Eyeworld

4 OSD: Honing diagnostic protocols to pinpoint disease, enhance surgical outcomes by Francis Mah, MD Initiating and advancing ocular surface therapies and treatments slit-lamp and a mobile pen-shaped meibograph. Cornea. 2013;32 Suppl 1:S65–70. Dr. Ciralsky is assistant pro- fessor of ophthalmology, Weill Cornell Medical College, New York. She can be contacted at jessciralsky@gmail.com. Lens Anterior Eye. 2010;33:61–67. 4. 2007 Report of the Dry Eye Work- shop. Ocul Surf. 2007;5:65–204. 5. Epitropoulos AT, et al. Effect of tear osmolarity on repeatability of keratometry for cataract surgery planning. J Cataract Refract Surg. 2015;41:1672–1677. 6. Arita R. Validity of noninvasive meibography systems: noncon- tact meibography equipped with a Conclusion Dry eye disease is prevalent, and signs and symptoms do not always match. Fortunate- ly, clinicians now have many more tools to diagnose this condition so that therapy can be initiated earlier. References 1. Trattler W, et al. Cataract and dry eye: Prospective Health Assessment of Cataract Patients' Ocular Surface study. ASCRS•ASOA Symposium & Congress, March 2011. 2. Sambursky R. Presence or absence of ocular surface inflammation directs clinical and therapeutic manage- ment of dry eye. Clin Ophthalmol. 2016;10:2337–2343. 3. Benelli U, et al. Tear osmolarity measurement using the TearLab Os- molarity System in the assessment of dry eye treatment effectiveness. Cont perform meibography (Fig- ure 2). New high-resolution meibography imaging offers a much more in-depth view of the meibomian glands. 6 Using this technology, we may find more disease than anticipat- ed, which may direct more aggressive treatment. Topography is often obtained during preopera- tive testing for both cataract surgery and laser vision correction. Patients with dry eye disease may have irregular topographies ranging from irregular astigmatism to areas of "drop out." Dry eye should be addressed preoperative- ly to improve preoperative measurements and visual outcomes. Signs and symptoms provide crucial cues in advancing dry eye treatment A dvanced diagnos- tic tools help us develop targeted strategies to more effectively initiate and advance dry eye treat- ment. However, clinicians also need to listen carefully as patients describe their symp- toms, which will guide them in their approach. Treatment progression When patients first mention dry eye symptoms, I begin with the safest, least aggres- sive therapy. Eighty to 90% of patients with dry eye have a combination of meibo- mian gland dysfunction and aqueous dysfunction. 1 There- fore, I utilize a multifaceted approach, which includes artificial tears 2 to 3 times per day. In addition, I explain how to apply warm compresses for 5 to 10 minutes, once or twice a day. According to Bitton et al., patients should know that a warm facecloth does not retain heat as long as the warming masks they studied. 2 After removing the com- press, patients should clean the base of the eyelashes with a clean facecloth and warm water, which massages the warmed meibomian glands, debrides thicker oils, and re- moves bacteria and Demodex. I also advise patients to use a white petrolatum-based ointment at night, which will keep eyes moist if they have meibomian gland dysfunction or lagophthalmos. Further- more, some think white petro- latum suffocates Demodex. Finally, I advise omega-3 fatty acids, approximately 2,000 to 4,000 mg/day. Considering subsequent steps At the 6-week follow-up, if the patient has more mei- bomian gland dysfunction with blepharitis (Figure 1), I prescribe erythromycin or bacitracin ointment at night, or I prescribe oral minocycline 50 mg QD or doxycycline 50 mg BID. In patients with more aqueous dysfunction, I Francis Mah, MD " Dry eye disease is prevalent, and signs and symptoms do not always match. " –Jessica Ciralsky, MD continued from page 3

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