BLOG: Teach patients how to recognize a dry eye flare
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In our practice, rather than using a questionnaire to determine whether patients have dry eye disease, we ask a lot of rapid-fire questions to get to the root of the problem.
Dry eye disease is multifactorial, and so are the underlying causes and contributing conditions. I want to know if the problem is chronic or episodic, if the patient has other health concerns or environmental challenges, and how the condition affects their life.
Here are some sample questions we ask:
- Do you ever have to blink your eyes to clear an image?
- Do you notice any blur or strain when you’re driving or staring at a computer screen or other digital device?
- Do your eyes feel dry when you wake up? What about after work?
- Are your contact lenses comfortable? How long do you wear them?
- Do you run a table or ceiling fan while sleeping?
- Do you use a CPAP machine while sleeping?
- Has anyone ever mentioned you sleep with your eyes opened or cracked?
- Have you been traveling and how often? Did you fly?
- Do you often wear an ill-fitted mask for long periods?
- Do you use digital devices for more than 4 hours daily?
- When you have a dry eye flare as a result of another condition, such as multiple sclerosis, Sjögren's syndrome, rheumatoid arthritis, seasonal allergies or ankylosing spondylitis, how do your eyes feel?
- What over-the-counter medications do you take and how often? For example, allergy or pain medications, vitamins, etc.
- Do you spend a lot of time outside? Hiking, gardening or using a backyard fire pit?
- Do you play any outdoor sports, such as golf, tennis or cycling?
All patients can have dry eye flares, whether they have chronic dry eye disease or have healthy tear film and feel comfortable. This acute worsening of symptoms may occur periodically with varied intensity in response to certain triggers, such as seasonal allergies, air conditioning use, digital screen time and contact lens wear. When a patient’s answers reveal they are experiencing flares or are at high risk, I want to ensure they know how to identify flares and when to contact me.
It is not a matter of “if” a dry eye patient will have an acute flare — it is a question of “when.” Patients need to know what to look for and what to do about it. Unfortunately, by the time patients get to me, they are often experiencing a dry eye flare and have had flares many times in the past. It is a frustrating experience, particularly because the problem is acute and cannot be remedied with artificial tears.
I educate patients about the symptoms — redness, discomfort and inflammation that do not quickly go away — and make sure they understand that these symptoms are not normal. I explain that lubricating tears are good for maintenance, but they do not put out the fire.
When patients experience a dry eye flare, they should come see me, and I can prescribe a short-term steroid treatment that will knock down the flare so they can return to normal activities. I will initiate treatment and see them for a recheck in 2 to 4 weeks. If needed, they can continue chronic therapy and check back when a dry eye flare occurs again; otherwise, I can monitor their dry eye condition with visits every 4 to 6 months without chronic therapy.
I want patients not only to recognize a flare, but also to feel comfortable coming in for therapy, knowing that we can solve the problem quickly and effectively.
For more information:
Jade Coats, OD, practices at McDonald Eye Associates, a large OD-MD clinic in Rogers, Ark. She dedicates most of her clinical practice to ocular disease, comprehensive eye care and refractive surgery/perioperative care, with an emphasis on treating dry eye disease.
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