Optometric Management Supplements

DRY EYE 2016

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I n my practice at the University o f C a l i f o r n i a , D a v i s , a substantial portion of my work involves ocular surface disease, dr y eye and fitting specialty contact lenses. I am extremely aware of the studies demonstrating that patients discontinue contact lens wear, most ofen due to discomfort, at a rate of 13% to 20%. 1 As such, I look at treating dry eye and ocular surface disease not only as a way to keep their eyes healthy, but also to keep them in their contact l e n s e s , w h i c h , i n tu r n , l e a d s t o satisfied patients and contributes to practice revenue. To identif y patients w ho need d r y e ye t re at me nt , I us e a l l t he available tests and to ols — f rom simple to advanced — an overview of which follows. Patient Education & Questionnaires Too ofen, patients aren't forthcoming about their symptoms, which is why patient education and clear commun- ication are critical to uncovering problems. In fact, informative bro- chures and questionnaires are the first step of diagnosing dry eye. I'm a firm believer in having informative brochures in the reception area to help start the dry eye conversation. I always have them available, along with a questionnaire, such as the SPEED or OSDI. The paper questionnaires work for me, but for practices that have digital devices for patients in the waiting room, an OSDI app is available. The questionnaire sets the stage for my second step: asking questions. Many patients are clearly symptomatic, reporting dry, watery, burning eyes, and so on. But others say their eyes feel fine. I always ask those patients with "fine" eyes if they experience blurr y or interr upted vision, and more often than not, they say yes. Typically, these patients are the ones whose vision improves to 20/20 if I instill an artifcial tear or ask them to blink repeatedly behind the phoropter. In my experience, it is this group of patients in particular who can be kept in contact lenses longer as a result of diagnosing and treating dry eye at an earlier stage. In addit ion to ask ing p at ients about symptoms, it's important to ask environmental and lifestyle questions. We know the myriad contributors to dry eye, but it's important that we convey that knowledge to our patients. For example, I talk with patients about aspects of their home and work environments that may contribute to their symptoms. In some cases, simple changes, such as turning of the ceiling fan, help significantly. And although patients may not be able to discontinue systemic medications that dry their eyes, they may be able to switch from oral allerg y medications to ocular allergy drops or nasal sprays. Clinical Examination When I examine a patient, I evaluate: • Adnexa (dermatological infammation, dermatochalasis, rosacea) • Eyelids and eyelid margins (infectious, infammatory, allergic, physiologic [lagophthalmos], blepharitis, meibomian gland dysfunction [MGD], lid-wiper epitheliopathy, giant papillary conjunctivitis) • Conjunctiva (staining, chemosis, conjuctivochalasis) • Cornea (topographical, hypoxia, secondary infectious/infammatory, dystrophy). A growing amount of research s u g g e s t s t h at M G D i s t h e m o s t frequent cause of dry eye. 2 Terefore, it is important to identify MGD or Diagnosing Dry Eye Simple and advanced tools help uncover the signs and symptoms of this common condition ■  By Melissa Barnett, OD, FAAO, FSLS Figure 1. Flipping the upper eyelid reveals staining associated with lid wiper epitheliopathy. 6 | FEBRUARY 2016

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