Eyeworld

83 EW CORNEA October 2018 percentage of patients with dry eye, including those who if promptly diagnosed could be helped by Xiidra at the start instead of having to turn things around with the drug later. "I think we should start diagnosing dry eye earlier in the disease process, be aggressive with dealing with the pathophysiology, and try to stop the progression," Dr. Holland said. EW Reference 1. Sheppard JD, et al. Effect of loteprednol etabonate 0.5% on initiation of dry eye treat- ment with topical cyclosporine 0.05%. Eye Contact Lens. 2014;40:289–96. Editors' note: Dr. Holland has finan- cial interests with Shire. Dr. Perry has financial interests with Allergan and BlephEx (Franklin, Tennessee). Contact information Holland: eholland@holprovision.com Perry: hankcornea@gmail.com "Xiidra and Restasis are part of the solution, but if you're not doing lid hygiene, if you're not paying attention to nutrition, possible bacterial colonization, infestation, or are not aware of what's going on in terms of dermatologic problems like acne rosacea, you're not doing service to your patient," Dr. Perry said. In Dr. Holland's view, practi- tioners are only diagnosing a small may have a bacterial or a dermato- logic component to it," Dr. Perry said. "I think it's good to check the meibum and see how that is." Also, many patients who have dry eye also have significant blepharitis, which should be treated in conjunc- tion with dry eye disease, Dr. Perry continued, adding that he typically checks meibography and does mi- croblepharoexfoliation to clean the lid margins. category, Dr. Holland said. "Try to figure out the primary pathophysi- ology and treat that entity first," he said, adding that some practitioners treat all dry eye patients the same even though MGD has a different treatment paradigm. "About half of patients can have components of both, but you have to decide which treatment paradigm you want to treat first," he said. In cases where a patient looks like a primary aqueous tear deficien- cy case and they improve somewhat after taking Xiidra but still have dry eye complaints, Dr. Holland advised reassessing the meibomian glands to see if this may be the lingering is- sue. If someone looks as if they have primary aqueous tear deficiency and minimal MGD, Dr. Holland will usually get the patient comfortable with Xiidra alone and will add in one or two MGD therapies and see how they do. Dr. Perry stressed that with re- calcitrant dry eye cases, it's import- ant to cover all bases. "Nutrition is also important in terms of treating the meibomian gland disease, which " I think we should start diagnosing dry eye earlier in the disease process, be aggressive with dealing with the pathophysiology, and try to stop the progression. " —Edward Holland, MD

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