Eyeworld

EW NEWS & OPINION 30 April 2017 complete resolution of symptoms," Dr. Rand said. If a patient uses a CPAP mask, Dr. Nicola will discuss whether an improper fit may contribute to lagophthalmos. Environmentally, ophthal- mologists discourage patients from using a ceiling fan over the bed or ask them to consider if they have direct air conditioning or wind from an open window blowing on them. They also will encourage the use of a humidifier at night, especially if patients live in a dry climate. For the daytime, "I will discuss with the patient the role that their decreased blinking plays in their symptoms and counsel them to conscious- ly and forcefully blink their eyes throughout the day," Dr. Nicola said. Dr. Rand has used amniotic membrane treatment in the past; although she said it does not solve the eyelid problem, it does improve the ocular surface and improve vi- sion until there is a more definitive solution for the eyelid. In motivated patients, she will also offer a custom fit with a scleral lens for daytime use. "Depending on the lid position and the ability of the patient, this is sometimes an excellent life-chang- ing solution. Sometimes it is just not possible for practical reasons," she said. Patients with a paralytic compo- nent to lagophthalmos may require the use of a gold weight in the upper eyelid or a tarsorrhaphy to minimize the palpebral fissure, Dr. Nicola said. The more challenging cases are ones where nocturnal lagophthal- mos is not obvious on exam but is suggested by exam and history and very severe cases where the lids cannot meet at all, Dr. Howard said. Lagophthalmos and paralytic ectro- pion due to Bell's palsy can resolve especially in younger patients, but may need months of supportive therapy. There are also instances, such as Bell's palsy in older patients and post tumor removal involving a facial nerve, when a complete recovery may not be possible, Dr. Goldfarb said. Some patients require a referral to an oculoplastics surgeon for surgi- cal correction. One key is to treat early and aggressively. "It's important to catch the problem early on to avoid permanent corneal scarring with loss of best corrected vision," Dr. Nicola said. Patients also need to under- stand their role in the condition's aggressive treatment. "If a person understands the reason why they need to use frequent medication, compliance will increase. It is espe- cially important for asymptomatic patients who may not have painful exposure," Dr. Rand said. EW Editors' note: The physicians inter- viewed have no financial interests related to their comments. Contact information Goldfarb: ms_goldfarb@yahoo.com Howard: Jennifer.Chatfield@sharp.com Nicola: amanda@macecarmichael.com Rand: jsandoval@randeye.com taping of the eye so it closes more completely, Dr. Howard said. Clinicians should make sure to treat blepharitis when it is seen, along with lagophthalmos. "Ome- ga-3 supplementation, medicated eyelid scrubs, warm compresses, and topical steroid treatment when indicated [for blepharitis] are not to be ignored. Failing to address these conditions will often result in in- Is astigmatism distorting your patients' view on life? There's a good chance it is, since the overwhelming majority of cataract patients suffer from astigmatism. But all joking aside, there's nothing funny about the way it can impact visual outcomes. That's why LENSAR ® has released Streamline ™ III, the third LENSAR Laser System upgrade in two years. With the latest enhancements, including wireless transfer* of pre-op diagnostics data and Total Corneal Astigmatism, post-op outcomes optimization, iris registration, and IntelliAxis ™ steep axis corneal marking, you can confidently and precisely manage astigmatism and deliver the outstanding outcomes your patients will be happy to see. Visit LENSAR Booth #2213 at ASCRS to learn more. Introducing * Available with the Cassini ® Corneal Shape Analyzer. USB integration available with Nidek ® OPD. © 2017 LENSAR, Inc. All rights reserved. LENSAR and the LENSAR logo are registered trademarks and Streamline and IntelliAxis are trademarks of LENSAR, Inc. All other trademarks are the property of their respective owners. 50-00154-000 Rev A 02/17 A closer look continued from page 28

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