Faster-acting, more effective methods improve dry eye treatment outcomes
Michael D. DePaolis
We have all been there. A new patient comes in for a consultation. You have come highly recommended, having successfully prescribed contact lenses for a coworker of hers. As you attentively listen to the history, a pattern emerges, one with which you are all too familiar. She reports having tried various lenses, care products and drops – all with the same outcome. Dropout due to dryness.
A quick biomicroscopy provides all the information you really need: lid telangiectasia, sporadic notching and meibomian glands ranging from inspissated to frankly dysfunctional. While you are confident with the diagnosis, you have that sinking feeling she may never be able to wear lenses. And you came so highly recommended.
Few conditions are as humbling as meibomian gland disease (MGD). It is actually quite common – especially among contact lens dry eye dropouts – and yet it is still often overlooked. Its diagnosis is pretty straightforward, while its treatment is anything but simple. For sure, it is one of the most frustrating entities we deal with. Because MGD management can be a “grind,” it often wears down both patient and practitioner. This, of course, is never a good thing, especially when the patient’s contact lens future and our reputation lie in the balance.
Historically, the challenge has been in keeping patients “vested” in their management. We would start with baby shampoo lid scrubs, salt water soaks and warm compresses … all of which seemed to make the doctor feel better. More recently, we have added oral doxycycline and omega-3 fatty acids. While these agents have merit, they, too, take some time to “kick in.” Unfortunately, without an immediate improvement in symptoms, patients become disenchanted and discontinue therapy. However, this does not have to be the case anymore.
Today, medicated eyelid cleansing pads validate and simplify lid hygiene. We are finding a short course of loteprednol significantly improves patient comfort, while topical azithromycin provides a tangible benefit in meibomian gland function. Commercially available heating pads, which increase heat intensity and duration, improve hot compress compliance. Perhaps most importantly is the emergence of instruments for probing and expressing meibomian glands. Done in-office, these devices provide an immediate and measurable benefit from the patient’s perspective – something that has always been lacking in MGD management.
If you have not embraced these new treatment strategies, there is no better time than now. Your patients’ contact lens future and your reputation will benefit.