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EW MEETING REPORTER 118 February 2015 Reporting from Hawaiian Eye 2015, Maui, Hawaii January 17–23 said patient education is key. If pos- sible, this complication should be prevented by detecting and treating dry eye before surgery. Surgeons should also carefully monitor and treat patients for prolonged periods after surgery. The surgeon should take the appropriate steps and iden- tify patients who do have dry eye. Preoperatively, he advised looking carefully to see if there is lid disease and treating that using nu- tritional supplements, artificial tears, and anti-inflammatories. Dry eye is common after cataract and refractive surgery, is frequently underdiag- nosed, decreases surgical predict- ability, and adversely affects out- comes, Dr. McCulley said. It requires accurate diagnosis, is reversible, and treatment leads to better vision and better patient satisfaction. Dr. Luchs highlighted ocular allergies, which he said are the sixth leading cause of chronic disease in the U.S. and affect up to 25% of the general population in the U.S. About 80 million people in the U.S. expe- rience some ocular allergy, while 15–20 million people may have chronic ocular allergy symptoms. Allergic conjunctivitis generally refers to the two major forms seen on a daily basis in offices: seasonal and perennial. The seasonal allergies include allergies to things such as pollen and ragweed, while perenni- al refers to year-round allergies to things such as animal dander and dust mites. Ocular itching is the most com- mon symptom of allergic conjunc- tivitis, he said, but proper diagnosis is determined most often by history and physical examination. Common signs and symptoms of ocular aller- gies include foreign body sensation, a dry or gritty ocular surface, itchy eyes, photosensitivity, hyperemia, chemosis, tearing, and lid swelling. However, all of these are similar to the other ocular surface diseases that are often present in these patients or present alongside allergy. To help diagnose ocular allergy, there are tools currently available, including in-office allergy testing. Avoiding exposure to allergens, not having pets, washing hands frequently, avoiding rubbing eyes, and using air filters in the home are a few recommendations that Dr. Luchs gave for patients. There are therapeutic options available as well. In the future, Dr. Luchs expects that there could be other treatments like new formulations of existing drugs, new indications for existing drugs, nanoparticle topical steroids, selec- tive glucocorticoid receptor agonists, and biologics. In order to help patients with ocular allergy, he said to take a careful history, consider other ocular surface diseases, use in-office allergy testing, and consider co-manage- ment with an allergist. Editors' note: Dr. McCulley has no related financial interests. Dr. Luchs has financial interests with Allergan, Bausch + Lomb, Alcon, Imprimis, Nicox, Santen (Osaka, Japan), Shire (Dublin), TearLab, Omega Ophthal- mics (Lexington, Ky.), Novartis (Basel, Switzerland), and Valeant (Montreal). The basics of ocular tumors Helen Wu, MD, Boston, presented comprehensively on ocular tumors, highlighting some of the basic information, surgical management, treatments, and postoperative care. OSSN, or ocular surface squamous neoplasia, is the most common tu- mor in the U.S., she said. Risk factors for OSSN include sunlight exposure, smoking, immunosuppression, genetic predisposition, age, and male gender. To diagnose these tumors, techniques include clinical appear- ance, impression cytology, biopsy with histopathologic examination, confocal microscopy, and ultra high resolution OCT. The tumors are typically located in the interpalpe- bral zone of the bulbar conjunctiva or on the cornea. They are usually slow growing and may appear flat or elevated. They may also coexist with pingueculum or pterygium and may appear gelatinous, papilliform, nodular, or diffuse. They may have feeder vessels and disorganized vascular patterns. It is rare to have intraocular invasion, Dr. Wu said, and invasion of orbit occurs in a minority of these invasive tumors. Recurrence can occur in up to 15% of cases, but is more frequent in older patients with larger tumors, scleral involvement, high proliferation index, and atypi- cal features. Mortality rate is low, she said, around 0 to 8%, and depends on the geographic region. To manage these tumors medi- cally, topical or intralesional che- motherapy is often used, or immu- notherapy. Surgical options include removing the lesion with wide excision by using a no-touch tech- nique and repairing with mucous or amniotic membrane for larger lesions. Cryotherapy and topical View it now: Hawaiian Eye 2015 ... EWrePlay.org Christopher Starr, MD, discusses results from the recent ASCRS dry eye survey of ophthalmologists.

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