JUN 2017

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/831102

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Supported by unrestricted educational grants from Allergan, Shire, TearLab, and TearScience 6. Beckman KA, et al. Making the diagnosis of Sjögren's syndrome in patients with dry eye. Clin Ophthalmol. 2015;10:43–53. 7. Rao SN. Topical cyclosporine 0.05% for the prevention of dry eye disease progression. J Ocul Pharmacol Ther. 2010;26:157–164. 8. Donnenfeld ED, et al. Safety of lifitegrast ophthalmic solution 5.0% in patients with dry eye disease: a 1-year, multicenter, ran- domized, placebo-controlled study. Cornea. 2016;35:741–748. 9. Epitropoulos AT. Evaluation of single thermal pulsation treatment for meibomian gland dysfunction and dry eye. ASCRS• ASOA Symposium & Congress, April 2015. 10. Epitropoulos AT, et al. Effect of oral re-esterified omega-3 nutritional supplementation on dry eyes. Cornea. 2016;35:1185–1191. Dr. Epitropoulos is clinical assistant professor, Ohio State University Wexner Medical Center, Columbus, Ohio, and co-founder of the Eye Center of Columbus. She can be contacted at eyesmd33@gmail.com. film is replenished less frequently and evaporates more quickly, compromising the lipid layer, tear film, and tear meniscus. Therefore, ophthalmologists need to assess all patients careful- ly for EDE and ADDE, even if they do not report symptoms suggest- ing dry eye. References 1. Lemp MA, et al. Distribution of aqueous- deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea. 2012;31:472–478. 2. 2007 Report of the Dry Eye Workshop. Ocul Surf. 2007;5:65–204. 3. Epitropoulos AT, et al. Effect of tear osmolarity on repeatability of keratometry for cataract surgery planning. J Cataract Refract Surg. 2015;41:1672–1677. 4. Messmer EM, et al. Matrix metallo- proteinase 9 testing in dry eye disease using a commercially available point- of-care immunoassay. Ophthalmology. 2016;123:2300–2308. 5. Arita R. Validity of noninvasive meibog- raphy systems: noncontact meibography equipped with a slit-lamp and a mobile pen-shaped meibograph. Cornea. 2013;32 Suppl 1:S65–70. supplement to reduce inflam- mation and increase the natural quality tear production, as well as thermal pulsation treatment to treat MGD. 7,8,9 Research has shown that re-esterified omega-3 supplements significantly improve tear osmo- larity, symptom scores, MMP-9 positivity, and tear film stability. 10 When considering punctal occlusion, performing the MMP-9 test provides helpful information to ensure inflammation has been eliminated; otherwise patient symptoms may worsen with this therapy. In a patient like this, tradi- tional treatments such as warm compresses, manual meibomian gland expression, artificial tears, or antibiotics are not very effec- tive because they do not address the root of the problem. Treat- ment must facilitate evacuation of the gland contents to restore gland function. This is accom- plished using thermal pulsation in combination with microbleph- aroexfoliation, a lid cleanser with pure hypochlorous acid, and continuing omega-3 supplemen- tation. If a patient's autoimmune disease is systemic, a rheuma- tologist or other specialist may prescribe systemic treatment that would potentially improve ADDE. Conclusion In the digital era that we live in today, dry eye is becoming more prevalent. Many daily tasks re- duce our blink rate, impeding the natural mechanism by which the meibomian glands release oil into the tear film. Therefore, the tear The ocular surface interferometer showed 6/10 partial blinks. At the slit lamp, the patient had a reduced tear meniscus, reduced tear breakup time, and some inferior corneal staining. It is important to evaluate the lids and examine how the meibomian glands are functioning along with the quality of secreted meibum. If less than 6 glands are function- ing, dry eye symptoms typically begin to emerge. Based on her symptoms, we screened her for Sjögren's disease. 6 If this test is positive, I refer patients to a rheumatologist for additional evaluation and treatment. All of these tests are import- ant in such a patient, but corneal staining, tear meniscus, and tear osmolarity are particularly essen- tial in diagnosing ADDE. Treatment guidance The tear film is the most import- ant refracting surface of the eye. An unhealthy ocular surface can affect the accuracy of biometry before refractive cataract sur- gery and result in choosing an inaccurate power implant, delay postoperative healing, and impact visual outcomes. 3 It is essential to treat dry eye in a timely fashion to avoid dis- ease progression. ADDE typically can be managed with artificial tears, an immunomodulator, and punctal occlusion. I use a combination of treatments, but in a case of mixed ADDE and EDE such as described above, I would prescribe a topical steroid and either cyclosporine or lifitegrast and a good-quality omega-3 " It is essential to treat dry eye in a timely fashion to avoid disease progression. " –Alice Epitropoulos, MD 7

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