How to better manage dry eye disease

Photography by Steve Craft.

Excerpted from page 56 of the July/Aug 2022 edition of AOA Focus.

Former American Optometric Student Association President Bibin Cherian, O.D., practices in Edmond, Oklahoma, at BeSpoke Vision and offers five ways to better manage dry eye disease (DED).

“Dry eye is a multifactorial disease that has long affected many of our patients,” Dr. Cherian says. “Additionally, the increase in computer use and mask wearing over the past few years have further compounded the problem. As technology continues to improve, it is important practitioners offer the latest therapies available to combat DED. Being at a private practice and dry-eye referral center alongside Dr. Selina McGee, an expert in dry eye, I’ve witnessed the positive impact treatments can have on patients’ lives.”

1. Assume every patient has the disease until proven otherwise.

At our practice, patients fill out a dry-eye questionnaire, meibography is performed and dye staining is assessed. Further testing (such as InflammaDry, TearLab, etc.) is ordered as necessary. It is important to know that dry eye affects every area of our exams. Sometimes, patients will deny symptoms, but fluctuation is noted during the refraction. In these instances, patients are educated on the importance of treatment to provide optimal vision.

2. Educate patients on good hygiene.

It is necessary that patients establish good hygiene. Simple environmental modifications including good hydration, no ceiling fan at night (or wearing a sleep mask), and using a humidifier offer a good start. For patients with thicker meibomian gland secretion, a heat mask should be considered. Hypochlorous spray and tea tree cleansers can be offered as a daily lid cleaner. Artificial tears can be used occasionally, but both doctors and patients should understand the limitations of these drops.

3. Use prescription drops and treatments.

Low-dose steroids can help with quickly reducing inflammation or helping to treat dry-eye flares. Patients can continue with cyclosporine or lifitegrast drops on a long-term basis to further decrease inflammation. Chemical or mechanical neurostimulation (such as Tyrvaya^TM or iTear100) is another option that has worked well for patients struggling with multiple drops.

4. Offer in-office treatments to further target underlying etiologies.

Intense pulsed light (IPL) is offered to patients with eyelid telangiectasia/ocular rosacea and doubles as an aesthetic treatment. In-office heat therapy (such as TearCare®) with manual expression can improve lid function. We also offer a package including IPL, TearCare and Hydro-Eye® tablets for patients to maximize therapy. Punctal plugs can be used to limit tear drainage if there isn’t ocular surface inflammation.

5. Consider merits of biologics.

Biologics work well for patients with persistent punctate keratitis. Autologous serum drops (such as Vital Tears) have been extremely effective for patients. Amniotic membrane contact lenses come in both cryopreserved and dry forms, and they also can be used to promote healing of the ocular surface. If neurotrophic keratitis is confirmed with corneal sensitivity testing, OXERVATE^TM drops serve to restore corneal integrity.