Rethink dry eye diagnosis in patients refractory to treatment
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CHICAGO — Many diseases can present as dry eye, leading to missed diagnoses and failed treatment, according to a speaker here.
In a presentation at Cornea Subspecialty Day at the American Academy of Ophthalmology meeting, Vatinee Y. Bunya, MD, MSCE, said it is common for clinicians to see patients who seem like they are not getting better or not responding to treatment.
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“As far as we’ve come with dry eye diagnostics, I think it’s still kind of an art,” she said. “You really need to try to rethink your diagnosis sometimes in some of these patients that are not getting better.”
However, this can be tricky because symptoms and the way patients describe them can be vague. Even on exams, there can be nonspecific findings, she said.
Bunya encouraged physicians to delay the use of proparacaine and first check for corneal sensation in these patients. She used an example of one patient who complained of foreign body sensation and tearing but failed multiple treatments. The key finding on exam was decreased sensation of the corneas in both eyes, and the patient was diagnosed with bilateral neurotrophic keratitis.
Another key test is to check for symblepharon during a slit lamp exam by pulling the lids and having the patient look up and down. There are a lot of diseases that cause symblepharon, but identifying it helps a clinician know they are not working with a straightforward dry eye case, Bunya said.
Other conditions that might seem like dry eye disease include anterior basement membrane dystrophy, conjunctivochalasis and superior limbic keratoconjunctivitis, Bunya said.
“A lot of patients will come in saying they have dry eye or they were diagnosed with dry eye years ago, but they’re just not getting better,” she said. “Don’t be afraid to question the diagnosis that they present with.”
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Bunya VY. When dry eye is not dry eye. Presented at: American Academy of Ophthalmology meeting; Oct. 18-21, 2024; Chicago.
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