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Speakers: Patient comfort paramount in dry eye

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PHOENIX – The symptoms of dry eye motivate patients to visit their optometrists, but the symptoms often do not match the clinical picture, said presenters here at Academy 2012.

“Diagnosing dry eye is simple,” Randall Thomas, OD, MPH, FAAO, said at a symposium sponsored by PRIMARY CARE OPTOMETRY NEWS. “The hard part is getting patients to where they feel more comfortable. That’s our job.”

“Decreased tear break-up time and decreased lacrimal lake indicate dry eye, but the symptoms are driving the patient in, and often they don’t match the clinical picture,” co-presenter Ron Melton, OD, FAAO, added. “You’re dealing with a patient with an inflamed ocular surface secondary to dry eye. There are different tests for this.”

Melton noted that InflammaDry (by RPS), a test expected to be available in the next few months, can be used to quantify dry eye signs.

Melton and Thomas shared their dry eye management protocol.

“Start patients on an ester-based steroid tapered down over 8 weeks, in conjunction with a lipid-based artificial tear,” Melton said.

According to the presenters, lipid-based tears include Soothe XP (Bausch + Lomb), Systane Balance (Alcon), Refresh Optive Advanced (Allergan) and FreshKote (Focus Laboratories).

Have patients return in 3 to 4 weeks to assess their performance and check for a pressure spike, and start them on fish oil to help complement the therapy, Melton said.

“After a few months, stop the steroid and have patients maintain lubrication with an artificial tear,” he continued. “If they become symptomatic again, offer doxycycline, punctal plugs, Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan) or Lacrisert (hydroxypropylcellulose ophthalmic insert, Aton Pharma) as alternatives to more aggressive therapy.

“Patients will either get slack on using their artificial tears, or they may break through and become symptomatic while using them,” Melton said. “If you have tested them and they are not a steroid responder, pull that steroid back out and pulse it three or four times throughout the course of the year. Literature is telling us that this is the way to keep it under control the best.”

Thomas added that this parallels the treatment for allergic rhinitis.

Disclosures: Melton and Thomas are consultants to Alcon, Bausch + Lomb and RPS.