discovering dry eye

Treatment Methods for Dry Eye Patients

BY BARBARA CAFFERY, O.D.
AUGUST 1999

Despite all of our efforts, history has shown that the problem of dry eye is not solvable. Therefore, when treating this condition, our job is to keep patients comfortable and to improve their lens wearing experience by determining which drops, ointments and living conditions are best suited for them.

H₂0 to the Rescue

Although mild forms of dry eye are typically easy to manage, it's still necessary to educate your patients about the chronic nature of their condition, its likely etiology and the fact that there is no risk of losing vision. Also make sure that they understand how often you wish to see them in order to monitor their condition.

Once you're sure that they understand the nature of their condition, then you can establish the practical aspect of their treatment. Begin by discussing their general health and well-being. Encourage them to begin drinking eight to 10 glasses of water each day to ensure that they are fully hydrated and that all of their liquid-secreting glands are functioning at their maximum. Also advise them to humidify their home and work environment.

Teach mild and severe dry eye sufferers about the effect of wind and drafts on the ocular environment and advise them to use protective sunglasses when outdoors.

Dry Eye Regimens

Patients with any present lid inflammation need to begin a regimen of lid scrubs and hot soaks to maintain clean lids. If the patient's lids are clear, have them maintain a weekly schedule. Tear substitutes used as needed or twice a day usually help to reduce symptoms.

The newest multidose systems are composed of active ingredients, such as methyl cellulose derivatives or polyvinyl alcohol derivatives and are then preserved with fast depleting preservatives that decompose when exposed to light. Thus, patients are able to use less expensive multidose drops that don't have the prolonged effect that preservatives do on the ocular surface.

Of course, if the patient finds these drops irritating, the more expensive unit dose nonpreserved drops can be substituted. To help patients find the best drops, give them two multidose drops with different active ingredients and have them use each one exclusively for 1 week. On their 2-week return visit to your office, you should be able to find out if they have a preference as to which drop gave them greater relief.

Measures for Severe Cases

You must put forth greater effort when attempting to treat severe cases of dry eye. If meibomian gland disease is present and severe, prescribe tetracycline. You may also have to express the meibomian glands weekly with greater pressure, thus causing more discomfort for the patient.

Although their effect on the ocular surface cells is not well understood, ointments, when used in the evening, have been theorized to create lubrication between the lids and the ocular surface that prevents morning discomfort.

Punctal occlusion in patients who have less than 5mm Shirmer wetting cannot hurt and may afford them a reduction in the use of their drops. Whether cautery or silicone plugs are used, patients are usually able to gain some measure of comfort.

Protective humidity shields increase the humidity around the eyes and also prevent wind and drafts from irritating the patient's ocular surface.

Research is continually being conducted to find better treatments for dry eye. As we learn more about the various causes of dry eye and the mechanism of discomfort, we will be able to prevent and treat this endemic condition more effectively.

Dr. Caffery has practiced optometry in Toronto, Canada, in a group setting dedicated to contact lens and tear film research since 1977.