Latin American Consensus on Ocular Lubricants and Dry Eye Disease (LUBOS): A Report on Severity Classification, Diagnosis, and Therapy

Purpose: This consensus aims to establish a practical severity classification for applying a tailored stepladder treatment algorithm helpful to any clinician. Methods: A modified Delphi methodology was used to establish a consensus on the definition, diagnosis, severity classification, and treatment algorithms for dry eye disease (DED) adapted to the needs of Latin America. The consensus focused on promoting the effective use of lubricants and providing straightforward, practical guidance for ophthalmologists treating dry eyes. Twenty-eight corneal specialists from representative Latin American countries reviewed the scientific evidence and drew on their expertise to answer specifically designed open-ended questions. Results: A simple diagnostic algorithm (clinical history, DED questionnaire, and dry eye clinical tests) identified patients with the disease. A practical severity classification system of four grades: mild, moderate, severe, and LUBOS plus DED was based on four criteria: OSDI, film break-up time, Sjögren International Collaborative Clinical Alliance ocular surface staining score, and international workshop on meibomian gland dysfunction meibomian gland functionality test. For classification, ≥2 criteria of the highest severity grade from the worse eye were considered. A stepladder therapeutic algorithm aligned with disease severity consisted of 5 steps, each with proposed and recommended treatment alternatives. Patient education, lifestyle recommendations, adverse environment avoidance, lubricants, and eyelid therapy were reinforced during the therapy period. Conclusions: The LUBOS expert panel consensus considered the diverse geoenvironmental, socioeconomic, cultural, and ethnic factors pertinent to Latin America. This consensus offers an accessible and cost-effective tool, enabling professionals to detect, evaluate, and grade the severity of dry eye disease effectively for planning adequate therapeutic strategies that can be monitored with confidence.