Eyeworld

5 what she had and for surface repair; she under- went thermal pulsation therapy and was started on amniotic cytokine extract drops. Case 2 is a 25-year-old woman with intermit- tent symptoms of foreign body sensation and red- ness that got worse when she was at work on the computer all day. The pa- tient tried using tears but hated putting in drops. Though both cyclospo- rine 0.05% and lifitegrast 5% were discussed as options for the patient, she didn't want to be on a chronic medication. Another option dis- cussed with this patient was using neurostimula- tion to treat dry eye dis- ease, specifically the new- ly FDA-approved nasal highlights the fact that we cannot see meibomian gland atrophy at the slit lamp, and it may be sur- prising to physicians how many patients actually have atrophy (Figure 4). The clinician must look for other contrib- utors of OSD beyond dry eye disease, such as meibomian gland disease, and address the problem accordingly. Since the patient had severe mei- bomian gland atrophy, it's important to also set realistic expectations. A patient in this situation should understand that achieving tear film ho- meostasis is difficult in the setting of extensive meibomian gland atro- phy. The patient in this case needed additional therapies to help preserve patient was still symp- tomatic. Where do you go from there? Ocular fatigue/fluctu- ating vision is one of the most telling symptoms of dry eye. It may be im- portant to look at the pa- tient's meibomian glands to see what they look like and what the secretion quality looks like. It is also key to con- centrate on the eyelids and make sure you're not missing any masquerade syndromes. From there, meibogra- phy diagnostics were run, and it became evident that the patient had 90% loss of glands. She also had extensive meibo- mian gland atrophy, with almost 90% of her glands gone. This is a case that Case reports Preeya Gupta, MD Case 1 is a 50-year-old woman who complained of chronic foreign body sensation, redness, and ocular fatigue. The pa- tient had a history of LASIK and later PRK enhancement, was healthy with no history of autoimmune disease, had been on cyclosporine 0.05% for a couple years, and had some dry eye. She had also tried lifite- grast 5% for 6 months, ar- tificial tears, and omega-3 supplementation. Despite these interventions, she remained symptomatic. Upon clinical exam, the LASIK flap and trace reticular changes were noticed, in addition to what appeared to be mild meibomian gland dys- function and mild cor- neal punctate epithelial erosions. What are we missing? The patient was on the maximum medical ther- apy, and she did improve with lifitegrast as well as other therapies, but the continued on page 6 Figure 4. Dr. Gupta's case demonstrates that meibomian gland atrophy may be hard to identify, and additional tests may be needed. Source: Preeya Gupta, MD Supported by unrestricted educational grants from Shire, TearLab, and TearScience

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