editor's perspective
How Dry I Am

I've had a number of chalazions in my life and my eye irritation is worse in the morning when I wake up. Typically I just use an OTC drop first thing in the morning. If I'm feeling diligent I use hot water on my lids, and when I really have my act together I use a hot compress on my lids. I have some lash drop out and mild, clinical acne rosacea. My meibomian glands just aren't what they were when I was a younger man.

The other day I was looking for information on the packaging of commercial cyclosporine A when I came across the Ocular Surface Disease Index (OSDI, Schiffman et al, 2000). So I took the test. As you may know, it asks 12 questions that you answer using a 0 to 4 scale. The questions pertain to problems with light sensitivity, grittiness, soreness, blurred and poor vision, reading, night driving, computer and ATM use and TV watching. It also asks about discomfort with wind, low humidity and air conditioning environments. Eleven of 12 questions applied to me and my sum of scores was only 9. Multiplying 9 times 25 and dividing by 11, my OSDI is only 20.45, which just gets me into the mild category of eye dryness.

How my eyes feel is one issue that limits my comfort with contact lens wear. That and my presbyopia, and I like the built-in (5.00D) add my myopia provides.

When I am fatigued, when I blink less and when I'm not fully hydrated, I have more dryness-related symptoms. But how dry my eyes are isn't the issue. However, my eye discomfort does help me understand what our patients experience.

Also, keep in mind that Begley, Chalmers, Nichols, and others have noted that late day symptoms with contact lens wear are good indicators of contact lens-induced dryness.

So ask your patients about light sensitivity, grittiness (or whatever they call it), soreness, blur or vision problems in all conditions and about their symptoms in dry and windy environments. Then gauge (with or without the OSDI) their level of dryness and tailor a treatment plan to help them minimize their symptoms. You'll probably never get rid of their symptoms entirely.

Do a thorough slit lamp exam to check for lid disease and for conjunctival and corneal signs of dryness. Read our column each month on this topic. Visit our archives at www.clspectrum.com for reference articles.

Next month, I'll talk about a comprehensive treatment plan for this condition.

For references, please visit www.clspectrum.com/references.asp and click on document #132.