TFOS DEWS III: A Fresh Look at Dry Eye Disease in 2025

From DEWS II to DEWS III: What’s Changed?

Back in 2017, DEWS II defined DED as a multifactorial disease involving tear film instability, hyperosmolarity, inflammation, and neurosensory abnormalities. That definition still holds—but DEWS III takes it further.

Now, there’s a stronger emphasis on symptoms and how they vary from person to person. The new approach integrates individual disease drivers into both diagnosis and treatment, making care more personalized and precise.

 

Key Highlights from DEWS III

Smarter Classification & Diagnosis

DEWS III refines how we classify DED—looking at underlying causes, mechanisms, and disease stages. Diagnosis now blends clinical signs with patient-reported symptoms, acknowledging that what patients feel often matters just as much as what we see.

A New Era in Treatment

This was a standout for me. DEWS III moves away from the old stepwise treatment model and introduces three targeted algorithms:

• One for the tear film
• One for the eyelids
• One for the ocular surface

These are designed to match treatments to the specific drivers of disease. And it includes exciting new therapies like:

• Neuromodulation
• Low-level light therapy
• Novel anti-inflammatory agents

It’s a more holistic, mechanism-based approach—and it’s exactly what we need.

Lifestyle Matters

Lifestyle and environment have always played a role in dry eye, but DEWS III, backed by the 2023 TFOS Lifestyle Report, puts them front and centre.

For example,

• Screen time
• Diet and nutrition
• Environmental exposures
• Cosmetic use

Helping patients help themselves is now a core part of management—not just an afterthought.

 

Nutrition: Clearing Up the Confusion

One of the most refreshing parts of DEWS III is clarification on nutrition. There’s no magic diet for dry eye—but poor nutrition that contributes to systemic inflammation may increase risk.

Here’s what the report found:

• Poor nutrition contributing to systemic inflammation may increase DED risk.
• There is moderate evidence linking vitamin B12 and D deficiencies to dry eye symptoms.
• The gut microbiome may influence ocular surface health, but this connection is still emerging and not yet fully understood.
• Despite its popularity, the Mediterranean diet, along with alcohol consumption and water intake, does not currently have clear evidence supporting a direct impact on DED development or prevention.

In short, while a healthy diet is important for overall well-being, TFOS DEWS III advises caution in making specific dietary recommendations for dry eye management until more robust evidence is available.

 

Contact lenses wear and dry eye disease

The relationship between contact lens wear and dry eye disease (DED) is complex and often misunderstood. While contact lens use is a well-established risk factor for DED, the symptoms—such as dryness and discomfort—can overlap with other lens-related issues, making diagnosis tricky. Contact lens wearers frequently report more ocular symptoms than non-wearers, and studies show they’re more likely to exhibit signs like tear film instability, corneal staining, and meibomian gland changes. Although discomfort often resolves after lens removal (unlike true DED), the terminology—ranging from contact lens discomfort to contact lens-associated dry eye—is often used interchangeably. This overlap highlights the need for clearer definitions and tailored management strategies for those experiencing dry eye symptoms with contact lens use.

 

Global Collaboration, Local Impact

DEWS III isn’t just a scientific paper—it’s a global effort. Over 80 experts from 18 countries contributed to this transparent, evidence-based report. The goal? To standardize care and improve outcomes for dry eye sufferers worldwide.

And the best part? It’s open access, published in the American Journal of Ophthalmology, with an executive summary on the way to make it even more accessible.

 

 

Why This Matters to Me—and to You

As someone living with dry eye and helping others manage it, DEWS III feels like a turning point. It’s not just about better treatments—it’s about understanding the patient experience, embracing lifestyle factors, and tailoring care to what really works.

Whether you’re a clinician, researcher, or patient, this report is a must-read. It’s a blueprint for the future of dry eye care—and it’s already making a difference.