Use tear breakup pattern to determine type of dry eye, treatment
Click Here to Manage Email Alerts
LAS VEGAS — The pattern of fluorescein staining indicates the tear film layer affected by dry eye and, thus, dictates the treatment choice, Milton M. Hom, OD, FAAO, said at Vision Expo West.
“Tear film breakup time looks at the pattern of the breakup,” Hom, who practices at Canyon City Eyecare in Azusa, California, said. “The pattern can indicate the layer that’s affected. Line break means aqueous deficient, spot break means mucin deficient, dimple break means mucin deficient and random means evaporative.”
Evaporative dry eye/meibomian gland dysfunction affects the lipid layer, he said, aqueous-deficient dry eye affects the aqueous layer, mucin-deficient dry eye affects the mucin layer, and lissamine green or fluorescein staining will show the impact of dry eye on the epithelium.
“And it has been said that there’s an inflammatory component to every type of dry eye out there,” he added. “Inflammation is cause and consequence.”
According to Hom, nearly every dry eye treatment regimen indicates the use of artificial tears.
“You use different tears for different patients, different subtypes, different layers of the tear film,” he said.
Aqueous-deficient dry eye should be treated with viscosity tears and punctal occlusion, Hom said.
However, “You have thin tears and thick tears,” he noted. “Thick tears stay on the eye longer. Thick tears give you blur. Thick tears are usually not as comfortable.”
Carboxymethylcellulose, HP-guar and vitamin A ointment can be used to treat mucin-deficient dry eye, Hom said.
With epithelial staining, trehalose protects the epithelial cells and hyaluronate acid heals the corneal surface, he said.
“My first choice for any corneal or conjunctival staining I see is trehalose,” Hom said.
Evaporative dry eye treatment choices include warm compresses, emulsions, mechanical therapy and manual expression, he said.
Hom recommended a number of prescription medications to treat inflammation, including cyclosporine, lifitegrast, loteprednol, intense pulsed light and low-level light therapy.
Friction-related disease is a new term for a category of conditions that includes superior limbic keratoconjunctivitis, conjunctivochalasis and lid wiper epitheliopathy. The best treatment options contain hyaluronate and HP-guar, he said.
Collapse
Hom MM. Lessons learned from things done well and things done poorly in dry eye. Presented at: Vision Expo West; Sept. 18-21, 2024; Las Vegas.
Read more about
Click Here to Manage Email Alerts