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Today’s dry eye management: a multifaceted approach
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If your practice is anything like mine you deal with it every day: the many faces of dry eye. It might be a senior citizen complaining of gritty eyes upon awakening, a contact lens wearer experiencing reduced wear time or a computer programmer noticing “filmy” vision later in the day. On occasion, it’s even a LASIK patient anguishing over persistent postoperative dryness. The reality is that dry eye is very prevalent, with an estimated 30 million Americans affected. It’s also very annoying — for both patients and clinicians.
Frustrating for everyone
For dry eye patients the condition is relentless, causing a variety of debilitating symptoms throughout the day. As there is no cure, dry eye sufferers hope — at best — to keep their symptoms at bay.
For clinicians dry eye is equally frustrating. It has long been a clinical enigma, masquerading in non-specific symptoms, diagnosed with marginally reliable tests and managed with moderately successful treatments. As there is often poor correlation between patient symptoms and objective findings, gauging the “success” of a particular treatment is difficult. Given these complexities it is understandable why dry eye has been somewhat of an ignored entity. Until recently.
In recent years there has been a significant paradigm shift in the way in which we view — and manage — dry eye. We no longer simply try to acquiesce patient symptoms by dousing the ocular surface with saline. We now appreciate dry eye as far too complex of a condition for such a simple remedy.
Today’s management
Today, managing dry eye involves a multi-faceted approach. We acknowledge the impact that environment, diet and lifestyle, systemic health and medications have on dry eye, and we manage these variables accordingly. We also prescribe “smarter” ocular surface lubricants: drops that are minimally (or non-) preserved and contain minerals, electrolytes and muco-adhesive agents for improved retention and ocular surface health.
Perhaps most importantly we recognize the role inflammation plays in dry eye. Certainly, the increasing use of omega-3 supplementation, doxycycline, corticosteroids and cyclosporine underscores the importance of controlling inflammation in dry eye. Add in adjunctive (though no less important) therapies such as punctal occlusion and eyelid hygiene, and it is apparent that we have a great deal to offer dry eye patients.
Indeed, the future of dry eye management looks even brighter. With androgen supplementation, mucin stimulants and lacrimal secretagogues in development, we are quite possibly entering an era of curative treatment for certain types of dry eye.
With all of these developments, contemporary dry eye management requires a bit of a behavioral change on our part. No longer do we simply send patients on their way with a couple of artificial tear samples. Instead, we educate, counsel and — with increasing frequency — actually prescribe. A paradigm shift for sure, but one that inevitably results in happier patients ... and doctors.