A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Dysfunctional tear syndrome: a Delphi approach to treatment recommendations.

PURPOSE: To develop current treatment recommendations for dry eye disease from consensus of expert advice. METHODS: Of 25 preselected international specialists on dry eye, 17 agreed to participate in a modified, 2-round Delphi panel approach. Based on available literature and standards of care, a survey was presented to each panelist. A two-thirds majority was used for consensus building from responses obtained. Treatment algorithms were created. Treatment recommendations for different types and severity levels of dry eye disease were the main outcome. RESULTS: A new term for dry eye disease was proposed: dysfunctional tear syndrome (DTS). Treatment recommendations were based primarily on patient symptoms and signs. Available diagnostic tests were considered of secondary importance in guiding therapy. Development of algorithms was based on the presence or absence of lid margin disease and disturbances of tear distribution and clearance. Disease severity was considered the most important factor for treatment decision-making and was categorized into 4 levels. Severity was assessed on the basis of tear substitute requirements, symptoms of ocular discomfort, and visual disturbance. Clinical signs present in lids, tear film, conjunctiva, and cornea were also used for categorization of severity. Consensus was reached on treatment algorithms for DTS with and without concurrent lid disease. CONCLUSION: Panelist opinion relied on symptoms and signs (not tests) for selection of treatment strategies. Therapy is chosen to match disease severity and presence versus absence of lid margin disease or tear distribution and clearance disturbances

MGD: Definition Versus Dry Eye Disease, Risk Factors

Meibomian gland dysfunction (MGD) is defined as any functional disorder of the meibomian glands. While MGD is commonly associated with lipid tear deficiency, patients with MGD may also be asymptomatic and/or may have normal tear film parameters. Although there are no standardized diagnostic criteria for the disease, epidemiologic studies have revealed that MGD is very common, especially in Asian populations. Risk factors for MGD include both ocular and systemic conditions. Ocular conditions specifically found to associate with MGD include contact lens wear and the use of glaucoma medications. Systemically, older age, lower androgen levels, rosacea, and Sjogren’s syndrome have all been associated with disease