Eyeworld

cornea), and uses low temperature cautery. Be sure to tell patients they will have red eyes, irri- tation, and symptoms of foreign body sensa- tion the first few days. This specific patient's symptoms significantly improved at the 4-week follow-up appointment. In summary, surgeons may want to look for masquerades if many of meibography, and slit lamp exam, among other advanced diagnostics. Case 1 is a 65-year-old woman who complained of blurred vision, "grav- el in the eyes," redness, and watering in both eyes who was undergo- ing cataract evaluation. Her BCVA was 20/60 OU, MMP-9 was negative, tear osmolarity was 306, topography showed min- imal regular astigmatism, mild meibomian gland dysfunction, and tear breakup time of less than 3. The slit lamp examina- tion with fluorescein and anterior segment OCT though showed signifi- cant conjunctivochalasis, which resulted in evapo- rative dry eye symptoms. One option is using cautery as treatment for conjunctivochala- sis, which is an in-office procedure. The physician takes the forceps and holds the conjunctiva posterior to the limbus (make sure not near the Case reports Zaina Al-Mohtaseb, MD It's incredibly important for surgeons to carefully navigate ocular surface disease in the preoper- ative surgical patient. Patients' expectations have changed, and they want perfection. Cataract surgery itself can worsen OSD by decreasing goblet cell density, decreasing corneal sensitivity, and decreasing TBUT. Prior to cataract surgery, surgeons may use point-of-care diagnostic tests such as questionnaires, corneal topography, tear osmo- larity, MMP-9 testing, neurostimulation device, which offers a drug-free option to temporarily increase tear production during neurostimulation in adult patients. It works by stimulation of the anterior ethmoid nerve, which triggers tear pro- duction via cranial nerve V as well as meibum Customizing modern OSD therapies to individual patient needs " It's incredibly important for surgeons to carefully navigate ocular surface disease in the preoperative surgical patient. Patients' expectations have changed, and they want perfection. " —Zaina Al-Mohtaseb, MD the point-of-care testing is normal. OSD encom- passes any disease affect- ing the ocular surface, and symptoms will wors- en after surgery if it is not treated appropriately preoperatively. Case 2 is a 69-year-old patient who was present- ing for cataract evalua- tion and was interested in a presbyopic lens. The MMP-9 test was positive. continued from page 5 release and goblet cell activation. In clinical studies, post-stimulation there was a two times increase in tear meniscus height as measured by optical coherence tomography (OCT) compared to pre-stimulation. There has been shown to be equivalent concentration of lipid and proteins in both pre- and post-stimu- lation tears, suggesting a complete tear is formed, not just aqueous. Further, corneal staining has been shown to be reduced rel- ative to baseline in both eyes, as was conjunctival staining, after use of the neurostimulation device. Nasal neurostimula- tion can be used to help patients with tear pro- duction. It can be used as a primary therapy or as an adjunct therapy, but patient education is key to successful use of the device. 6

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