Eyeworld

I JUNE/JULY 2020 | EYEWORLD | 41 Dr. Matossian said that even if the doctor does not have diagnostic tests readily available, a basic slit lamp and two vital dyes that every practice can easily obtain, lissamine green and fluorescein, can tell a lot about the surface. She added that looking at the glands, eyelid margins, meibomian gland orifices, and staining the con- junctiva and cornea will tell a lot of the story. Dr. Trattler said he uses a slit lamp exam to diagnose dry eye. He examines the tear volume and degree of corneal staining. He will perform a subjective tear breakup time to evaluate the quality of the tear film. He also reviews the topography of patients scheduled for surgery, noting that irregular topography can potentially be a sign of dry eye. Dr. Trattler also evaluates the eyelids for MGD and blepharitis. Dr. Starr recommends the quick and direct- ed yet thorough "look, lift, pull, push," or LLPP, ocular surface exam for all patients undergoing surgery. Treatment If the focus is stabilizing the tear film as quickly as possible prior to cataract surgery, continued on page 42 Dr. Matossian's treatment is intentionally more aggressive to get the patient to that level quickly as opposed to treatment for the chronic, long- term period post-cataract surgery. To get the surface tuned up, first educate the patient or they won't be compliant, she said. Next, start the patient on oral omega-3 supple- ments, a heated, microwaveable mask, and pre- servative-free artificial tears. They will continue with all of these post-surgery. She uses a short-term steroid BID for 2 weeks to get the surface optimized, but this is discontinued after cataract surgery. Dr. Matossian recommends a treatment like LipiFlow (Johnson & Johnson Vision) or a combination of LipiFlow and BlephEx to evacuate the meibomian glands and exfoliate the biofilm on the lid margin to achieve a more stable tear film as quickly as possible in prepara- tion for surgical measurements. Dr. Trattler said it's important to determine if you're dealing with evaporative or aqueous deficient dry eye. For aqueous deficient dry eye, he typically treats with topical steroids short Surface qualifier images from the Cassini (Cassini Technologies) showing missing and irregular lines consistent with an unstable tear film Placido disc images from OPD-Scan III (Nidek) showing irregular and warped mires consistent with an unstable tear film Source (all): Cynthia Matossian, MD Cassini OD Cassini OS C. Matossian, MD Cassini OD Cassini OS C. Matossian, MD Female Teacher Placido OD Placido OS C. Matossian, MD Female Teacher Placido OD Placido OS C. Matossian, MD About the doctors Alice Epitropoulos, MD Clinical assistant professor of ophthalmology The Ohio State University Columbus, Ohio Cynthia Matossian, MD Matossian Eye Associates Doylestown, Pennsylvania Christopher Starr, MD Associate professor of ophthalmology Weill Cornell Medicine New York, New York William Trattler, MD Director of Cornea Center for Excellence in Eye Care Miami, Florida

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