Multiple medical options available for dry eye
LONDON — Clinical assessment is “critically important” in evaluating dry eye syndrome, according to a speaker here.
“Most of our patients do not have a clearly defined cause for their dry eye syndrome,” Peter McCluskey, MD, said at the EuCornea Congress. “There is an enormous disconnect between the patient’s symptoms and the signs that we see.”
McCluskey said his approach to treatment starts with ocular lubrication using nonpreserved lubricants to prevent preservative toxicity. He then treats blepharitis with lid scrubs and low-dose tetracycline/doxycycline.
After that, if more treatment is needed and depending on the case, McCluskey chooses among punctual plugs, autologous serum drops or topical retinoids. Older treatments — oral secretagogues, tarsorrhaphy and moist chambers — are also useful in some cases, he said.
McCluskey recommended giving patients a trial of punctual occlusion before committing to the therapy because some patients have unpredictable worsening of their condition with that treatment.
“I think the best treatment that we have is autologous serum eye drops, although it is a challenging treatment to organize for a number of our patients,” McCluskey said.
In Australia, autologous serum is available through blood banks, he said, but not all patients are able to give blood.
Topical retinoids are useful but have a variable response, and topical steroids, although effective, have long-term adverse effects.
“I never use maximum therapy at the first visit, because then you have nowhere to go,” McCluskey said of his approach to dry eye syndrome. “You always have to leave yourself some treatment options.”
Disclosure: McCluskey has no relevant financial disclosures.