BLOG: Early intervention matters when treating dry eye
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As eye care practitioners, we seek to preserve the vision and ocular health of our patients — we are the gatekeepers who can find eye disease before it progresses. Just as we are vigilant in looking for early stage glaucoma, we must also look for dry eye disease, even in asymptomatic patients.
Dry eye disease is often an overlooked source of irritation that can also exacerbate the symptoms of other pathology. Every comprehensive exam should look at the ocular surface and meibomian glands to detect any dry eye disease process early on, thus offering patients the highest chance for successful intervention.
Preventing lifelong complications
Often, patients confuse symptoms such as unstable vision or watery eyes for something else and are surprised to find they have dry eye; they may think it’s no big deal. It is our responsibility to educate patients that this disease is chronic and progressive, and postponing treatment can be detrimental.
Administration of over-the-counter artificial tears is the first course of action, but is it enough? A study examining the efficacy of cyclosporine demonstrated that patients treated solely with artificial tears have a 32% chance of progressing to the next disease level in as little as a year (Rao). This is significant; using artificial tears alone does not adequately prevent disease progression, even though it may alleviate symptoms.
Nutraceuticals as a first-line treatment
If the patient has already tried and failed with artificial tears, I immediately move on the next phase of treatment including prescription topical medications such as cyclosporine or lifitegrast or an antibiotic for meibomian gland dysfunction. For patients with meibomian gland dysfunction, I also implement warm compresses and, as necessitated, will proceed with thermal pulsation, such as Lipiflow (Johnson & Johnson Vision), to remove gland obstructions. While all of these treatments provide a level of immediate relief, they do not treat the root cause.
At the earliest indication of dry eye disease, I discuss adding a quality nutraceutical that provides a safe, noninvasive treatment designed to target the source of the disease. It can also help maintain eye health once symptoms are under control with the use of other interventions. Nutraceuticals are not a quick fix, so patients need to allow at least 60 days to notice the effects.
Better clinical outcomes make happy patients
Effective dry eye treatment is life changing. We have many options to treat dry eye symptoms — polyacrylic therapy, prescription medications, warm compresses, thermal pulsation — and adding a quality nutraceutical takes us a step further by addressing the root cause.
Reference:
Rao SN. J Ocul Pharmacol Ther. 2010;doi:10.1089/jop.2009.0091.