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PUBLICATION EXCLUSIVE: Dry eye disease in the surgical patient

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“If you diagnose dry eye before you operate, it is your patient’s problem. If you diagnose it postoperatively, it is your problem.”
–Eric Donnenfeld

“You can’t handle the truth.”
– Col. Jessup, A Few Good Men

For most of us who practice in the anterior segment, surgery is what we do best. Not only that, but most of us would choose to spend more time in the OR if we could. Reality for most of us is that we must spend as much or more time in the office engaged in not only pre- and postoperative examination and testing, but we must also spend quite a bit of time in conversation with our patients about both what they should expect from surgery and why they got the outcome they ended up getting. The first harsh truth of being any kind of surgeon whatsoever is that you must see your surgical patients before you operate on them, and then you are responsible for everything that happens to them afterward, even if you never see them again.

Everyone has dry eye

Your default position when you are contemplating anterior segment surgery of any kind whatsoever is that your patient has a DED of some sort. Really and truly. Every single one. If you enter each preop evaluation with this assumption, you are less likely to miss a dry eye that you would otherwise have treated. Sometimes your patient makes it very easy for you by declaring that their eyes are dry. Other times it is a staff member who saves your bacon by highlighting some other historical clue in your patient’s narrative. Most of the time, though, you are on your own.

Knowing that Eric is a very smart guy who has only your best interest at heart, you are going to do everything in your power to make a diagnosis of DED in as many operative candidates as you possibly can. Mind you, this is all comers and includes cataract patients, LASIK, Raindrop (ReVision Optics) or Kamra (AcuFocus) candidates, or glaucoma patients referred to get your MIGS flavor of the day. All of them. Strictly speaking, all of you retina folks should be doing this, too, but I understand you probably will not because, you know, retina.

• Click here to read the full publication exclusive, The Dry Eye, published in Ocular Surgery News U.S. Edition, March 25, 2017.