advancing surgical outcomes:
Algorithm launches new era in preoperative OSD management
2 | SUPPLEMENT TO EYEWORLD | JULY 2019
Figure 1. Part 1 of ASCRS Preoperative OSD Algorithm
continued from page 1
colleagues at Duke University,
a majority of our preoperative
cataract surgery patients had
objective signs of OSD as
measured by osmolarity and
MMP-9.
4
Surprisingly, almost
50% of those who reported
no symptoms had abnormal
osmolarity and MMP-9.
If results are positive on
any of these screening tests,
OSD is likely, and additional
but non-essential point-
of-care OSD tests can be
performed if available in the
office. While the OSD screen-
ing battery helps identify the
presence of OSD, it does not
narrow down the various sub-
types. Tests such as meibogra-
phy, noninvasive tear breakup
time, lactoferrin, tear me-
niscus height, and lipid layer
interferometry, among others,
can aid in OSD subtype iden-
tification when available.
The next part of the
algorithm involves a quick
directed clinical exam called
"LLPP"—look, lift, pull, and
push. We look at the base of
the lashes, eyelids, lid po-
sition, blink position, tear
meniscus, conjunctiva, and
cornea. Then, we lift the upper
eyelid to examine the superi-
or cornea for lumps and/or
bumps and the conjunctiva
for superior limbic keratocon-
junctivitis. Next, the upper
eyelid is pulled away from the
eye to assess laxity and flop-
piness. Finally, we gently push
on the lower lid to express the
meibomian glands and deter-
mine the quality and quantity
of meibum. Staining with
lissamine green, fluorescein,
Figure 2. Part 2 of ASCRS Preoperative OSD Algorithm
Start/End
Diagnosis
Optional Data Collection
Essential Data Collection
Decision/Informational
CLINICAL EXAM (LLPP)
