Eyeworld

C ORNEA 8 | EYEWORLD BONUS ISSUE | OCTOBER 2025 by Julie Schallhorn, MD Cornea Editor Being systematic matters T his bonus issue on dry eye and ocular surface disease unites experts from multiple subspecial- ties to discuss the options for one of the most vexing issues in ophthalmology. Reading through the articles, you'll find an excellent overview of the treatment landscape, as well as subspecialty-specific recommendations on the most effective approaches to treatment. The basis of this all, of course, is the ability to be able to accurately diagnose the presence of ocular surface disease and the specific factors that are giving rise to the problem. Simple, right? Unfortunately, in dry eye and ocular sur- face disease, this can be a very complex. Enter the ASCRS Preoperative OSD Algo- rithm, a masterwork spearheaded by Chris- topher Starr, MD, and Preeya K. Gupta, MD. This algorithm provides us with a systematic pathway to step through for every preoperative patient and includes a method for assessing patient-reported dry eye symptoms as well as clinical findings of ocular surface disease. The reason this algorithm is so critical is that it reminds us busy clinicians of the importance of being systematic in the face of complex disease. Ocular surface disease is protean—it can adopt many forms, and the patient experience can be varied. The patient who comes in com- plaining that their eyes feel like sand and has classic interpalpebral epitheliopathy is a slam dunk; we all will get this without even thinking about it. However, ocular surface disease can be insidious; more dangerous is missing the patient with sleep apnea and floppy eyelid syndrome who is at risk of developing post-refractive ecta- sia after LASIK from nighttime eye rubbing. Following a systematic approach to the evaluation of every patient in your office helps standardize and elevate the level of care each patient receives. The patient complaining that their eyes are like the Sahara Desert will be diagnosed every time, but we owe it to our pa- tients (and to our outcomes!) to diagnose those patients who present in a different manner. To date, there is no one test that will accu- rately diagnose every patient with ocular sur- face disease. Given the multifactorial nature of the disease, I am not quite sure if there ever will be. For now, and maybe for always, a systemat- ic, algorithmic approach to every patient offers the best pathway for care. Following a systematic approach to the evaluation of every patient in your office helps standardize and elevate the level of care each patient receives. Gerami Seitzman, MD, EyeWorld Cornea Editorial Board member, shared these tips related to dry eye and ocular surface disease: "A careful dry eye exam begins with the eyes closed." "Dry eye is an umbrella diagnosis—and many doctors use different language describing this. Your 'dry eye' is not my 'dry eye.'" "If the corneas appear dry and the pa- tient does not have a lot of symptoms, check corneal sensation." "If your ocular surface treatments aren't working, take away all preservatives, think about epithelial basement mem- brane dystrophy, and think about ocular rosacea." DRY EYE AND OCUL AR SURFACE DISEASE

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