Eyeworld

EW FEATURE 56 Ocular surface disease • February 2016 AT A GLANCE by Maxine Lipner EyeWorld Senior Contributing Writer • Incomplete eye closure can affect the ocular surface. • Patients with floppy eyelids may be suffering from lid eversion while they sleep. • Mechanical rubbing of redundant tissue on the underside of the eyelid can mimic dry eye. a fluorescein strip to stain the eye. "I don't even tell them I'm watching them blink," she said. "I say, 'Just be normal. You can blink whenever you need to,' because if you ask patients to blink, they will blink fully," Dr. Dr. Dhaliwal said it's important not to overlook the external exam. From the minute patients walk into the room, she makes a point of watching them blink. "I'm check- ing if they have a decreased blink rate, as that greatly affects the ocular surface." In addition, a lot of people have incomplete lid closure, which leads to exposure keratopathy. Dr. Dhaliwal watches patients closely at the slit lamp before using Looking beyond the obvious in dry eye cases Monthly Pulse Ocular surface disease T he topic of this Monthly Pulse survey was "Ocular surface disease." We asked, "Which of the following statements best describes your experience with the management of dry eye patients?" The majority of respondents answered, B and C: "I would welcome another FDA approved product for the management of dry eye," and "Optimizing the ocular surface prior to cataract surgery is something that I do for all my cataract patients." When asked which of the following statements about evaporative tear dysfunction is false, the majority said, "It is possible to cure and eradicate evaporative tear dysfunction." Allergic eye disease can be managed with topical steroids and mast cell stabilizers, topical cyclosporine, topical tacrolimus, and referral to an allergist, according to the respondents. Finally, we asked, "Which of the following statements about structural eye disorders and their contribution to dry eye symptoms is true?" The majority said, "Floppy eyelids are associated with keratoconus and sleep apnea." Structural disorders contribute to dry eye symptoms T he first thing many practi- tioners think of when a pa- tient complains of dry eye is that it is emanating from an imbalance in the tear system. However, this is not nec- essarily the case. Often a structural disorder is at the root, said Deepin- der K. Dhaliwal, MD, professor of ophthalmology, University of Pittsburgh School of Medicine. "The lid functional unit contributes to dry eye and to ocular surface problems more than 50% of the time," Dr. Dhaliwal said. In the blink of an eye Determining if a structural problem may be the issue begins when the patient first enters the exam room. Dr. Dhaliwal watches patients closely at the slit lamp before using a fluorescein strip to stain the eye. Source: Getty Images Restasis as the only FDA approved treatment for dry eye is sufficient to treat most of my dry eye patients. I would welcome another FDA approved product for the management of dry eye. Optimizing the ocular surface prior to cataract surgery is something that I do for all my cataract patients. B and C

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