CommentaryFrom OSN EuropePublication Exclusive

Dry eye a common but still often-overlooked condition

Dry eye is a problem that every ophthalmologist faces on a daily basis. It is one of the most frequent causes for patients to visit the ophthalmologist. Dry eye is a progressive disease, so the longer it goes untreated, the worse the symptoms become. Dry eye should also be considered as a risk factor when planning surgery, and it can influence the visual outcome in cataract and refractive surgery.

For sheer treatment purposes, the most common treatment regimen addresses the most frequent reason for dry eye: daily lid margin cleansing for chronic blepharitis, which can be as simple as warm and moist towelettes to a more sophisticated approach using mechanical devices that provide warm pressure to the lids to stimulate lipid flow, such as LipiFlow (TearScience).

As with many ocular surface problems, dry eye is multifactorial. As Richard L. Lindstrom, MD, stated in a recent editorial, dry eye patients should be approached from a holistic perspective to properly diagnosis the disease. Dedicating time to speaking with the patient, conducting questionnaires, evaluating the tear film, and examining the skin quality on the patient’s face and hands will provide a more comprehensive understanding about how to manage the symptoms before even examining the patient at the slit lamp.

Farhad Hafezi
Nikki Hafezi

For decades, little has been done in most practices to diagnose and properly treat dry eye patients other than just providing them with artificial tears. With the massive increase of dry eye among the population, we see even more patients presenting with symptoms of dry eye in our practices. In the past few years, industry has learned that dry eye represents a rapidly growing field, and developing techniques and devices are now commercially available to help us better diagnose the disease.

Finally, we have underestimated the suffering of our patients with dry eye for a long time: When examining a dry eye patient, we often assess the clinical severity of the disease as “mild to moderate” and are surprised to see that he or she seems to suffer more than we would expect.

Schiffman and colleagues used a special questioning technique in their 2003 paper in Ophthalmology. The time trade-off technique, which is also used in other fields of medicine, is asking the following question: “Imagine you had a set amount of years to live. If we were able to free you completely from your symptoms from one day to the next, how many years of your life would you be willing to give away for finding a cure?” When applying this questioning technique to dry eye patients, and comparing the score to scores described for other diseases, the authors faced surprising outcomes: Patients with severe dry eye rank their degree of suffering as much as severe angina and dialysis.

In conclusion, dry eye is common but still an often-overlooked condition. Better diagnostic tools will lead to better treatment options, extending the portfolio of services of any comprehensive ophthalmologist and anterior segment specialist to better manage his or her patient’s condition.

Disclosures: The authors report no relevant financial disclosures.