Tw
(not vitamin A\320deficient. Because retinol is present)Tj
T*
0.025 Tw
(in tears, it has been hypothesized that DED may be)Tj
T*
-0.025 Tw
(associated with local retinol deficiency at the ocular)Tj
T*
0 Tw
(surface.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 352.3568 553.2512 Tm
0 0 0 1 k
(83)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 361.8814 550.0912 Tm
0 0 0 1 k
-0.005 Tc
0.126 Tw
(Based on this hypothesis, topical retinol)Tj
-3.98751 -1.36842 TD
0.092 Tw
(has been used to treat various forms of DED, with)Tj
T*
0.223 Tw
(variable results.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 384.901 527.2513 Tm
0 0 0 1 k
(83)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 395.3458 524.0912 Tm
0 0 0 1 k
-0.005 Tc
0.223 Tw
(Limited data suggest a possible)Tj
-7.51008 -1.36841 TD
0.257 Tw
(role in reversing squamous metaplasia and kera-)Tj
0 -1.36842 TD
0.108 Tw
(tinization of the ocular surface in severe DED, for)Tj
T*
0.147 Tw
(example, in cicatrizing conjunctivitis or graft-ver-)Tj
T*
0.128 Tw
(sus-host disease.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 386.1046 475.2513 Tm
0 0 0 1 k
(83,85-87)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 411.1413 472.0913 Tm
0 0 0 1 k
-0.005 Tc
0.128 Tw
[(However)55(, the use of topical)]TJ
-9.17277 -1.36842 TD
0.025 Tw
(retinol in DED remains controversial.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 468.0061 462.2513 Tm
0 0 0 1 k
(83)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
9 0 0 9 324 433.0913 Tm
0.95 0.44 0 0.32 k
0.028 Tw
[(Guidelines and tr)30(eatment selection)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 336 420.0913 Tm
0 0 0 1 k
-0.005 Tc
0.203 Tw
(Previous practice guidelines have used an eti-)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
9 0 0 9 38.561 391.1626 Tm
0.665 0.308 0 0.224 k
(n)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
9 0 0 9 50.941 391.1626 Tm
0 0 0 1 k
(T)Tj
0.48317 0 TD
0.022 Tc
0.028 Tw
(able 1)Tj
2.9456 0 TD
0 Tc
(.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
9 0 0 9 87.227 391.1626 Tm
0 0 0 1 k
-0.006 Tc
(DEWS )Tj
3.2776 0 TD
0.028 Tw
(Dry Eye S)Tj
4.59784 0 TD
(everity Grading S)Tj
8.22016 0 TD
0 Tc
(c)Tj
0.44463 0 TD
-0.006 Tc
0 Tw
(heme)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
4.5 0 0 4.5 259.8877 394.3501 Tm
0 0 0 1 k
(2)Tj
ET
0.065 0 0.045 0.06 k
38.561 80.186 481.1429 305.848 re
f
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
8 0 0 8 46.9691 372.2666 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(Dry Ey)20(e Sev)19(er)40(ity Lev)20(el)-5514(1)-11228(2)-10677(3)-11091(4*)]TJ
ET
/GS2 gs
0 0 0 0 k
35.313 289.706 488.167 32.938 re
f
35.313 251.2559 488.167 18.49 re
f
35.313 189.849 488.167 34.407 re
f
35.313 145.019 488.167 18.0741 re
f
2 w
0.22 0 0.1 0.19 K
38.561 365.256 m
519.704 365.256 l
S
38.561 115.287 m
519.704 115.287 l
S
Q
/GS2 gs
/GS1 gs
q
BT
/F17 1 Tf
7 0 0 7 51.5956 104.9788 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(*Must ha)20(v)19(e signs )25(AND symptoms. )]TJ
0 -1.28572 TD
[(DEWS indicates Dr)-40(y Ey)20(e )74(W)40(orkShop; )120(TBU)44(T)170(, tear breakup time; MGD)50(, meibomian gland dy)19(sfunction.)]TJ
T*
[(Modified from International )120(T)94(ask F)40(orce guidelines f)20(or the classification of dr)-40(y e)19(y)20(e disease.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F17 1 Tf
6 0 0 6 327.2647 89.1388 Tm
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(32)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F17 1 Tf
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0 0 0 1 k
-0.006 Tc
0.028 Tw
[(Discomf)20(ort, se)19(v)20(erit)-20(y )]TJ
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(&)Tj
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(frequency)Tj
9.96903 1.125 TD
0.028 Tw
(Mild and/or episodic;)Tj
0 -1.125 TD
[(occurs under en)20(viron-)]TJ
T*
[(ment)-20(al stress)]TJ
10.77082 2.25 TD
(Moderate episodic or)Tj
0 -1.125 TD
[(c)49(hronic, stress or no)]TJ
T*
0 Tw
(stress)Tj
11.98724 2.25 TD
0.028 Tw
[(Se)20(v)19(ere frequent or con-)]TJ
0 -1.125 TD
[(st)-20(ant without stress)]TJ
11.98723 1.125 TD
[(Se)20(v)19(ere and/or disabling)]TJ
0 -1.125 TD
[(and const)-20(ant)]TJ
-45.73079 -3.30749 TD
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(V)Tj
0.5855 0 TD
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8.29689 1.125 TD
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0.028 Tw
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(y)Tj
0.47466 0 TD
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(Anno)Tj
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(c)Tj
0.44462 0 TD
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(hronic )Tj
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0.028 Tw
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-5.48161 -1.125 TD
0.028 Tw
(limiting activit)Tj
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0 Tc
(y)Tj
5.92017 2.25 TD
-0.006 Tc
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(Const)Tj
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0.028 Tw
(ant and/or )Tj
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(possibly disabling)Tj
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[(Conjunctiv)20(al st)-20(aining)-1963(None to mild)-5060(V)55(ariable)-8587(Moderate to mark)19(ed)-2940(Mark)19(ed)]TJ
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[(\(se)20(v)19(erit)-20(y/location\))]TJ
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0.028 Tw
[(None to mild)-5059(V)54(ariable)-8587(Mark)20(ed central )-5092(Se)20(v)19(ere punct)25(uate )]TJ
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(erosions )Tj
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[(Corneal/tear signs )-2757(None to mild )-4760(Mild debris, )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
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0 0 0 1 k
($)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
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0 0 0 1 k
-0.006 Tc
(meniscus )Tj
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(Filament)Tj
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(ar)Tj
0.86145 0.00001 TD
-0.0056 Tc
(y)Tj
0.79453 0 Td
-0.006 Tc
[(k)20(eratitis,)]TJ
-5.46455 -1.12501 TD
0.028 Tw
(mucus clumping)Tj
7.30474 0.00001 TD
-0.0059 Tc
(,)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F22 1 Tf
8 0 0 8 319.9659 197.3987 Tm
0 0 0 1 k
(#)Tj
ET
Q
/GS2 gs
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q
BT
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0 0 0 1 k
-0.006 Tc
0.028 Tw
(tear debris )Tj
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(Filament)Tj
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(ar)Tj
0.86145 0.00001 TD
-0.0056 Tc
(y)Tj
0.79453 0 Td
-0.006 Tc
[(k)20(eratitis,)]TJ
-5.46455 -1.12501 TD
0.028 Tw
(mucus clumping)Tj
7.30474 0.00001 TD
-0.0059 Tc
(,)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F22 1 Tf
8 0 0 8 415.8638 197.3987 Tm
0 0 0 1 k
(#)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F17 1 Tf
8 0 0 8 422.6535 197.3987 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
(tear debris, ulceration )Tj
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[(Lid/meibomian glands )-1044(MGD v)]TJ
14.13124 0.00001 TD
(ariably present )Tj
7.62507 -0.00001 TD
(MGD v)Tj
3.14576 0.00001 TD
(ariably present )Tj
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0 Tc
(F)Tj
0.49542 0.00001 TD
-0.006 Tc
0 Tw
(requent )Tj
11.49181 -0.00001 TD
0 Tc
(T)Tj
0.43536 0.00001 TD
-0.006 Tc
(ric)Tj
0.98821 0.00001 TD
0.028 Tw
[(hiasis, k)20(eratinization,)]TJ
-1.42358 -1.12501 TD
(symblepharon )Tj
-45.73079 -1.99882 TD
[(TBU)45(T (sec) )-5568(V)55(ariable)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F23 1 Tf
8 0 0 8 224.068 152.1649 Tm
0 0 0 1 k
Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F17 1 Tf
8 0 0 8 228.8208 152.1649 Tm
0 0 0 1 k
-0.081 Tc
(10)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F23 1 Tf
8 0 0 8 319.9659 152.1649 Tm
0 0 0 1 k
Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F17 1 Tf
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0 0 0 1 k
(5)Tj
11.39314 0.27905 TD
-0.006 Tc
0.028 Tw
(Immediate )Tj
-45.73079 -2.31393 TD
[(Sc)50(hirmer score )]TJ
0 -1.125 TD
((mm/5 min) )Tj
10.98549 1.125 TD
0 Tw
[(V)55(ariable)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F23 1 Tf
8 0 0 8 224.068 133.6536 Tm
0 0 0 1 k
Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F17 1 Tf
8 0 0 8 228.8208 133.6536 Tm
0 0 0 1 k
-0.081 Tc
(10)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F23 1 Tf
8 0 0 8 319.9659 133.6536 Tm
0 0 0 1 k
Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F17 1 Tf
8 0 0 8 324.7187 133.6536 Tm
0 0 0 1 k
(5)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F23 1 Tf
8 0 0 8 415.8638 133.6536 Tm
0 0 0 1 k
Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F17 1 Tf
8 0 0 8 420.6166 133.6536 Tm
0 0 0 1 k
(2)Tj
ET
Q
endstream
endobj
14 0 obj
<<
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>>
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f
q
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f
Q
/GS1 gs
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BT
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0 0 0 1 k
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(M)Tj
0.88387 0.00001 TD
-0.005 Tc
0.025 Tw
(anagement of Dry Eye Disease)Tj
ET
0 0 0 0 k
47.52 28.7999 480.528 16 re
f
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
7.5 0 0 7.5 48.52 35.6064 Tm
0 0 0 1 k
(V)Tj
0.71216 0.00001 TD
0.025 Tw
(OL. 14, NO. 3)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
5 0 0 5 195.3852 35.6064 Tm
0.95 0.44 0 0.32 k
(n)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
7.5 0 0 7.5 202.9401 35.6064 Tm
0 0 0 1 k
0.025 Tw
(THE AMERICAN JOURNAL OF MANAGED CARE)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
5 0 0 5 377.8499 35.6064 Tm
0.95 0.44 0 0.32 k
(n)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F13 1 Tf
11 0 0 11 508.703 35.6064 Tm
0.95 0.44 0 0.32 k
(S97)Tj
ET
0.25 w
0 0 0 1 K
47.52 54 m
526.226 54 l
S
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 47.52 705.4595 Tm
0 0 0 1 k
-0.005 Tc
-0.032 Tw
(ology-oriented approach to DED.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 172.7897 708.6195 Tm
0 0 0 1 k
(1,34)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 185.3106 705.4595 Tm
0 0 0 1 k
-0.005 Tc
-0.032 Tw
[(However)55(, com-)]TJ
-14.50427 -1.36842 TD
-0.012 Tw
[(monly used etiologic classifications \(eg, aqueo)15(u)15(s)15(-)15(d)15(e)15(-)]TJ
T*
-0.02 Tc
0.002 Tw
[(ficient vs evaporative, Sj\232gren vs non-S)-15(j)-15<9A>-15(g)-15(r)-15(e)-15(n)-15(\))-15( )-15(o)-15(f)-15(t)-15(e)-15(n)]TJ
T*
-0.005 Tc
0.025 Tw
(are not helpful in establishing a treatment plan.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 229.9125 669.6195 Tm
0 0 0 1 k
(32)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 59.52 653.4595 Tm
0 0 0 1 k
-0.005 Tc
0.088 Tw
[(International T)111(ask Force (ITF) guidelines, pub)-1(-)]TJ
-1.26316 -1.36842 TD
0.291 Tw
(lished in 2006, propose a classification of DED)Tj
T*
0.047 Tw
(severity based on clinical signs and symptoms. The)Tj
T*
0.038 Tw
(ITF also developed treatment algorithms according)Tj
T*
-0.015 Tc
0.022 Tw
[(to severity classification and the presence or abs)5(e)5(n)5(c)5(e)]TJ
T*
-0.008 Tw
(of lid margin disease.)Tj
ET
Q
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/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 124.3277 591.6195 Tm
0 0 0 1 k
-0.015 Tc
(32)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 132.2997 588.4595 Tm
0 0 0 1 k
-0.015 Tc
-0.008 Tw
[(In 2007 the Management a)-5(n)-5(d)]TJ
-8.92418 -1.36842 TD
-0.01 Tc
-0.026 Tw
(Therapy Subcommittee of the International Dry Eye)Tj
T*
0 Tc
0.197 Tw
[(W)55(orkShop (DEWS) adopted a mo)-10(dified form of)]TJ
T*
-0.005 Tc
0.006 Tw
[(t)-5(h)-5(e)-5( )-5(ITF severity grading, as shown in )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F13 1 Tf
9.5 0 0 9.5 190.3106 549.4595 Tm
0.95 0.44 0 0.32 k
-0.006 Tc
0.006 Tw
[(T)110(able 1)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 219.5506 549.4595 Tm
0 0 0 1 k
(.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 221.8781 552.6194 Tm
0 0 0 1 k
(2)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 227.2607 549.4595 Tm
0 0 0 1 k
-0.005 Tc
(The)Tj
-18.92007 -1.36842 TD
0.066 Tw
(DEWS treatment recommendations were based on)Tj
T*
0.025 Tw
[(the mo)-10(dified severity grading. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
9 0 0 9 47.52 497.4594 Tm
0.95 0.44 0 0.32 k
0.028 Tw
[(Cy)20(clospor)39(ine v)20(ersus other )]TJ
0 -1.44444 TD
[(anti-inflammat)20(ory ag)19(ents)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 59.52 471.4595 Tm
0 0 0 1 k
-0.005 Tc
0.215 Tw
(As discussed above under )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F13 1 Tf
9.5 0 0 9.5 166.1843 471.4595 Tm
0 0 0 1 k
(T)Tj
0.60553 0 TD
-0.006 Tc
0.238 Tw
(reatment options,)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 47.52 458.4595 Tm
0 0 0 1 k
-0.005 Tc
0.288 Tw
(topical cyclosporine has demonstrated long-term)Tj
0 -1.36842 TD
-0.017 Tw
(efficacy and safety in the treatment of DED. In con-)Tj
T*
-0.027 Tw
(trast, topical corticosteroids are effective but are not)Tj
T*
0.228 Tw
(recommended for long-term use because of their)Tj
T*
0.213 Tw
(AEs. Oral tetracyclines have been used for their)Tj
T*
0.103 Tw
[(anti-inflammatory activity)74(, primarily in DED asso-)]TJ
T*
0.057 Tw
(ciated with ocular rosacea; however)Tj
14.40763 0 TD
-0.0051 Tc
(,)Tj
0.54707 0 Td
-0.005 Tc
(this use is off-)Tj
-14.9547 -1.36843 TD
0.283 Tw
[(label and is based on limited evidence. T)111(opical)]TJ
0 -1.36842 TD
0.015 Tw
(NSAIDs have also been used off-label, but whether)Tj
T*
0.198 Tw
(they have any role in DED has been questioned)Tj
T*
0.047 Tw
(because of reports of serious AEs in patients with a)Tj
T*
0.025 Tw
(compromised ocular surface. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
9 0 0 9 47.52 289.4595 Tm
0.95 0.44 0 0.32 k
0.028 Tw
[(Cy)20(clospor)39(ine v)20(ersus punctal plugs )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 59.52 276.4595 Tm
0 0 0 1 k
-0.005 Tc
-0.021 Tw
(In the ITF algorithm for treatment of DED with)Tj
18.98093 0.00001 TD
0 Tc
(-)Tj
-20.24408 -1.36843 TD
-0.005 Tc
0.045 Tw
(out lid margin disease \()Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F13 1 Tf
9.5 0 0 9.5 137.232 263.4595 Tm
0.95 0.44 0 0.32 k
-0.006 Tc
0.05 Tw
[(T)110(able 2)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 166.8834 263.4595 Tm
0 0 0 1 k
-0.005 Tc
0.045 Tw
(\), topical cyclospor-)Tj
-12.56457 -1.36842 TD
0.026 Tw
(ine is recommended as a treatment option for DED)Tj
T*
0.019 Tw
(at level 2 severity \(but only in the presence of clin-)Tj
T*
-0.022 Tw
(ically evident inflammation\), whereas punctal plugs)Tj
T*
0.092 Tw
(are recommended at level 3 severity \(after control)Tj
T*
0.057 Tw
(of inflammation\).)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 115.334 201.6195 Tm
0 0 0 1 k
(32)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 124.2053 198.4594 Tm
0 0 0 1 k
-0.005 Tc
0.057 Tw
(In contrast, the DEWS recom-)Tj
-8.07214 -1.36842 TD
-0.027 Tw
(mendations list both cyclosporine and punctal plugs)Tj
T*
0.088 Tw
(as level 2 options, without specifying the presence)Tj
T*
0.176 Tw
(or absence of clinical inflammation.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 190.48 162.6195 Tm
0 0 0 1 k
(2)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 197.4833 159.4594 Tm
0 0 0 1 k
-0.005 Tc
0.176 Tw
(Thus, there)Tj
-15.78561 -1.36842 TD
0.015 Tw
(appears to be no clear consensus regarding the rela-)Tj
T*
0.025 Tw
(tive roles of cyclosporine versus punctal plugs. )Tj
1.26316 -1.36842 TD
0.197 Tw
(In a small comparative trial, 30 patients with)Tj
-1.26316 -1.36842 TD
0.219 Tw
[(mo)-10(derate DED were randomized to 6 months of)]TJ
T*
0.02 Tw
(treatment with either cyclosporine 0.05% or lower)Tj
20.24408 0.00001 TD
0 Tc
(-)Tj
-20.24408 -1.36843 TD
0.002 Tc
0.368 Tw
(lid punctal plugs, or both. Outcome measures)Tj
22.47158 65.68421 TD
-0.005 Tc
-0.031 Tw
(included rose bengal staining, Schirmer scores with-)Tj
0 -1.36842 TD
0.025 Tw
(out anesthesia, and artificial tear use.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 402.427 695.6194 Tm
0 0 0 1 k
(8)Tj
0.5 -0.00001 TD
(8)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 273 671.4595 Tm
0 0 0 1 k
-0.005 Tc
0.008 Tw
[-452(At 1 and 3 months, both of the plug-contain-)]TJ
1.05263 -1.1579 TD
0.024 Tw
(ing regimens significantly improved Schirmer)Tj
0 -1.15789 TD
-0.036 Tw
[(scores compared with baseline and with cyc)5(l)5(o)5(-)]TJ
0 -1.1579 TD
-0.01 Tc
0.244 Tw
[(sporine alone. Cyclosporine alone pro)-10(duced)]TJ
0 -1.15789 TD
-0.005 Tc
0.124 Tw
[(no initial Schirmer score response; however)55(,)]TJ
T*
0.064 Tw
(by 6 months, all 3 groups had significant im-)Tj
T*
0.127 Tw
(provement compared with baseline, with no)Tj
0 -1.1579 TD
0.025 Tw
(significant between-group differences.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 426.9938 597.6195 Tm
0 0 0 1 k
(88)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 273 583.4595 Tm
0 0 0 1 k
0.276 Tw
[-447(In contrast, both of the cyclosporine-con-)]TJ
1.05263 -1.15789 TD
0.095 Tw
(taining regimens significantly improved rose)Tj
0 -1.1579 TD
0.005 Tc
0.021 Tw
(bengal staining at 3 and 6 months compared)Tj
0 -1.15789 TD
0 Tc
0.263 Tw
(with baseline; there was no statistical dif-)Tj
T*
0.003 Tc
0.372 Tw
(ference between cyclosporine with versus)Tj
0 -1.1579 TD
0 Tc
0.16 Tw
(without plugs. Plugs alone did not improve)Tj
0 -1.15789 TD
0.166 Tw
(staining scores at any time point compared)Tj
0 -1.1579 TD
0.025 Tw
(with baseline.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
6 0 0 6 336.5266 509.6195 Tm
0 0 0 1 k
0.005 Tc
(8)Tj
0.505 -0.00001 TD
(8)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 273 495.4595 Tm
0 0 0 1 k
-0.025 Tc
0.07 Tw
[-472(Artificial tear use declined significantly in all 3)]TJ
1.05263 -1.1579 TD
0.375 Tw
(groups compared with baseline, at all time)Tj
T*
0.061 Tw
(points except in the cyclosporine-only group at)Tj
0 -1.15789 TD
-0.0251 Tc
(1)Tj
0.79792 0 Td
-0.025 Tc
0.098 Tw
(month. At 6 months there was no statistical)Tj
-0.79792 -1.15789 TD
0.072 Tw
(difference between combination treatment and)Tj
0 -1.1579 TD
-0.034 Tw
[(cyclosporine alone; however)55(, combination treat-)]TJ
0 -1.15789 TD
0.025 Tw
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q
BT
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(88)Tj
ET
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q
BT
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0 0 0 1 k
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0.285 Tw
(The investigators concluded that all 3 treat-)Tj
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0.005 Tc
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(ments were effective, but that plugs were more)Tj
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262.525 81.002 267 288.3449 re
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/GS2 gs
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261 354.135 271.593 12 re
f
261 296.641 271.593 12 re
f
261 222.679 271.593 12 re
f
261 164.381 271.593 12 re
f
Q
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/GS1 gs
q
BT
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0 0 0 1 k
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0.028 Tw
[(Lev)20(el 1:)]TJ
ET
Q
/GS2 gs
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q
BT
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0 0 0 1 k
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T*
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(el 2:)Tj
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0 0 0 1 k
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0.028 Tw
[(If L)10(evel 1 treatments are inadequate, add:)]TJ
ET
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(A)Tj
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(Lev)Tj
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[(If L)10(evel 2 treatments are inadequate, add:)]TJ
ET
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q
BT
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[(T)115(etracyclines)]TJ
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[(Autologous serum tear)-20(s)]TJ
T*
[(P)19(unctal plugs \(af)25(ter control of inflammation\))]TJ
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q
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(Lev)Tj
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(el 4:)Tj
ET
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q
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0 0 0 1 k
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0.028 Tw
(If L)Tj
1.44014 0.00001 TD
(evel 3 treatments are inadequate, add:)Tj
ET
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/GS2 gs
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q
BT
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0 0 0 1 k
(T)Tj
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[(opical vitamin )50(A)]TJ
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T*
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(Moisture goggles)Tj
T*
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(Surgery )Tj
ET
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q
BT
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0 0 0 1 k
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0.028 Tw
[(Modified from International )120(T)94(ask F)40(orce dy)20(sfunctional tear syndrome treatment)]TJ
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(algorithm.)Tj
ET
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0 0 0 1 k
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(32)Tj
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529.525 103.942 l
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0.01 Tc
(Reports)Tj
ET
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Q
/GS2 gs
/GS1 gs
q
BT
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(S98)Tj
ET
Q
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q
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(n)Tj
ET
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/F14 1 Tf
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(www)Tj
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ET
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/GS2 gs
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q
BT
/F0 1 Tf
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0.95 0.44 0 0.32 k
(n)Tj
ET
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/GS2 gs
/GS1 gs
q
BT
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0 0 0 1 k
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(APRIL 2008)Tj
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519.48 54 l
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/GS2 gs
/GS1 gs
q
BT
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0 0 0 1 k
-0.005 Tc
0.121 Tw
[(b)-10(e)-10(n)-10(eficial for immediate relief of dryness, whereas)]TJ
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T*
0.219 Tw
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T*
0.025 Tw
(duced the greatest overall improvement.)Tj
ET
Q
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/GS1 gs
q
BT
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0 0 0 1 k
(88)Tj
ET
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/GS1 gs
q
BT
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(Summary)Tj
ET
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q
BT
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(Pharmacologic and nonpharmacologic approaches)Tj
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(to management of DED include: )Tj
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[-452(A)75(voidance of exacerbating factors such as low)]TJ
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[(humidity)74(, wind or drafts, dust or smoke, pro-)]TJ
T*
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0.137 Tw
[-452(Eyelid hygiene \(particularly in patients with)]TJ
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(MGD\).)Tj
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[-452(T)111(ear supplementation\321for example, artificial)]TJ
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(tears, autologous serum tears.)Tj
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[-452(T)111(ear retention\321for example, punctal plugs,)]TJ
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(.)Tj
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(ical corticosteroids, oral tetracyclines, topical)Tj
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(cyclosporine.)Tj
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0.366 Tw
[-443(Other therapies\321for example, nutritional)]TJ
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(supplements (essential fatty acids); mucolytics)Tj
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(\(topical acetylcysteine, used off-label in DED)Tj
T*
0.144 Tw
(with filamentary keratitis\); and topical vita-)Tj
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(min A \(off-label and controversial, but pos)Tj
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(-)Tj
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0.29 Tw
(sibly useful in severe DED with squamous)Tj
T*
0.025 Tw
(metaplasia or ocular surface keratinization\).)Tj
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[(Artificial tears are the mainstay of DED therapy)74(.)]TJ
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0.374 Tw
(Most tear supplements act as lubricants; other)Tj
T*
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(actions may include replacement of deficient tear)Tj
T*
0.011 Tc
0.359 Tw
(constituents, dilution of proinflammatory sub)Tj
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(-)Tj
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[(stances, reduction of tear osmolarity)74(, and protection)]TJ
T*
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(against osmotic stress. A wide variety of OTC arti-)Tj
T*
0.08 Tw
[(ficial tear pro)-10(ducts are available, which differ with)]TJ
T*
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(respect to a number of variables that include: )Tj
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0 Tc
Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
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0 0 0 1 k
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(Electrolyte composition.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
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0 0 0 1 k
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0.206 Tw
(Potassium and bicar-)Tj
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(bonate appear to be the most important.)Tj
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0 Tc
Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F21 1 Tf
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-0.015 Tc
(Osmolarity/osmolality)Tj
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0 Tc
(.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
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0 0 0 1 k
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(Some studies suggest that)Tj
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(artificial tears should ideally mimic the osmo-)Tj
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[(larity of normal tears; however)55(, others suggest)]TJ
T*
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Tj
ET
Q
/GS2 gs
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q
BT
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[(V)18(iscosity)37(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
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0 0 0 1 k
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(Higher viscosity increases tear re-)Tj
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T*
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[(ring. V)55(iscosity agents used in artificial tears)]TJ
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[(include CMC, HP-guar)55(, and lipids such as)]TJ
T*
0.099 Tw
(those that make up castor oil or mineral oil.)Tj
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0.001 Tw
[(Lipid-containing pro)-10(ducts are intended to de-)]TJ
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T*
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(layer of the tear film.)Tj
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Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F21 1 Tf
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(Preservatives.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
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0.122 Tw
(There are 2 main types of pre-)Tj
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(servatives: detergent \(eg, benzalkonium chlo-)Tj
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(ride\) and oxidative \(eg, stabilized oxychloro)Tj
T*
0.13 Tw
(complex\). Detergents can irritate or damage)Tj
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T*
0.129 Tw
(tears are usually well tolerated in mild DED)Tj
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[(when used no more than 4 to 6 times daily)74(. If)]TJ
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(more frequent application is required, unpre-)Tj
T*
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(served tears should be used.)Tj
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Tj
ET
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q
BT
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(Compatible solutes.)Tj
ET
Q
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q
BT
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(These are small nonionic)Tj
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T*
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(Although artificial tears can improve DED symp-)Tj
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0.15 Tw
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T*
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T*
0.08 Tw
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T*
0.025 Tw
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Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F21 1 Tf
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[(T)111(opical corticosteroids.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
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0 0 0 1 k
-0.015 Tc
-0.019 Tw
(Although effective, these)Tj
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0.233 Tw
(agents are generally recommended only for)Tj
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0.035 Tw
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0 -1.1579 TD
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T*
0.025 Tw
(ma, and cataracts.)Tj
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0 Tc
Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F21 1 Tf
9.5 0 0 9.5 346 329.0186 Tm
0 0 0 1 k
-0.005 Tc
0.077 Tw
(Oral tetracyclines.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
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0.077 Tw
(Based on limited evidence,)Tj
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(oral tetracyclines have been used off-label to)Tj
T*
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(treat DED, primarily DED associated with)Tj
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[(o)-10(c)-10(ular rosacea.)]TJ
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Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F21 1 Tf
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0 0 0 1 k
(T)Tj
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(opical cyclosporine.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
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(T)Tj
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0.025 Tw
(rently the only pharmacologic treatment that)Tj
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T*
0.028 Tw
(though its onset of action is relatively slow)Tj
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(,)Tj
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0 Tw
(it)Tj
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(is)Tj
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(safe for long-term use and appears to be dis-)Tj
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0.086 Tw
[(ease-mo)-10(difying rather than merely palliative.)]TJ
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T*
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(d)Tj
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[(T)111(opical NSAIDs have been used off-label in)]TJ
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T*
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(a)'
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(compromised ocular surface. Some experts feel)Tj
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0.025 Tw
[(that they have no role in DED therapy)74(.)]TJ
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0.092 Tw
[(T)111(reatment selection is guided primarily by DED)]TJ
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(severity)Tj
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(.)Tj
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(ITF guidelines, published in 2006, proposed)Tj
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f
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(THE AMERICAN JOURNAL OF MANAGED CARE)Tj
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5 0 0 5 377.8499 35.6064 Tm
0.95 0.44 0 0.32 k
(n)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F13 1 Tf
11 0 0 11 508.703 35.6064 Tm
0.95 0.44 0 0.32 k
(S99)Tj
ET
0.25 w
0 0 0 1 K
47.52 54 m
526.226 54 l
S
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9.5 0 0 9.5 47.52 705.4599 Tm
0 0 0 1 k
-0.0101 Tc
(a)Tj
0.72493 0 Td
-0.01 Tc
0.051 Tw
(DED severity classification based on clinical signs)Tj
-0.72493 -1.36842 TD
0.04 Tw
(and symptoms. The ITF also developed a treatment)Tj
T*
-0.036 Tw
(algorithm according to severity grading and the pres-)Tj
T*
0.113 Tw
(ence or absence of lid margin disease. In 2007 the)Tj
T*
0.257 Tw
(DEWS Management and Therapy Subcommittee)Tj
T*
0.191 Tw
(published treatment recommendations based on a)Tj
T*
0.025 Tw
[(mo)-10(dified form of the ITF severity classification. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F16 1 Tf
7.5 0 0 7.5 59.52 605.4599 Tm
0 0 0 1 k
-0.006 Tc
0.002 Tw
(Author Affiliations:)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
7.5 0 0 7.5 122.168 605.4599 Tm
0 0 0 1 k
-0.01 Tc
0.002 Tw
[(From Georgetown and George W)55(ashing)-1(-)]TJ
-9.95307 -1.2 TD
-0.0051 Tc
(t)Tj
0.32789 -0.00001 TD
-0.005 Tc
0.025 Tw
[(on Universities, and OcuSense, Inc, W)55(ashington, DC.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F16 1 Tf
7.5 0 0 7.5 59.52 587.4599 Tm
0 0 0 1 k
0.035 Tw
(Funding Sources:)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
7.5 0 0 7.5 116.4273 587.4599 Tm
0 0 0 1 k
-0.005 Tc
0.032 Tw
(The research and manuscript were funded)Tj
-9.18764 -1.2 TD
0.025 Tw
(by Allergan, Inc.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F16 1 Tf
7.5 0 0 7.5 59.52 569.4599 Tm
0 0 0 1 k
-0.006 Tc
-0.042 Tw
(Author Disclosures: )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
7.5 0 0 7.5 123.0448 569.4599 Tm
0 0 0 1 k
-0.01 Tc
-0.037 Tw
[(The author reports being a consultant f)20(o)20(r)]TJ
-10.06997 -1.2 TD
-0.03 Tc
0.124 Tw
[(Alcon, Allergan, Novagali Pharma, OcuSense, Inc, and SARc)-20(o)-30(d)-20(e)-20(;)]TJ
-0.0101 Tc
(a)'
0.43389 -0.00001 TD
-0.01 Tc
0.025 Tw
(nd being a major stock shareholder for OcuSense, Inc.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F16 1 Tf
7.5 0 0 7.5 59.52 542.4599 Tm
0 0 0 1 k
-0.034 Tw
(Authorship Information:)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
7.5 0 0 7.5 137.9505 542.4599 Tm
0 0 0 1 k
-0.005 Tc
-0.03 Tw
(Concept and design, drafting of the)Tj
-12.0574 -1.2 TD
0.039 Tw
(manuscript, and critical revision of the manuscript for important)Tj
T*
0.025 Tw
(intellectual content.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F16 1 Tf
7.5 0 0 7.5 59.52 515.4599 Tm
0 0 0 1 k
0.151 Tw
(Address Correspondence to:)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
7.5 0 0 7.5 151.6983 515.4599 Tm
0 0 0 1 k
-0.005 Tc
0.136 Tw
(Michael A. Lemp, MD, 4000)Tj
-13.89044 -1.2 TD
-0.0051 Tc
(C)Tj
0.71686 -0.00001 TD
-0.005 Tc
0.029 Tw
[(athedral A)74(venue, NW #828B, W)55(ashington, DC 20016. E-mail:)]TJ
-0.71686 -1.19999 TD
0 Tw
(malemp@lempdc.com.)Tj
ET
4.5 w
0.22 0 0.1 0.19 K
47.52 474.71 m
243 474.71 l
S
Q
/GS2 gs
/GS1 gs
q
BT
/F17 1 Tf
11.5 0 0 11.5 47.52 459.4599 Tm
0 0 0 1 k
0.072 Tc
(REFERENCES)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 444.0599 Tm
0 0 0 1 k
0.028 Tw
[(1)50(.)-201(Amer)40(ican )80(A)19(cadem)40(y of Ophthalmolog)20(y)95(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 184.6729 444.0599 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(P)19(refer)25(red prac-)]TJ
-18.28705 -1.12 TD
[(tice pat)25(tern: dry eye syndrome. ht)24(tp://www)20(.aao.org/)]TJ
T*
0 Tw
(education/guidelines/ppp/upload/Dry_Eye_S)Tj
20.5842 0 TD
(yndrome-)Tj
-20.5842 -1.12 TD
0.028 Tw
[(2.pdf)25(. P)19(ublished 20)-40(03. )50(Accessed F)20(ebruary 1)14(3, 20)-40(08.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 407.4599 Tm
0 0 0 1 k
(2.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 55.3212 407.4599 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(Management and therapy of dry eye disease: repor)25(t)]TJ
-1.04016 -1.12 TD
[(of the Management and )180(Therapy Subcommit)24(tee of the)]TJ
T*
[(International Dry Eye )100(W)54(orkShop \(20)-40(07\). )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 188.1532 390.6599 Tm
0 0 0 1 k
0.028 Tw
[(Ocul Surf)25(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 47.52 382.26 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(20)-40(07;5:1)15(63-1)14(78. ht)25(tp://www)20(.tearfilm.org/dewsrepor)24(t/.)]TJ
0 -1.12 TD
0 Tc
(P)Tj
0.58551 0 TD
-0.006 Tc
0 Tw
(ublished )Tj
4.26073 0 TD
0.028 Tw
(April 20)Tj
3.69013 0 TD
0 Tw
(07)Tj
0.91076 0 TD
-0.0059 Tc
(.)Tj
0.52253 0 Td
-0.006 Tc
0.028 Tw
[(Accessed F)20(ebruary 1)14(3, 20)-40(08.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 362.46 Tm
0 0 0 1 k
0.028 Tw
[(3.)-281(Blehm C,)-156(V)20(ishnu S)20(,)-281(Khat)25(tak )80(A,)-281(Mitr)19(a S)20(,)-131(Y)165(ee R)20(W)40(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 212.917 362.46 Tm
0 0 0 1 k
-0.006 Tc
(Com-)Tj
-22.05293 -1.12 TD
0.028 Tw
[(puter vision syndrome: a review)20(. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 165.3704 354.06 Tm
0 0 0 1 k
0.028 Tw
(Surv Ophthalmol.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 47.52 345.66 Tm
0 0 0 1 k
-0.0057 Tc
(20)Tj
1.14049 0 TD
-0.006 Tc
(05;50:253-262. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 334.26 Tm
0 0 0 1 k
(4.)Tj
0.98946 0 TD
(W)Tj
0.9602 0 TD
(olk)Tj
1.40967 0 TD
(of)Tj
0.9187 0 TD
-0.0003 Tc
(f)Tj
0.63822 0 Td
(P)Tj
0.37614 0 TD
0 Tc
0.028 Tw
[(,)-281(Nojg)20(aar)20(d JK,)-131(T)150(r)25(oiano P)234(,)-280(Piccoli B)20(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 197.853 334.26 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
(Eye com)Tj
4.04407 0 TD
0 Tc
(-)Tj
-24.08847 -1.12001 TD
-0.006 Tc
[(plaints in the of)25(fice en)19(vironment: precorneal tear film)]TJ
0 -1.12 TD
[(integrity influenced by eye blinking ef)25(ficiency)54(. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 210.703 317.46 Tm
0 0 0 1 k
(Occup)Tj
-21.75773 -1.12 TD
(En)Tj
1.20191 0.00001 TD
0.028 Tw
(viron Med.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 97.3226 309.06 Tm
0 0 0 1 k
-0.006 Tc
(20)Tj
1.14049 0.00001 TD
(05;62:4-1)Tj
4.15899 0.00001 TD
(2.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 297.66 Tm
0 0 0 1 k
-0.011 Tc
0.028 Tw
[(5.)-270(P)40(er)40(ry HD)25(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 87.5178 297.66 Tm
0 0 0 1 k
-0.017 Tc
0.028 Tw
[(Dry eye disease: pathoph)20(ysiology)54(, classifica-)]TJ
-5.33304 -1.12 TD
(tion, and diagnosis. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 117.1732 289.26 Tm
0 0 0 1 k
-0.011 Tc
0.028 Tw
(Am J Manag Care.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 184.4675 289.26 Tm
0 0 0 1 k
-0.017 Tc
(20)Tj
1.11827 0 TD
[(08;1)35(4:S79-S87)190(. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 277.81 Tm
0 0 0 1 k
0.028 Tw
[(6.)-281(Gilbar)20(d JP)234(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 91.6496 277.81 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
(The diagnosis and management of dry)Tj
-5.88395 -1.12667 TD
0 Tw
(eyes. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 67.9038 269.3599 Tm
0 0 0 1 k
0.028 Tw
[(Otolaryngol Clin Nor)25(th )49(Am.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 167.2851 269.3599 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(05;38:871)40(-885.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 257.9099 Tm
0 0 0 1 k
0.028 Tw
[(7)170(.)-281(Cr)20(aig JP)235(,)-281(Blades K,)-281(P)40(at)20(el S)20(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 142.7839 257.9099 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(T)115(ear lipid layer structure)]TJ
-12.70185 -1.12666 TD
(and stability following expression of the meibomian)Tj
T*
0 Tw
(glands. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 75.3094 241.01 Tm
0 0 0 1 k
0.028 Tw
[(Ophthalmic Ph)20(ysiol Opt.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 164.0601 241.01 Tm
0 0 0 1 k
-0.006 Tc
[(1)59(995;1)15(5:569-57)55(4.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 229.56 Tm
0 0 0 1 k
0.028 Tw
[(8.)-281(K)15(orb DR,)-281(Gr)30(einer JV)134(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 125.9522 229.56 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
(Increase in tear film lipid layer)Tj
-10.45763 -1.12666 TD
[(thic)50(kness following treatment of meibomian gland )]TJ
0 -1.12667 TD
0 Tw
(dysfunction. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 93.0051 212.6599 Tm
0 0 0 1 k
0.028 Tw
(Adv Exp Med Biol.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 161.2934 212.6599 Tm
0 0 0 1 k
-0.006 Tc
[(1)59(994;350:293-298.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 201.21 Tm
0 0 0 1 k
0.028 Tw
[(9.)-201(Asbell P)100(A.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 90.3377 201.21 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(Increasing impor)25(tance of dry eye syn-)]TJ
-5.70903 -1.12667 TD
[(drome and the ideal ar)25(tificial tear: consensus views)]TJ
0 -1.12666 TD
(from a roundtable discussion. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 154.9983 184.31 Tm
0 0 0 1 k
0.028 Tw
[(Cur)25(r Med R)19(es Opin.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 47.52 175.8601 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(06;22:21)35(49-21)14(57)190(. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 164.4101 Tm
0 0 0 1 k
0.028 Tw
[(1)60(0.)-281(McDonald M.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 105.5596 164.4101 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
(Latest trends in dry eye treatments)Tj
-7.73861 -1.12667 TD
0 Tw
[(\(adver)25(torial\). )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 94.4123 155.9601 Tm
0 0 0 1 k
0.028 Tw
[(Cornea S)20(ociety News.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 174.8536 155.9601 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(20)-40(07 Spring;3:7)75(-8. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 144.3801 Tm
0 0 0 1 k
(1)Tj
0.44983 0.00001 TD
(1)Tj
0.49499 0.00001 TD
0.028 Tw
[(.)-258(Gut)24(tman C.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 98.5735 144.3801 Tm
0 0 0 1 k
-0.017 Tc
0.028 Tw
(Dry eye patients tak)Tj
9.10308 0.00001 TD
-0.0168 Tc
(e)Tj
0.82813 0 Td
-0.017 Tc
0 Tw
(pic)Tj
1.28888 0.00001 TD
-0.0168 Tc
(k)Tj
0.77215 0 Td
-0.017 Tc
0.028 Tw
(as new treat-)Tj
-18.79937 -1.14402 TD
[(ments flood mark)-20(et. Eurotimes, Eye to Eye Supplement.)]TJ
0 -1.14401 TD
[(May 20)-40(03. ht)25(tp://www)19(.escr)-20(s.org/eurotimes/May20)-40(03/)]TJ
T*
0 Tw
(dryeye.asp. )Tj
5.50149 0.00001 TD
0.028 Tw
(Accessed F)Tj
5.11956 0.00001 TD
[(ebruary 1)15(3, 20)-40(08. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 107.06 Tm
0 0 0 1 k
(12.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 59.2125 107.06 Tm
0 0 0 1 k
(S)Tj
0.64167 0.00001 TD
-0.006 Tc
0.028 Tw
[(oothe XP emollient (lubricant) eye drops F)39(A)20(Qs.)]TJ
-2.20067 -1.14402 TD
[(Bausc)50(h & L)9(omb, 20)-40(08. ht)25(tp://www)19(.bausc)50(h.com/en_US/)]TJ
0 -1.14399 TD
0 Tw
(consumer/visioncare/faq/soothe_eyedrops_faqs.aspx.)Tj
0 -1.144 TD
0.028 Tw
[(Accessed F)20(ebruary 1)14(3, 20)-40(08. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 261 707.1291 Tm
0 0 0 1 k
-0.0002 Tc
(1)Tj
0.55582 0.00001 TD
0 Tc
0.028 Tw
[(3.)-281(Di P)40(ascuale MA,)-281(Got)19(o E,)-131(Tseng SC.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 390.1795 707.1291 Tm
0 0 0 1 k
-0.006 Tc
[(S)19(equential)]TJ
-17.22393 -1.144 TD
0.028 Tw
[(c)49(hanges of lipid tear film af)25(ter the instillation of a )]TJ
T*
(single drop of a new emulsion eye drop in dry eye)Tj
T*
0 Tw
(patients. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 293.2856 681.3891 Tm
0 0 0 1 k
(Ophthalmology)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 348.6878 681.3891 Tm
0 0 0 1 k
-0.0057 Tc
(.)Tj
0.57232 0 Td
-0.006 Tc
[(20)-40(04;1)135(1)134(1:783-791)100(. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 261 669.8091 Tm
0 0 0 1 k
-0.0002 Tc
(1)Tj
0.55582 0.00001 TD
0 Tc
0.028 Tw
[(4.)-281(F)20(oulks GN.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 311.5576 669.8091 Tm
0 0 0 1 k
-0.0057 Tc
(C)Tj
0.66129 -0.00001 TD
-0.006 Tc
0.028 Tw
[(linical evaluation of the ef)25(ficacy of)]TJ
-7.4023 -1.14399 TD
[(PE)39(G/PG lubricant eye drops with gelling agent \(HP)120(-)]TJ
0 -1.144 TD
-0.017 Tc
(guar\) for the relief of the signs and symptoms of dry eye)Tj
T*
-0.006 Tc
[(disease: a review)20(. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 325.7003 644.0691 Tm
0 0 0 1 k
-0.152 Tw
[(Drugs T)115(oday )-180((Barc).)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 396.5634 644.0691 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(07;43:887)75(-896. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 261 632.4891 Tm
0 0 0 1 k
0.028 Tw
[(15.)-281(Gif)25(f)20(or)19(d P)235(,)-281(Ev)40(ans BJ)30(,)-281(Mor)40(r)39(is J)30(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 369.0609 632.4891 Tm
0 0 0 1 k
-0.0057 Tc
(A)Tj
1.01638 0 Td
-0.006 Tc
0.028 Tw
(clinical evaluation of)Tj
-15.4245 -1.144 TD
0 Tw
[(S)19(ystane. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 293.1899 623.9091 Tm
0 0 0 1 k
0.028 Tw
[(Cont L)10(ens )49(Anterior Eye. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 379.4055 623.9091 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(06;29:31)40(-40. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 261 612.3291 Tm
0 0 0 1 k
0.028 Tw
[(16.)-281(Pr)20(abhasa)19(w)20(at P)235(,)-186(T)150(esa)19(vibul N,)-281(Kasetsuw)20(an N.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 261 603.7491 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(P)30(erformance profile of sodium h)19(yaluronate in patients)]TJ
0 -1.144 TD
(with lipid tear deficiency: randomised, double-blind,)Tj
-0.0057 Tc
(c)'
0.4943 -0.00001 TD
-0.006 Tc
[(ontrolled, exploratory study)55(. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 366.5766 586.5891 Tm
0 0 0 1 k
-0.0002 Tc
(B)Tj
0.66685 -0.00001 TD
(r)Tj
0.69448 0 Td
(J)Tj
0.86148 0 Td
0 Tc
(Ophthalmol.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 261 578.0091 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(07;91:47)75(-50. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 261 566.4291 Tm
0 0 0 1 k
0.028 Tw
[(1)30(7)170(.)-281(Moon JW)40(,)-281(Lee HJ)30(,)-280(Shin KC,)-156(W)40(ee )124(WR,)-280(Lee JH,)-281(Kim MK.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 261 557.8491 Tm
0 0 0 1 k
-0.0057 Tc
(S)Tj
0.6613 -0.00001 TD
-0.006 Tc
0.028 Tw
[(hor)25(t term ef)24(fects of topical cyclosporine and vis-)]TJ
-0.6613 -1.14399 TD
(coelastic on the ocular surfaces in patients with dry)Tj
0 -1.144 TD
0 Tw
(eye. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 277.6754 540.6891 Tm
0 0 0 1 k
0.028 Tw
[(K)20(orean J Ophthalmol)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 353.7715 540.6891 Tm
0 0 0 1 k
-0.0057 Tc
(.)Tj
0.57232 0 Td
-0.006 Tc
[(20)-40(07;21:1)15(89-1)59(94. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 261 529.1091 Tm
0 0 0 1 k
0.028 Tw
[(1)20(8.)-201(Ar)19(ag)20(ona P)235(,)-281(P)40(apa )125(V)135(,)-281(Micali )80(A,)-281(Sant)19(ocono M,)-280(Milazz)19(o G.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 261 520.5291 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(L)9(ong term treatment with sodium h)20(yaluronate-contain-)]TJ
0 -1.144 TD
[(ing ar)25(tificial tear)-20(s reduces ocular surface damage in)]TJ
-0.0168 Tc
(p)'
0.59416 -0.00001 TD
-0.017 Tc
(atients with dry eye. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 337.2838 503.3691 Tm
0 0 0 1 k
-0.0113 Tc
(B)Tj
0.65574 -0.00001 TD
(r)Tj
0.67227 0 Td
(J)Tj
0.83926 0 Td
-0.011 Tc
(Ophthalmol.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 398.9443 503.3691 Tm
0 0 0 1 k
-0.0169 Tc
(2)Tj
0.53913 -0.00001 TD
-0.017 Tc
[(0)-40(02;86:1)15(81)39(-1)15(84. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 261 491.7891 Tm
0 0 0 1 k
0.028 Tw
[(1)20(9.)-281(Br)40(ignole F)174(,)-280(Pisella PJ)29(,)-280(Dupas B)19(,)-280(Bae)20(y)19(ens )125(V)135(,)-280(Baudouin C.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 261 483.209 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(Ef)24(fi)1(cacy and safety of 0.1)14(8% sodium h)20(yaluronate in)]TJ
0 -1.144 TD
(patients with moderate dry eye syndrome and super-)Tj
T*
(ficial k)Tj
3.0031 0 TD
0 Tw
(eratitis. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 311.6469 466.049 Tm
0 0 0 1 k
(Graefes )Tj
3.92305 0 TD
(Arc)Tj
1.56102 0 TD
-0.0002 Tc
(h)Tj
0.91647 0 Td
0 Tc
0.028 Tw
(Clin Exp Ophthalmol.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 261 457.469 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(05;243:531)40(-538. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 261 445.889 Tm
0 0 0 1 k
(20.)Tj
1.54536 0 TD
(V)Tj
0.62696 0 TD
(ehig)Tj
2.03564 0 TD
-0.0002 Tc
(e)Tj
0.86144 0 Td
0 Tc
(JG,)Tj
1.89238 0 TD
0.028 Tw
(Simmons P)Tj
5.3708 0 TD
0 Tw
(A.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 356.5767 445.889 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
(Ocular lubrication vs. vis)Tj
11.60565 0 TD
0 Tc
(-)Tj
-24.34921 -1.14401 TD
-0.006 Tc
[(cosity of ophthalmic products. Contact L)9(ens Spectrum;)]TJ
0 -1.144 TD
[(December 20)-40(04. ht)25(tp://www)19(.clspectrum.com/ar)25(ticle.)]TJ
T*
0 Tw
(aspx?ar)Tj
3.60368 0 TD
(ticle=1)Tj
3.03044 0 TD
(2720. )Tj
2.72395 0 TD
0.028 Tw
[(Accessed F)20(ebruary 1)14(8, 20)-40(08. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 261 408.569 Tm
0 0 0 1 k
0.028 Tw
[(21)50(.)-281(Harv)20(e)20(y B)19(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 306.2735 408.569 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(Fi)-20(ve days in Den)20(ver \(conference repor)24(t\).)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 261 399.989 Tm
0 0 0 1 k
(Optician.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 294.9131 399.989 Tm
0 0 0 1 k
-0.006 Tc
(20)Tj
1.1405 0 TD
0.028 Tw
(07 J)Tj
1.93135 0 TD
(an 1)Tj
1.99114 0 TD
[(2;233:1)15(5-1)14(6. ht)25(tp://www)20(.optician)]TJ
-9.58473 -1.14402 TD
-0.021 Tw
[(online.net/assets/getAsset.aspx?ItemID=21)35(43. Accessed)]TJ
0 -1.144 TD
0.028 Tw
[(F)19(ebruary 1)15(8, 20)-40(08. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 261 371.249 Tm
0 0 0 1 k
0.028 Tw
[(22.)-281(Sall KN,)-281(Cohen SM,)-281(Chr)40(ist)20(ensen MT)149(,)-280(St)20(ein JM.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 428.9773 371.249 Tm
0 0 0 1 k
-0.006 Tc
(An)Tj
-22.39697 -1.144 TD
0.028 Tw
(evaluation of the ef)Tj
9.05718 0 TD
(ficacy of a cyclosporine-based dry)Tj
-9.05718 -1.14401 TD
(eye therapy when used with mark)Tj
15.98524 0 TD
[(eted ar)25(tificial tear)-20(s as)]TJ
-15.98524 -1.144 TD
0 Tw
(suppor)Tj
3.27404 0 TD
(ti)Tj
0.61925 0 TD
0.028 Tw
(ve therapy in dry eye. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 369.0478 345.509 Tm
0 0 0 1 k
0.028 Tw
(Eye Contact L)Tj
6.49015 0 TD
0 Tw
(ens.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 261 336.929 Tm
0 0 0 1 k
-0.006 Tc
(20)Tj
1.14049 0 TD
(06;32:21)Tj
3.80688 0 TD
(-26. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 261 325.349 Tm
0 0 0 1 k
0.028 Tw
[(23.)-281(Chr)40(ist)19(ensen MT)150(,)-280(Cohen S)19(,)-280(Rinehar)19(t J)30(,)-281(et al.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 416.5659 325.349 Tm
0 0 0 1 k
-0.006 Tc
(Clinical)Tj
-20.74212 -1.14399 TD
0.028 Tw
(evaluation of an HP)Tj
9.07911 0 TD
(-guar gellable lubricant eye drop for)Tj
-9.07911 -1.14401 TD
(the relief of dryness of the eye. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 372.7033 308.189 Tm
0 0 0 1 k
0.028 Tw
[(Cur)25(r Eye R)19(es.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 261 299.609 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(04;28:55-62. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 261 288.029 Tm
0 0 0 1 k
0.028 Tw
[(24.)-281(Ousler GW)40(,)-281(Mic)20(haelson C,)-281(Chr)40(ist)19(ensen MT)150(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 416.4203 288.029 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
(An evalua-)Tj
-20.7227 -1.144 TD
(tion of tear film breakup time extension and ocular)Tj
T*
[(protection index scores among three mark)-20(eted lubri-)]TJ
T*
(cant eye drops. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 317.2084 262.289 Tm
0 0 0 1 k
(Cornea.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 346.9631 262.289 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(07;26:949-952. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 261 250.709 Tm
0 0 0 1 k
0.028 Tw
[(25.)-281(K)15(orb DR,)-281(Scaf)25(fidi R)10(C,)-281(Gr)29(einer JV)135(,)-281(et al.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 400.502 250.709 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(The ef)25(fect of)]TJ
-18.60027 -1.14399 TD
[(two no)15(vel lubricant eye drops on tear film lipid layer)]TJ
0 -1.144 TD
[(thic)50(kness in subjects with dry eye symptoms. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 422.6849 233.549 Tm
0 0 0 1 k
(Optom)Tj
-21.55799 -1.144 TD
0.028 Tw
[(V)25(is S)20(ci.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 288.9636 224.9689 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(05;82:594-60)55(1)99(. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 261 213.3889 Tm
0 0 0 1 k
(26.)Tj
1.67036 0.00001 TD
(Scaf)Tj
2.03077 0.00001 TD
0.028 Tw
[(fidi R)10(C,)-281(K)15(orb DR.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 344.6173 213.3889 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
(Comparison of the ef)Tj
9.88947 0.00001 TD
(ficacy of)Tj
-21.03844 -1.144 TD
(two lipid emulsion eyedrops in increasing tear film)Tj
0 -1.14401 TD
[(lipid layer thic)50(kness. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 334.4619 196.229 Tm
0 0 0 1 k
0.028 Tw
[(Eye Contact L)10(ens.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 399.9727 196.229 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(07;33:38-44. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 261 184.649 Tm
0 0 0 1 k
0.028 Tw
[(27)170(.)-281(Geer)40(ling G,)-281(MacLennan S)20(,)-281(Har)20(twig D)24(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 397.724 184.649 Tm
0 0 0 1 k
-0.006 Tc
(Autologous)Tj
-18.22986 -1.144 TD
0.028 Tw
[(serum eye drops for ocular surface disorder)-20(s. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 424.0147 176.069 Tm
0 0 0 1 k
0.028 Tw
(Br J)Tj
-21.73529 -1.14399 TD
0 Tw
(Ophthalmol.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 307.4045 167.489 Tm
0 0 0 1 k
-0.006 Tc
(20)Tj
1.14049 0.00001 TD
(04;88:1)Tj
3.2614 0.00001 TD
(467)Tj
1.57611 0.00001 TD
(-1)Tj
0.84265 0.00001 TD
(47)Tj
1.04577 0.00001 TD
(4. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 261 155.909 Tm
0 0 0 1 k
0.028 Tw
[(28.)-281(Noble BA,)-281(Loh R)10(S)20(,)-281(MacLennan S)20(,)-281(et al.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 403.7844 155.909 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
(Comparison of)Tj
-19.03792 -1.144 TD
(autologous serum eye drops with con)Tj
17.80993 0.00001 TD
(ventional therapy)Tj
-17.80993 -1.144 TD
[(in a randomised controlled crosso)15(ver trial for ocular)]TJ
0 -1.14401 TD
(surface disease. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 319.4651 130.1689 Tm
0 0 0 1 k
0.028 Tw
(Br J Ophthalmol.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 382.5425 130.1689 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(04;88:647)75(-652. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 261 118.669 Tm
0 0 0 1 k
0.028 Tw
[(29.)-131(T)150(ananuv)40(at N,)-281(D)25(aniell M,)-281(Sulliv)40(an LJ)29(,)-280(et al.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 411.3107 118.669 Tm
0 0 0 1 k
-0.006 Tc
(Controlled)Tj
-20.04143 -1.13333 TD
0.028 Tw
(study of the use of autologous serum in dry eye pa-)Tj
T*
0 Tw
(tients. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 284.6183 101.669 Tm
0 0 0 1 k
(Cornea.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 314.373 101.669 Tm
0 0 0 1 k
-0.006 Tc
(20)Tj
1.1405 -0.00001 TD
[(0)55(1;20:802-806. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 261 90.169 Tm
0 0 0 1 k
(30.)Tj
1.67036 0.00001 TD
(K)Tj
0.6521 0.00001 TD
(ojima )Tj
2.82197 0.00001 TD
(T)Tj
0.46094 0.00001 TD
0.028 Tw
[(,)-281(Ishida R,)-280(Dogr)39(u M,)-281(et al.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 385.1143 90.169 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
(The ef)Tj
2.91364 0.00001 TD
(fect of autolo)Tj
6.1975 0.00001 TD
0 Tc
(-)Tj
-25.65972 -1.13335 TD
-0.006 Tc
(gous serum eyedrops in the treatment of severe dry)Tj
ET
Q
endstream
endobj
17 0 obj
<<
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1 g
0 774 0 0 re
f
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q
BT
/F14 1 Tf
11 0 0 11 39.943 721.2969 Tm
0 0 0 1 k
0.01 Tc
(Reports)Tj
ET
0 0 0 0 k
38.949 28.7999 480.531 16 re
f
Q
/GS2 gs
/GS1 gs
q
BT
/F13 1 Tf
11 0 0 11 39.9489 35.6064 Tm
0.95 0.44 0 0.32 k
(S100)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
5 0 0 5 246.7298 35.6064 Tm
0.95 0.44 0 0.32 k
(n)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
9 0 0 9 254.2847 35.6064 Tm
0 0 0 1 k
(www)Tj
1.927 0.00001 TD
(.ajmc.com)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
5 0 0 5 312.8631 35.6064 Tm
0.95 0.44 0 0.32 k
(n)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F14 1 Tf
7.5 0 0 7.5 479.7469 35.6064 Tm
0 0 0 1 k
0.025 Tw
(APRIL 2008)Tj
ET
0.25 w
0 0 0 1 K
40.774 54 m
519.48 54 l
S
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 110.52 707.7609 Tm
0 0 0 1 k
-0.0057 Tc
(e)Tj
0.55032 -0.00001 TD
-0.006 Tc
0.028 Tw
[(ye disease: a prospecti)-20(ve randomiz)20(ed case-control)]TJ
-0.55032 -1.13332 TD
0 Tw
[(study)55(. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 133.7698 699.2609 Tm
0 0 0 1 k
0.028 Tw
(Am J Ophthalmol)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 197.087 699.2609 Tm
0 0 0 1 k
-0.0057 Tc
(.)Tj
0.57232 0 Td
-0.006 Tc
[(20)-40(05;1)15(39:242-246. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 110.52 687.7609 Tm
0 0 0 1 k
-0.0002 Tc
(3)Tj
0.55581 0.00001 TD
0 Tc
0.028 Tw
[(1)50(.)-281(Noda-Tsur)40(uy)19(a )150(T)150(,)-201(Asano-Kat)20(o N,)-131(T)150(oda I,)-131(Tsubota K.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 110.52 679.2609 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(Autologous serum eye drops for dry eye af)25(ter LA)19(SIK. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 110.52 670.7609 Tm
0 0 0 1 k
-0.0001 Tc
(J)Tj
0.86152 0 Td
0 Tc
0.028 Tw
[(R)20(efract Surg.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 165.5408 670.7609 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(06;22:61)40(-66.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 110.52 659.2609 Tm
0 0 0 1 k
-0.0002 Tc
(3)Tj
0.55582 0.00001 TD
0 Tc
0.028 Tw
[(2.)-281(Behr)30(ens )79(A,)-280(Do)19(yle JJ)30(,)-281(St)20(er)39(n L,)-280(et al.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 238.9045 659.2609 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
(Dysfunctional tear)Tj
-17.11794 -1.13334 TD
[(syndrome: a Delphi approac)50(h to treatment recommen)-1(-)]TJ
0 -1.13333 TD
0 Tw
(dations. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 140.7635 642.2609 Tm
0 0 0 1 k
(Cornea. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 170.5599 642.2609 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(06;25:90)-40(0-907)190(. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 110.52 630.7609 Tm
0 0 0 1 k
0.028 Tw
[(33.)-131(T)150(aban M,)-281(Chen B)20(,)-281(P)40(er)40(ry JD)25(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 213.1234 630.7609 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
(Update on punctal )Tj
-13.68045 -1.13334 TD
0 Tw
(plugs. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 134.1818 622.2609 Tm
0 0 0 1 k
0.028 Tw
(Compr Ophthalmol Update.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 235.162 622.2609 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(06;7:205-21)15(2; )]TJ
-16.61893 -1.13333 TD
0.028 Tw
[(discussion 21)15(3-21)34(4. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 110.52 602.2609 Tm
0 0 0 1 k
-0.0002 Tc
(3)Tj
0.55582 0.00001 TD
0 Tc
0.028 Tw
[(4.)-201(Amer)40(ican Opt)19(ometr)40(ic )80(Association.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 237.7509 602.2609 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
(Optometric clinical)Tj
-16.96412 -1.13334 TD
(practice guideline: care of the patient with ocular sur-)Tj
0 -1.13333 TD
[(face disorder)-20(s. ht)25(tp://www)19(.aoa.org/documents/CPG-)]TJ
0 -1.13334 TD
[(1)55(0.pdf)24(. 20)-40(02, updates )50(April and J)19(une 20)-39(03. )49(Accessed)]TJ
T*
[(F)19(ebruary 1)15(3, 20)-40(08.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 110.52 556.7609 Tm
0 0 0 1 k
0.028 Tw
[(35.)-281(Lindsa)20(y R)9(G.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 162.7753 556.7609 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(Therapeutic use of silicone h)20(ydrogel)]TJ
-6.96737 -1.13334 TD
[(lenses for the management of dry eye. In )180(The P)19(ractice;)]TJ
-0.0057 Tc
(M)'
0.93833 -0.00001 TD
-0.006 Tc
[(arc)50(h 20)-40(07)189(. ht)25(tp://www)20(.siliconeh)19(ydrogels.org/in_)]TJ
-0.93833 -1.13332 TD
[(the_practice/mar_07)190(.asp. )49(Accessed F)20(ebruary 1)15(8, 20)-40(08. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 110.52 519.7609 Tm
0 0 0 1 k
-0.0002 Tc
(3)Tj
0.55582 0.00001 TD
0 Tc
0.028 Tw
[(6.)-281(Diller R,)-281(Sant S)20(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 176.4825 519.7609 Tm
0 0 0 1 k
-0.0057 Tc
(A)Tj
1.01645 -0.00001 TD
-0.006 Tc
0.028 Tw
[(case repor)25(t and review of filamen-)]TJ
-9.81145 -1.13333 TD
[(tary k)-20(eratitis. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 158.3352 511.2608 Tm
0 0 0 1 k
[(Optometry)55(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 200.5796 511.2608 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(05;7)40(6:30-36. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 110.52 499.7609 Tm
0 0 0 1 k
-0.0002 Tc
(3)Tj
0.55581 0.00001 TD
0 Tc
0.028 Tw
[(7)170(.)-201(Albietz J)30(,)-281(Sanfilippo P)235(,)-131(T)150(r)25(outbec)20(k R,)-281(Lent)20(on LM.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 277.9171 499.7609 Tm
0 0 0 1 k
-0.0058 Tc
(M)Tj
0.93824 -0.00001 TD
-0.006 Tc
(an-)Tj
-23.25785 -1.13333 TD
0.028 Tw
[(agement of filamentary k)-20(eratitis associated with aque-)]TJ
T*
(ous-deficient dry eye. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 188.5156 482.7609 Tm
0 0 0 1 k
(Optom )Tj
3.48188 0 TD
(V)Tj
0.64209 0 TD
0.028 Tw
[(is S)20(ci.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 242.5933 482.7609 Tm
0 0 0 1 k
-0.006 Tc
(20)Tj
1.1405 0 TD
(03;80:420-430. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 110.52 471.2609 Tm
0 0 0 1 k
(38.)Tj
1.67036 0 TD
-0.0001 Tc
(R)Tj
0.66688 0.00001 TD
0 Tc
0.028 Tw
[(osenthal P)235(,)-281(Cr)25(ot)20(eau )79(A.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 201.3048 471.2609 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
(Fluid-ventilated, g)Tj
8.40146 0 TD
0 Tw
(as-perme-)Tj
-20.50609 -1.13334 TD
0.028 Tw
[(able scleral contact lens is an ef)25(fecti)-20(ve option for man)-1(-)]TJ
0 -1.13333 TD
[(aging severe ocular surface disease and man)19(y corn)1(eal)]TJ
T*
0 Tw
(disorder)Tj
3.91942 0 TD
-0.0057 Tc
(s)Tj
0.79436 0 Td
-0.006 Tc
0.028 Tw
(that would otherwise require penetrating)Tj
-4.71378 -1.13334 TD
0 Tw
[(k)-20(eratoplasty)55(. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 157.3807 437.2609 Tm
0 0 0 1 k
0.028 Tw
[(Eye Contact L)10(ens.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 222.8916 437.2609 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(05;31:1)15(30-1)14(34. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 110.52 425.7609 Tm
0 0 0 1 k
0.028 Tw
[(39.)-281(J)20(acobs DS)20(,)-281(Rosenthal P)235(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 203.4547 425.7609 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(Boston S)20(cleral L)9(ens pros-)]TJ
-12.39129 -1.13333 TD
[(thetic device for treatment of severe dry eye in c)50(hronic)]TJ
0 -1.13334 TD
[(graf)25(t-ver)-20(sus-host disease. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 203.0929 408.7609 Tm
0 0 0 1 k
(Cornea.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 232.8476 408.7609 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(07;26:1)135(1)59(95-1)135(1)59(99. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 110.52 397.2609 Tm
0 0 0 1 k
(40.)Tj
1.67036 0 TD
0.028 Tw
[(Rosenthal P)235(,)-281(Cot)25(t)20(er J)29(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 193.6987 397.2609 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
(The Boston S)Tj
6.30164 0 TD
[(cleral L)10(ens in the)]TJ
-17.39213 -1.13334 TD
(management of severe ocular surface disease.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 110.52 380.2609 Tm
0 0 0 1 k
0.028 Tw
[(Ophthalmol Clin Nor)25(th )49(Am.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 209.894 380.2609 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(03;1)15(6:89-93.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 110.52 368.7609 Tm
0 0 0 1 k
(41)Tj
1.06201 0 TD
(.)Tj
0.55854 0 TD
0.028 Tw
(Cosar CB)Tj
4.34249 0 TD
(,)Tj
0.55854 0 TD
[(Cohen EJ)30(,)-281(Rapuano CJ)30(,)-281(et al.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 254.0221 368.7609 Tm
0 0 0 1 k
(T)Tj
0.49029 0 TD
-0.006 Tc
(ar)Tj
0.95349 0 TD
(sor)Tj
1.45818 0 TD
(rhaph)Tj
2.72979 0 TD
(y:)Tj
-24.76536 -1.13335 TD
0.028 Tw
(clinical experience from a cornea practice. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 261.1947 360.2609 Tm
0 0 0 1 k
(Cornea.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 110.52 351.7609 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(0)55(1;20:787)74(-791)100(. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 110.52 340.2609 Tm
0 0 0 1 k
(42.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 122.2125 340.2609 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(S)19(alagen (pilocarpine) product information. MGI)]TJ
-1.559 -1.13333 TD
[(Pharma; S)20(eptember 20)-40(03. ht)24(tp://www)20(.mgipharma.com/)]TJ
0 -1.13334 TD
[(pdfs/salagen_pi.pdf)25(. )49(Accessed F)20(ebruary 1)15(8, 20)-40(08. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 110.52 311.7609 Tm
0 0 0 1 k
(43.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 122.2125 311.7609 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(Ev)15(o)14(xac (cevimeline) product information. Daiic)50(hi)]TJ
-1.559 -1.13333 TD
0 Tc
(S)Tj
0.64167 0 TD
-0.006 Tc
[(ank)-40(yo; )50(April 20)-40(05. ht)24(tp://www)20(.ev)15(o)14(xac.com/prescrib)]TJ
-0.64167 -1.13334 TD
[(ing_info.htm. )50(Accessed F)19(ebruary 1)15(8, 20)-40(08.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 110.52 283.2609 Tm
0 0 0 1 k
(44.)Tj
1.67036 0 TD
0.028 Tw
[(Nelson JD)25(,)-281(F)20(r)40(iedlaender M,)-131(Y)165(eat)25(ts RP)234(,)-280(et al;)-281(and MGI)]TJ
-1.67036 -1.21429 TD
[(PHARMA Sj\232gr)30(en\325)74(s S)20(yndr)25(ome St)15(udy Gr)24(oup.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 259.5982 274.7609 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
(Oral pilo-)Tj
-19.87709 -1.13334 TD
[(carpine for symptomatic relief of k)-20(eratoconjuncti)-20(vitis)]TJ
0 -1.13333 TD
[(sicca in patients with Sj\232gren)2099(s syndrome. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 261.1467 257.7609 Tm
0 0 0 1 k
0.028 Tw
(Adv Exp)Tj
-20.08356 -1.13334 TD
(Med Biol.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 146.727 249.2609 Tm
0 0 0 1 k
-0.006 Tc
[(1)59(998;438:979-983. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 110.52 237.7109 Tm
0 0 0 1 k
-0.022 Tc
0.028 Tw
[(45.)-259(P)41(apas )79(A)20(S)20(,)-258(F)20(er)40(nandez MM,)-259(Castano RA,)-258(Gallagher SC,)]TJ
0 -1.22143 TD
[(T)150(r)40(iv)20(edi M,)-259(Shr)25(otr)40(iy)19(a R)10(C.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 186.8829 229.1609 Tm
0 0 0 1 k
-0.028 Tc
0.028 Tw
(Oral pilocarpine for symptomatic)Tj
-10.18172 -1.14 TD
[(relief of dry mouth and dry eyes in patients with Sj\232gren)20100(s)]TJ
T*
0 Tw
(syndrome. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 148.6399 212.0609 Tm
0 0 0 1 k
-0.022 Tc
0.028 Tw
(Adv Exp Med Biol. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 213.9683 212.0609 Tm
0 0 0 1 k
-0.028 Tc
[(1)60(998;438:973-978. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 110.52 200.5109 Tm
0 0 0 1 k
0.028 Tw
[(46.)-156(V)20(ivino FB)20(,)-201(Al-Hashimi I,)-281(Khan Z,)-281(et al,)-281(f)20(or the P92-0)55(1)]TJ
0 -1.22143 TD
0 Tw
(St)Tj
1.04101 0.00001 TD
0.028 Tw
(udy Gr)Tj
3.22506 0.00001 TD
0 Tw
(oup.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 157.4054 191.9609 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
(Pilocarpine tablets for the treatment of)Tj
-6.25139 -1.14 TD
(dry mouth and dry eye symptoms in patients with)Tj
T*
[(Sj\232gren syndrome: a randomiz)20(ed, placebo-controlled,)]TJ
T*
(fixed-dose, multicenter trial. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 211.5043 166.3109 Tm
0 0 0 1 k
0.028 Tw
[(Arc)50(h Intern Med.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 110.52 157.7609 Tm
0 0 0 1 k
(1)Tj
0.49053 0.00001 TD
-0.006 Tc
(999;1)Tj
2.4588 0.00001 TD
(59:1)Tj
1.90844 0.00001 TD
0 Tc
(7)Tj
0.49541 0.00001 TD
-0.006 Tc
[(4-1)15(81)99(. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 110.52 146.2109 Tm
0 0 0 1 k
-0.011 Tc
(47)Tj
0.91967 0.00001 TD
0 Tc
(.)Tj
0.38641 0.00001 TD
-0.011 Tc
(Tsif)Tj
1.63719 0.00001 TD
0.028 Tw
(etaki N,)Tj
3.87646 0.00001 TD
(Kitsos G,)Tj
4.47544 0.00001 TD
0 Tc
(P)Tj
0.55993 0.00001 TD
-0.011 Tc
[(asc)20(hides CA,)-270(et al.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 255.1413 146.2109 Tm
0 0 0 1 k
-0.017 Tc
0.028 Tw
(Oral pilo)Tj
3.93336 0.00001 TD
0 Tc
(-)Tj
-23.2162 -1.14001 TD
-0.017 Tc
(carpine for the treatment of ocular symptoms in patients)Tj
0 -1.14 TD
(with Sj\232gren)Tj
5.86209 0.00001 TD
[100(s syndrome: a randomised 1)14(2 week con-)]TJ
-5.86209 -1.14001 TD
[(trolled study)55(. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 157.3895 120.5609 Tm
0 0 0 1 k
-0.011 Tc
0.028 Tw
(Ann Rheum Dis.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 216.2961 120.5609 Tm
0 0 0 1 k
-0.017 Tc
[(20)-40(03;62:1)15(204-1)14(207)190(. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 110.52 109.0109 Tm
0 0 0 1 k
0.028 Tw
[(48.)-281(P)40(etr)25(one D)25(,)-281(Condemi JJ)30(,)-281(Fif)40(e R,)-281(Gluc)19(k O)20(,)-281(Cohen S)20(,)]TJ
0 -1.22144 TD
[(D)25(algin P)235(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 140.3248 100.4609 Tm
0 0 0 1 k
-0.0057 Tc
(A)Tj
1.01635 0 Td
-0.006 Tc
0.028 Tw
[(double-blind, randomiz)20(ed, placebo-con)-1(-)]TJ
-4.99032 -1.14001 TD
[(trolled study of cevimeline in Sj\232gren)19100(s syndrome)]TJ
T*
[(patients with xerostomia and k)-20(eratoconjuncti)-20(vitis sicca.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 110.52 74.8107 Tm
0 0 0 1 k
0.028 Tw
[(Ar)25(thritis Rheum.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 171.1112 74.8107 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(02;46:7)55(48-754.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 324 707.7609 Tm
0 0 0 1 k
-0.0002 Tc
(4)Tj
0.55582 0.00001 TD
0 Tc
0.028 Tw
[(9.)-281(Ono M,)-131(T)150(ak)15(amur)19(a E,)-280(Shinozaki K,)-281(et al.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 464.5975 707.7609 Tm
0 0 0 1 k
-0.0057 Tc
(T)Tj
0.6053 -0.00001 TD
-0.006 Tc
(herapeutic)Tj
-19.35163 -1.13999 TD
0.028 Tw
[(ef)25(fect of cevimeline on dry eye in patients)-1( with)]TJ
0 -1.14 TD
[(Sj\232gren)2099(s syndrome: a randomiz)20(ed, double-blind clini-)]TJ
T*
[(cal study)55(. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 359.3783 682.1108 Tm
0 0 0 1 k
0.028 Tw
(Am J Ophthalmol.)Tj
ET
Q
/GS2 gs
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q
BT
/F18 1 Tf
7.5 0 0 7.5 427.0297 682.1108 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(04;1)15(38:6-1)14(7)190(. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 324 670.5609 Tm
0 0 0 1 k
-0.0002 Tc
(5)Tj
0.55582 0.00001 TD
0 Tc
0.028 Tw
[(0.)-201(A)55(vunduk )80(AM,)-201(A)55(vunduk MC,)-156(V)95(ar)39(nell ED)25(,)-280(Kaufman HE.)]TJ
ET
Q
/GS2 gs
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q
BT
/F18 1 Tf
7.5 0 0 7.5 324 662.0109 Tm
0 0 0 1 k
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0.028 Tw
[(The comparison of ef)25(ficacies of topical cor)24(ticosteroids)]TJ
0 -1.14 TD
(and nonsteroidal anti-inflammatory drops on dry eye)Tj
T*
[(patients: a clinical and immunocytoc)50(hemical study)54(. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 324 636.3608 Tm
0 0 0 1 k
0.028 Tw
(Am J Ophthalmol.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 391.6514 636.3608 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(03;1)15(36:593-602.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 324 624.8109 Tm
0 0 0 1 k
-0.0057 Tc
(5)Tj
0.55026 0.00001 TD
-0.006 Tc
0.028 Tw
[(1)50(.)-276(Pflugf)40(elder SC,)-276(Maskin SL,)-195(Anderson B)20(,)-276(et al.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 484.0842 624.8109 Tm
0 0 0 1 k
-0.0113 Tc
(A)Tj
1.00528 0 Td
-0.011 Tc
(ran-)Tj
-22.34984 -1.14 TD
0.028 Tw
[(domiz)20(ed, double-mask)-20(ed, placebo-controlled, multicen-)]TJ
T*
(ter comparison of loteprednol etabonate ophthalmic)Tj
T*
[(suspension, 0.5%, and placebo for treatment of k)-20(erato-)]TJ
T*
[(conjuncti)-20(vitis sicca in patients with delayed tear clear-)]TJ
T*
0 Tw
(ance. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 344.5457 582.0609 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
(Am J Ophthalmol. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 411.5303 582.0609 Tm
0 0 0 1 k
-0.011 Tc
[(20)-40(04;1)15(38:444-457)190(. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 324 570.5109 Tm
0 0 0 1 k
0.028 Tw
[(52.)-281(Lee HK,)-281(Ryu IH,)-281(Seo KY)130(,)-280(Hong S)19(,)-280(Kim HC,)-281(Kim EK.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 324 561.9608 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(T)115(opical 0.1% prednisolone lower)-20(s nerve growth factor)]TJ
0 -1.14001 TD
[(expression in k)-20(eratoconjuncti)-20(vitis sicca patients.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 324 544.8608 Tm
0 0 0 1 k
-0.0002 Tc
(O)Tj
0.77783 -0.00001 TD
0 Tc
[(phthalmology)55(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 383.3244 544.8608 Tm
0 0 0 1 k
-0.0057 Tc
(2)Tj
0.55025 -0.00001 TD
-0.006 Tc
[(0)-40(06;1)135(1)14(3:1)60(98-205. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 324 533.3108 Tm
0 0 0 1 k
0.028 Tw
[(53.)-281(Sainz De La Maza Ser)40(r)20(a M,)-281(Simon Cast)19(ellvi C,)-280(Kabbani)]TJ
0 -1.22143 TD
-0.02 Tc
0 Tw
(O.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 333.5017 524.7608 Tm
0 0 0 1 k
-0.0057 Tc
(N)Tj
0.77231 -0.00001 TD
-0.006 Tc
0.028 Tw
(onpreserved topical steroids and lacrimal punctal)Tj
-2.0392 -1.14 TD
[(occlusion for severe k)-20(eratoconjuncti)-20(vitis sicca. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 489.5363 516.2107 Tm
0 0 0 1 k
[(Arc)50(h)]TJ
-22.0715 -1.13999 TD
(S)Tj
0.64721 0.00001 TD
0.028 Tw
[(oc Esp Of)25(talmol.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 389.6519 507.6608 Tm
0 0 0 1 k
-0.006 Tc
(20)Tj
1.1405 0.00001 TD
0.028 Tw
[(0)-40(0;75:751)39(-756. [English abstract;)]TJ
-9.89408 -1.14001 TD
[(ar)25(ticle in Spanish] )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 324 487.5608 Tm
0 0 0 1 k
(54.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 335.6925 487.5608 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(L)9(otemax \(loteprednol etabonate ophthalmic sus-)]TJ
-1.559 -1.14 TD
[(pension\) product information. Bausc)50(h & L)9(omb; )50(April)]TJ
T*
[(20)-40(06. ht)25(tp://www)19(.bausc)50(h.com/en_US/downloads/)]TJ
T*
-0.022 Tw
[(ecp/pharma/general/lotemaxinser)25(t.pdf)24(. Accessed)]TJ
T*
0.028 Tw
[(F)19(ebruary 1)60(9, 20)-40(08. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 324 441.8108 Tm
0 0 0 1 k
(55.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 335.6925 441.8108 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(Oracea \(do)15(xycycline\) product information.)]TJ
-1.559 -1.14 TD
(CollaGenex Pharmaceuticals; J)Tj
14.48722 0 TD
(une 20)Tj
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(07)Tj
0.91076 0 TD
-0.0058 Tc
(.)Tj
0.57217 0 Td
-0.006 Tc
(ht)Tj
0.90774 0 TD
[(tp://www)20(.)]TJ
-20.07937 -1.14002 TD
-0.022 Tw
[(oracea.com/PDF/ORA-021)35(4_F)19(ull_PI_m2.pdf)25(. Accessed)]TJ
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0 Tw
(Marc)Tj
2.31664 0 TD
-0.0057 Tc
(h)Tj
0.90537 0 Td
-0.006 Tc
0.028 Tw
(26, 20)Tj
2.81351 0 TD
0 Tw
(08.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 324 404.6108 Tm
0 0 0 1 k
0.028 Tw
[(56.)-281(Seal D)55(V)135(,)-156(W)20(r)40(ight P)235(,)-281(Fic)20(k)35(er L,)-281(Hag)19(an K,)-131(T)151(r)24(oski M,)-280(Menda)19(y)]TJ
0 -1.22143 TD
(P)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
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-0.0057 Tc
(.)Tj
0.57238 0 Td
-0.006 Tc
0.028 Tw
[(Placebo controlled trial of fusidic acid gel and o)15(xy)-1(-)]TJ
-1.1425 -1.14 TD
[(tetracycline for recur)25(rent blepharitis and rosacea. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 324 378.9608 Tm
0 0 0 1 k
0.028 Tw
(Br J Ophthalmol.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
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0 0 0 1 k
-0.006 Tc
[(1)59(995;79:42-45. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 324 367.4108 Tm
0 0 0 1 k
0.028 Tw
[(57)170(.)-281(Bar)20(tholomew R)9(S)20(,)-280(Reid BJ)29(,)-280(Cheesbr)25(ough MJ)29(,)]TJ
0 -1.22143 TD
[(Macdonald M,)-281(Gallo)20(w)20(a)19(y NR.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 421.134 358.8608 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
(Oxytetracycline in the)Tj
-12.9512 -1.14 TD
(treatment of ocular rosacea: a double-blind trial. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 324 341.7608 Tm
0 0 0 1 k
0.028 Tw
(Br J Ophthalmol)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
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(.)Tj
0.57224 0 Td
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[(1)60(982;66:386-388. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
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0.028 Tw
[(58.)-281(Zengin N,)-131(T)150(ol H,)-281(Gunduz K,)-281(Okudan S)20(,)-281(Balevi S)20(,)]TJ
0 -1.22143 TD
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(Endogr)Tj
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-0.0002 Tc
(u)Tj
0.91641 0 Td
0 Tc
(H.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
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0 0 0 1 k
-0.006 Tc
0.028 Tw
(Meibomian gland dysfunction and tear film)Tj
-5.26496 -1.14 TD
(abnormalities in rosacea. )Tj
ET
Q
/GS2 gs
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q
BT
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0 0 0 1 k
(Cornea.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
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0 0 0 1 k
-0.006 Tc
[(1)59(995;1)35(4:1)35(44-1)35(46. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 324 301.5608 Tm
0 0 0 1 k
(59.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
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0 0 0 1 k
(R)Tj
0.64166 0.00001 TD
-0.006 Tc
0.028 Tw
(estasis (cyclosporine ophthalmic emulsion) prod)Tj
22.78994 0 TD
0 Tc
(-)Tj
-24.9906 -1.14001 TD
-0.006 Tc
(uct information. )Tj
7.74163 0 TD
[(Allerg)20(an, Inc, F)19(ebruary 20)-40(04.)]TJ
-7.74163 -1.14001 TD
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[(ht)24(tp://www)20(.restasisprofessional.com/_prescribe/)]TJ
0 -1.14 TD
0.028 Tw
[(prescribe_home.htm. )50(Accessed F)19(ebruary 1)60(9, 20)-40(08. )]TJ
ET
Q
/GS2 gs
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q
BT
/F15 1 Tf
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0 0 0 1 k
0.005 Tc
0.028 Tw
[(60.)-137(T)150(ur)40(ner K,)-287(Pflugf)40(elder SC,)-287(Ji Z,)-286(F)19(ener )125(WJ)30(,)-287(St)20(er)39(n M,)-286(Reis)]TJ
0 -1.22144 TD
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(BL.)Tj
ET
Q
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q
BT
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0.028 Tw
[(Interleukin-6 levels in the conjuncti)-20(val epithelium)]TJ
-1.72185 -1.14001 TD
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ET
Q
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Q
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[(20)-40(0)-40(0;1)60(9:)]TJ
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(492-496. )Tj
ET
Q
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ET
Q
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q
BT
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(Analysis of topical cyclosporine treatment of patients)Tj
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0 Tw
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ET
Q
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q
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[(Arc)50(h Ophthalmol.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
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0 0 0 1 k
-0.006 Tc
[(20)-40(0)-40(0;1)134(1)15(8:1)35(489-1)34(496. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
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0 0 0 1 k
0.028 Tw
[(62.)-281(Br)40(ignole F)174(,)-280(Pisella PJ)30(,)-281(De Saint J)15(ean M,)-281(Goldsc)20(hild M,)]TJ
0 -1.21429 TD
-0.052 Tw
[(Goguel A,)-281(Baudouin )-80(C.)]TJ
ET
Q
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q
BT
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0.028 Tw
(Flow cytometric analysis of)Tj
-10.33873 -1.13333 TD
[(inflammatory mark)-20(er)-20(s in KCS: 6-month treatment with)]TJ
0 -1.13334 TD
[(topical cyclosporin )50(A. )]TJ
ET
Q
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q
BT
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0.028 Tw
[(In)19(vest Ophthalmol )100(V)25(is S)20(ci.)]TJ
ET
Q
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BT
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[(20)-40(0)55(1;42:90-95. )]TJ
ET
Q
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BT
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(63.)Tj
1.67036 0.00001 TD
0.028 Tw
(Baudouin C,)Tj
6.08608 0.00001 TD
[(Br)40(ignole F)174(,)-280(Pisella PJ)29(,)-280(De Saint J)15(ean MS)19(,)]TJ
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(Goguel A.)Tj
ET
Q
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(Flow cytometric analysis of the inflammatory)Tj
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[(mark)-20(er HLA DR in dry eye syndrome: results from 1)15(2)]TJ
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(months of randomiz)Tj
9.48705 0.00001 TD
(ed treatment with topical cyclo)Tj
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ET
Q
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BT
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(Adv Exp Med Biol.)Tj
ET
Q
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q
BT
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[(20)-40(02;506(Pt B):7)40(61)39(-7)40(69. )]TJ
ET
Q
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q
BT
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0.028 Tw
[(64.)-281(K)15(uner)20(t KS)19(,)-130(Tisdale )79(A)20(S)20(,)-281(Gipson IK.)]TJ
ET
Q
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q
BT
/F18 1 Tf
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0 0 0 1 k
-0.006 Tc
0.028 Tw
[(Goblet cell number)-20(s)]TJ
-16.47088 -1.13333 TD
(and epithelial proliferation in the conjuncti)Tj
19.96092 0.00001 TD
(va of)Tj
-19.96092 -1.13334 TD
(patients with dry eye syndrome treated with)Tj
ET
Q
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q
BT
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0 0 0 1 k
Tj
ET
Q
endstream
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<<
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>>
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(M)Tj
0.88387 0.00001 TD
-0.005 Tc
0.025 Tw
(anagement of Dry Eye Disease)Tj
ET
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47.52 28.7999 480.528 16 re
f
Q
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(V)Tj
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ET
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(n)Tj
ET
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BT
/F14 1 Tf
7.5 0 0 7.5 202.9401 35.6064 Tm
0 0 0 1 k
0.025 Tw
(THE AMERICAN JOURNAL OF MANAGED CARE)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
5 0 0 5 377.8499 35.6064 Tm
0.95 0.44 0 0.32 k
(n)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F13 1 Tf
11 0 0 11 502.588 35.6064 Tm
0.95 0.44 0 0.32 k
(S101)Tj
ET
0.25 w
0 0 0 1 K
47.52 54 m
526.226 54 l
S
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 47.52 707.1291 Tm
0 0 0 1 k
-0.006 Tc
(cyclosporine. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 96.3106 707.1291 Tm
0 0 0 1 k
0.028 Tw
[(Arc)50(h Ophthalmol.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 161.2963 707.1291 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(02;1)15(20:330-337)190(.)]TJ
-15.17017 -1.13334 TD
0.028 Tw
[(Er)25(ratum in: )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 88.9064 698.6291 Tm
0 0 0 1 k
0.028 Tw
[(Arc)50(h Ophthalmol.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 153.8921 698.6291 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(02;1)15(20:1)55(099. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 687.129 Tm
0 0 0 1 k
0.028 Tw
[(65.)-281(Sall K,)-281(St)20(ev)20(enson OD)24(,)-280(Mundorf )149(TK,)-280(Reis BL.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 204.1273 687.129 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(T)95(wo multi)-1(-)]TJ
-20.88097 -1.13333 TD
[(center)55(, randomiz)19(ed studies of the ef)25(ficacy and safety of)]TJ
0 -1.13334 TD
-0.0057 Tc
(c)Tj
0.4943 -0.00001 TD
-0.006 Tc
(yclosporine ophthalmic emulsion in moderate to)Tj
-0.4943 -1.13333 TD
(severe dry eye disease. CsA Phase 3 Study Group.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 47.52 653.1291 Tm
0 0 0 1 k
[(Ophthalmology)55(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 106.8444 653.1291 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(20)-40(0)-40(0;1)55(07:631)39(-639. Er)25(ratum in:)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 47.52 644.6291 Tm
0 0 0 1 k
[(Ophthalmology)55(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 106.8444 644.6291 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(0)-40(0;1)55(07:1)14(220. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 633.129 Tm
0 0 0 1 k
0.028 Tw
[(66.)-281(Barber LD)25(,)-281(Pflugf)40(elder SC,)-131(T)150(auber J)30(,)-281(F)20(oulks GN.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 217.0158 633.129 Tm
0 0 0 1 k
-0.006 Tc
(Phase)Tj
-22.59944 -1.13333 TD
0.028 Tw
(III safety evaluation of cyclosporine 0.1% ophthalmic)Tj
0 -1.13334 TD
(emulsion administered twice daily to dry eye disease)Tj
T*
[(patients for up to 3 year)-20(s. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 140.2421 607.629 Tm
0 0 0 1 k
[(Ophthalmology)55(. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 199.6082 607.629 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(05;1)135(1)14(2:)]TJ
-20.27843 -1.13333 TD
[(1)15(790-1)14(794. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 587.6291 Tm
0 0 0 1 k
-0.0002 Tc
(6)Tj
0.55581 0.00001 TD
0 Tc
0.028 Tw
[(7)170(.)-281(Small DS)20(,)-201(A)20(c)20(heampong )79(A,)-281(Reis B)20(,)-280(et al.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 190.113 587.6291 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
(Blood concen-)Tj
-19.0124 -1.13334 TD
[(trations of cyclosporin )50(A during long-term treatment)]TJ
0 -1.13333 TD
[(with cyclosporin )50(A ophthalmic emulsions in patients)]TJ
0 -1.13334 TD
(with moderate to severe dry eye disease. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 194.7781 562.1291 Tm
0 0 0 1 k
-0.0002 Tc
(J)Tj
0.86148 0 Td
0 Tc
(Ocul)Tj
-20.4959 -1.13334 TD
-0.152 Tw
[(Pharmacol Ther)55(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 106.5456 553.629 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(02;1)15(8:41)134(1)40(-41)14(8. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 542.1291 Tm
0 0 0 1 k
0.028 Tw
[(68.)-201(A)55(visar R,)-281(Robinson )80(A,)-201(Appel I,)-281(et al.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 177.6887 542.1291 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
(Diclofenac sodi-)Tj
-17.35583 -1.13334 TD
[(um, 0.1% \(V)75(oltaren Ophtha\), ver)-20(sus sodium c)49(hloride,)]TJ
T*
[(5%, in the treatment of filamentary k)-20(eratitis. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 204.6465 525.129 Tm
0 0 0 1 k
(Cornea.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 47.52 516.6291 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(0)-40(0;1)59(9:1)35(45-1)35(47)190(. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 505.1291 Tm
0 0 0 1 k
-0.0002 Tc
(6)Tj
0.55582 0.00001 TD
0 Tc
0.028 Tw
[(9.)-281(Sc)20(hec)19(ht)20(er BA.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 108.3025 505.1291 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(K)19(etorolac during the induction phase)]TJ
-8.10433 -1.13334 TD
[(of cyclosporin-A therapy)55(. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 137.8838 496.629 Tm
0 0 0 1 k
-0.0001 Tc
(J)Tj
0.86152 0 Td
0 Tc
0.028 Tw
[(Ocul Pharmacol )180(Ther)55(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 47.52 488.1291 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(06;22:1)15(50-1)14(54. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 476.6291 Tm
0 0 0 1 k
0.028 Tw
[(70.)-201(Ar)20(ag)19(ona P)235(,)-281(Stilo )80(A,)-281(F)20(er)39(r)30(er)40(i F)175(,)-281(Mobr)40(ici M.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 188.7919 476.6291 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(Ef)24(fects of the)]TJ
-18.83625 -1.13333 TD
(topical treatment with NS)Tj
12.03283 0 TD
(AIDs on corneal sensiti)Tj
10.80761 0 TD
0 Tw
(vity)Tj
-22.84044 -1.13334 TD
0.028 Tw
[(and ocular surface of Sj\232gren)2099(s syndrome patients.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 47.52 451.1291 Tm
0 0 0 1 k
(Eye.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 64.7741 451.1291 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(05;1)60(9:535-539. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 439.6291 Tm
0 0 0 1 k
(71)Tj
1.06201 0 TD
(.)Tj
0.47871 0 TD
(Ar)Tj
1.09106 0 TD
(ag)Tj
1.14697 0 TD
0.028 Tw
(ona P)Tj
2.45919 0 TD
[(,)-281(Di Pietr)25(o R.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 134.895 439.6291 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
(Is it safe to use topical)Tj
-11.65 -1.13334 TD
[(NS)20(AIDs for corneal sensiti)-20(vity in Sj\232gren)19100(s syndrome)]TJ
0 -1.13333 TD
0 Tw
(patients? )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 81.4718 422.6291 Tm
0 0 0 1 k
0.028 Tw
[(Exper)25(t Opin Drug S)19(af)25(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 161.3158 422.6291 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(07;6:33-43. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 411.1291 Tm
0 0 0 1 k
0.028 Tw
[(72.)-281(Pinna )80(A,)-281(Piccinini P)235(,)-281(Car)20(ta F)174(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 151.4684 411.1291 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(Ef)24(fect of oral linoleic and)]TJ
-13.85979 -1.13334 TD
[(g)19(amma-linolenic acid on mei)1(bomian gland dysfunc)-1(-)]TJ
0 -1.13333 TD
0 Tw
(tion. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 65.3879 394.1291 Tm
0 0 0 1 k
(Cornea.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 95.1426 394.1291 Tm
0 0 0 1 k
-0.006 Tc
(20)Tj
1.14051 0 TD
(07;26:260-264. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 382.6291 Tm
0 0 0 1 k
(73.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 59.2125 382.6291 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(TheraT)115(ear)-20(s Nutrition. )49(Advanced)1( )99(V)25(ision R)19(esearc)50(h,)]TJ
-1.559 -1.13333 TD
[(Inc. ht)25(tp://www)19(.theratear)-20(s.com/nutrition.aspx.)]TJ
T*
[(Accessed F)20(ebruary 21, 20)-40(08. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 354.0291 Tm
0 0 0 1 k
-0.072 Tc
[(74)-55(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7 0 0 7 58.3611 354.0291 Tm
0 0 0 1 k
-0.017 Tc
[(BioT)115(ear)-20(s.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 89.8849 354.0291 Tm
0 0 0 1 k
-0.022 Tc
0.028 Tw
[(Biosyntrx. ht)25(tp://www)19(.biosyntrx.com/)]TJ
-5.64865 -1.14667 TD
[(Supplement.php?item_id=1)100(.)1( )50(Accessed F)20(ebruary 21, 20)-40(08. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 333.8291 Tm
0 0 0 1 k
(75.)Tj
1.67036 0 TD
(Miljano)Tj
3.53516 0 TD
0.028 Tw
(vic B)Tj
2.28657 0 TD
(,)Tj
0.40864 0 TD
(T)Tj
0.46094 0 TD
(r)Tj
0.34913 0 TD
0 Tw
(iv)Tj
0.81396 0 TD
0.028 Tw
[(edi KA,)-281(D)25(ana MR,)-281(Gilbar)20(d JP)235(,)-281(Bur)40(ing)]TJ
-9.52476 -1.2286 TD
0 Tw
(JE,)Tj
1.7253 0 TD
(Sc)Tj
1.14722 0 TD
(haumber)Tj
4.2522 0 TD
-0.0002 Tc
(g)Tj
0.91639 0 Td
(D)Tj
0.68219 0 TD
0 Tc
(A.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 117.8318 325.2291 Tm
0 0 0 1 k
(R)Tj
0.64167 0 TD
-0.006 Tc
0.028 Tw
(elation between dietary n-3 and)Tj
-10.01657 -1.14667 TD
(n-6 fat)Tj
2.96277 0 TD
(ty acids and clinically diagnosed dry eye syn)Tj
20.94592 0 TD
0 Tc
(-)Tj
-23.9087 -1.14667 TD
-0.006 Tc
(drome in women. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 112.4626 308.0291 Tm
0 0 0 1 k
0.028 Tw
(Am J Clin Nutr)Tj
7.02744 0 TD
(.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 169.5026 308.0291 Tm
0 0 0 1 k
-0.006 Tc
(20)Tj
1.14049 0 TD
(05;82:887)Tj
4.32207 0 TD
(-893. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 47.52 296.4291 Tm
0 0 0 1 k
0.028 Tw
[(7)20(6.)-281(Singh M,)-281(Singh M,)-281(P)40(apas )80(A.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 152.3047 296.4291 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(The ef)25(fect of an omeg)19(a-3)]TJ
-13.97129 -1.14668 TD
(supplement on dry mouth and dry eye in Sj\232gren)Tj
23.27748 0 TD
-0.106 Tc
0 Tw
Tj
-23.27748 -1.14667 TD
-0.006 Tc
0.028 Tw
[(patients. )50(Abstract #87)189(. IXth International S)20(ymposium)]TJ
28.464 57.05334 TD
[(on Sj\232gren)2099(s S)20(yndrome; )49(April 27)75(-29, 20)-40(06; )100(W)54(ashington,)]TJ
0 -1.14667 TD
[(DC. ht)25(tp://www)19(.sjogrens.org/researc)50(h/ISSS/isss_poster_)]TJ
0 -1.14666 TD
[(abstracts_day2.pdf)25(. )49(Accessed F)20(ebruary 1)15(8, 20)-40(08. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 261 678.3791 Tm
0 0 0 1 k
-0.0002 Tc
(7)Tj
0.55582 0.00001 TD
0 Tc
0.028 Tw
[(7)170(.)-281(Oxholm P)235(,)-281(Manthor)40(pe R,)-281(Pr)20(ause JU)24(,)-280(Hor)40(r)25(obin D)24(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 261 669.829 Tm
0 0 0 1 k
-0.006 Tc
0.028 Tw
[(P)30(atients with primary Sj\232gren)19100(s syndrome treated for)]TJ
0 -1.14 TD
-0.0057 Tc
(t)Tj
0.32728 -0.00001 TD
-0.006 Tc
(wo months with evening primrose oil. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 400.2133 661.2791 Tm
0 0 0 1 k
(S)Tj
0.64722 -0.00001 TD
0.028 Tw
(cand J)Tj
-19.20898 -1.13999 TD
-0.0002 Tc
(R)Tj
0.66684 -0.00001 TD
0 Tc
0 Tw
(heumatol.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 304.0775 652.7291 Tm
0 0 0 1 k
(1)Tj
0.49053 -0.00001 TD
-0.006 Tc
[(986;1)15(5:1)54(03-)1(1)54(08. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 261 641.1791 Tm
0 0 0 1 k
-0.0002 Tc
(7)Tj
0.55582 0.00001 TD
0 Tc
0.028 Tw
[(8.)-131(Theander E,)-281(Hor)40(r)25(obin DF)174(,)-280(J)20(acobsson L)95(T)150(,)-281(Manthor)40(pe R.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 261 632.6291 Tm
0 0 0 1 k
-0.0057 Tc
(G)Tj
0.7723 -0.00001 TD
-0.006 Tc
0.028 Tw
(ammalinolenic acid treatment of fatigue associated)Tj
-0.7723 -1.13999 TD
[(with primary Sj\232gren)2099(s syndrome. )]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 382.8809 624.079 Tm
0 0 0 1 k
0.028 Tw
[(S)20(cand J Rheumatol.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 261 615.5291 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(02;31:72-79.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 261 603.9791 Tm
0 0 0 1 k
-0.0002 Tc
(7)Tj
0.55582 0.00001 TD
0 Tc
0.028 Tw
[(9.)-281(Bar)20(abino S)19(,)-280(Rolando M,)-281(Camicione P)235(,)-281(et al.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 415.5251 603.9791 Tm
0 0 0 1 k
-0.006 Tc
[(S)19(ystemic)]TJ
-20.60334 -1.14 TD
0.028 Tw
[(linoleic and g)20(amma-linolenic acid therapy in dry eye)]TJ
0 -1.14002 TD
(syndrome with an inflammatory component. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F19 1 Tf
7.5 0 0 7.5 421.1256 586.879 Tm
0 0 0 1 k
(Cornea.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
7.5 0 0 7.5 261 578.3289 Tm
0 0 0 1 k
-0.006 Tc
[(20)-40(03;22:97)75(-1)54(0)55(1)99(.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F15 1 Tf
7 0 0 7 261 566.779 Tm
0 0 0 1 k
0.028 Tw
[(80.)-201(Ar)20(ag)19(ona P)235(,)-281(Bucolo C,)-281(Spinella R,)-280(Giuf)24(fr)40(ida S)19(,)-280(F)20(er)39(r)30(er)40(i G.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F18 1 Tf
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