Dry eye specialists should be on the lookout for ‘zebras’ in the summer
It is summertime in the northern latitudes, and all is well in the dry eye clinics of North America. Remember how hard it was to be a dry eye doc last winter during the polar vortex? All of your patients felt lousy, and every day you questioned the wisdom of treating dry eye. Now, the weather is warm, the humidity is high, you are between the allergy vortex of the shoulder seasons, and all of your patients are convinced that you are a genius. Be careful, though. The summer clime is the perfect environment for zebras.
Common things are common. You certainly remember that old saw, “When you hear hoofbeats, think horses, not zebras.” The daily life of a dry eye expert is as filled with horses as a wrangler on the Montana plain. Except in the summer, that is. When the weather is warm and your patients are well and happy, now is the time to be on the lookout for the unusual and rare. Let me share a couple of conditions that are uncommon and easy to miss unless you have your “zebra sensor” on: molluscum contagiosum (MC) and superior limbic keratoconjunctivitis (SLK).
Darrell E. White
Bob Cykiert, my NYU cornea professor, once said that the only difference between a general ophthalmologist and a cornea specialist in the clinic is that the cornea specialist always lifts up the upper lid to look at the superior cornea and sclera. I am pretty sure that my fancy cornea colleagues, including Neda Shamie and Mark Milner, would take issue with that, but this little nugget of wisdom — that the only thing that separates a general ophthalmologist from a cornea specialist is looking at the superior limbus, sclera and conjunctiva, tarsal conjunctiva, and maybe even the closed upper lid — is one way to avoid missing the kind of zebra diagnosis that masquerades as the common dry eye syndrome horse. Your typical patient arrives with complaints of dryness, redness, a foreign body sensation and tearing, just like so many before. Maybe the tear osmolarity is elevated, and perhaps there is a positive InflammaDry (RPS) result. Dry eye, right? Careful! Remember, it is summertime.
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