My first Contact Lens Spectrum article was published almost 20 years ago, and soon thereafter, I became a quarterly columnist focusing on dry eye. Here, I reflect on those early days to see how things have changed in the dry eye world and where we are today.

MGD

In February 2013, meibomian gland dysfunction (MGD) and the potential therapeutic benefits of manual gland expression was described (Gaume, 2013). The procedure was recommended by The International Workshop on MGD (Geerling et al, 2013) but was time-consuming for practitioners and uncomfortable for patients. Mostly, manual expression with a metal paddle or cotton-tipped applicator was the method to address obstructive MGD in-office; a thermal pulsation system had just recently received U.S. Food and Drug Administration (FDA) approval and carried a hefty start-up cost.

Since then, the number of therapeutic interventions has skyrocketed, and there are now many on-label and off-label options from which choose, intra-ductal meibomian gland probing, intense pulsed light therapy, low-level light therapy, and radiofrequency. Anyone who wishes to offer in-office MGD care should be able to find a suitable option for their practice in 2023.

UVEITIS

Back in 2015, it was mentioned in a CLS article about our dry eye clinic functioning as a uveitis center in disguise (Gaume, August 2015) and this statement stands true today. It’s amazing how many “dry eye” sufferers actually have low-grade anterior chamber cells. A chronic, smoldering uveitis doesn’t tend to produce the same symptoms as an acute attack, producing vague symptoms that can be incorrectly identified as “dry eye.” And with ocular dryness being one of the most common complaints in those with underlying autoimmune rheumatic disease (and in whom uveitis is more prevalent) (Shan et al, 2023; Hysa et al, 2021) it’s important to remember that more than one ocular condition can present itself.

Recently, a self-referred patient came to our office for dryness because she hadn’t achieved relief over the past two years with her current practitioner. She had undiagnosed grade 1+ bilateral anterior chamber cells with several old cornea-lens adhesions. How long had this chronic inflammation been going on? It’s tough to say because she reported no history of uveitis or past steroid prescriptions. But if you take anything away from this column, please don’t ever assume that vague dry eye complaints always equate to only dry eye disease. Turn off your overhead lights, increase your slit lamp magnification, and look closely for those cells.

PEDIATRIC DRY EYE

Having written articles about dry eye in children over the past 11 years (Gaume, November 2015; Gaume and Nichols, 2012; Gaume, July/August 2012), it appears to me that the subject doesn’t get the attention it deserves. Kids tend to have few ocular surface issues, however, due to a variety of factors, including living in a digital world, they are showing up in the dry eye practice a lot more often than they used to.

As a profession, we are prescribing contact lenses more frequently and at an earlier age than we ever have, thanks to safety studies and a recent surge in myopia management interest (Nichols and Fisher, 2023). Although this is a positive step, contact lenses challenge the tear film and ocular surface, so it is more important than ever to closely evaluate all patients for ocular surface changes, regardless of age.

Looking back at this past decade has been nostalgic! The area of dry eye has grown by leaps and bounds and it will be very interesting to see what the next decade will bring.

References

1. Gaume Giannoni A. Therapeutic Meibomian Gland Expression: Squeeze to Please. Contact Lens Spectrum. 2013 Feb;28:22.
2. Geerling G, Tauber J, Baudouin C, et al. The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction. Invest Ophthalmol Vis Sci. 2011 Mar 30;52:2050-2064.
3. Gaume Giannoni A. When Dry Eye Isn’t Dry Eye: Revisited. Contact Lens Spectrum. 2015 Aug;30:18.
4. 4. Shan H, Liu W, Li Y, Pang K. The Autoimmune Rheumatic Disease Related Dry Eye and Its Association with Retinopathy. Biomolecules. 2023 Apr 23;13:724.
5. 5. Hysa E, Cutolo CA, Gotelli E, et al. Immunopathophysiology and clinical impact of uveitis in inflammatory rheumatic diseases: An update. Eur J Clin Invest. 2021 Aug;51:e13572.
6. Gaume Giannoni A. Sjogren Syndrome…in a 10-Year-Old Boy? Contact Lens Spectrum. 2015 Nov;30:19.
7. Gaume Giannoni A, Nichols K. Detecting OSD in Children. Optometric Management. 2012 May;47:57-60,72.
8. Gaume Giannoni A. Dry Eye Disease in Children. Are You Missing Something? Advanced Ocular Care. 2012 July/Aug;32-40.
9. Nichols JJ, Fisher D. Contact Lenses 2022. Contact Lens Spectrum. 2023 Jan;38:20-22,24-26.