First line of attack
To restore tear film homeostasis, the Tear Film & Ocular Surface Society Dry Eye Workshop II lists therapy options organized in a stepwise fashion (Craig et al.). For example, the OSD patients with elevated MMP-9 indicating inflammation will likely require prescription therapy, and topical antibiotic or antibiotic-steroid combinations can be considered if there is anterior blepharitis, along with lid hygiene products that include hypochlorous acid.
A majority of dry eye disease patients have meibomian gland dysfunction (Nichols et al.), necessitating lid disease treatments along with physical heating and expression of the meibomian glands. LipiFlow (Johnson & Johnson Vision) applies localized heat to the meibomian glands to improve meibum mobility during a bilateral, 12-minute, in-office procedure.
Two new device-based meibomian gland dysfunction treatments that also use the application of heat are Alcon's iLux system and TearCare from Sight Science.
Don’t forget the questionnaires
Physicians should implement questionnaires such as Standardized Patient Evaluation of Eye Dryness or the Ocular Surface Disease Index to capture subjective information about patients’ dry eye disease and the condition’s overall impact on their daily life. Patients who score at an established threshold can then automatically receive point-of-care tests.
An aggressive, strategic and straightforward approach to OSD treatment for presurgical patients will ensure they cross the finish line boasting about their visual results – even if they have a slight delay along the way!
Blackie CA, et al. Cornea. 2009;doi:10.1097/ICO.0b013e318191b870.
Craig JP, et al. Ocul Surf. 2017;doi:10.1016/j.jtos.2017.08.003.
Lemp M, et al. Am J Ophthalmol. 2011;doi:10.1016/j.ajo.2010.10.032.
Nichols KK, et al. Invest Ophthalmol Vis Sci. 2011;doi:10.1167/iovs.10-6997a.
Potvin R, et al. Clin Ophthalmol. 2015;doi:10.2147/OPTH.S95242.
Sambursky R, Davitt W, et al. Cornea. 2014;doi:10.1097/ICO.0000000000000175.
Sambursky R, O’Brien TP. Curr Opin Ophthalmol. 2011;doi:10.1097/ICU.0b013e32834787bb.
Schiffman RM, et al. Arch Ophthalmol. 2000;118(5):615-621.
Sullivan B, et al. Invest Ophthalmol Vis Sci. 2010;doi:10.1167/iovs.10-5390.