As the theme of this issue is dry eye disease (DED), and recent graduates continue to start practicing optometry, here are some tips for managing the chronic condition effectively in 2024.
1. Look for it in everyone
The DED patient population has expanded beyond those older than age 50, women going through hormonal changes, and those on medications linked with the condition. In fact, I recently saw a 13-year-old who had over 50% meibomian gland dropout.
With digital device use (computers, laptops, tablets, phones, etc.) now the norm, digital eye strain has increased dramatically. And, with digital eye strain comes meibomian gland dysfunction (MGD), one of the leading root causes of DED. (Don’t forget: When working on a digital device, patients tend to reduce their blink rate. This causes the eye to be open for a longer period of time, increasing the chance of ocular dryness.) As illustrated, DED is presenting in younger patients more frequently.
2. Use images for patient education
Several imaging devices, such as corneal topographers, interferometers, meibographers, osmolarity systems, and multi-DED testing instruments, are available that provide the OD with data on the best management, and patients with a clear picture (no pun intended) of the severity of their DED.
Veteran optometrists know that a picture is worth a thousand words. Showing patients what is happening to their meibomian glands, their tear meniscus, the telangiectasia within the lids, etc. helps increase the likelihood of compliance with prescribed at-home and in-office treatments.
Additionally, images help the provider and the patient at the follow-up visits. Sometimes, it is hard for the patient to have a “wow” effect with a chronic disease, but photos from baseline compared with photos after treatment can give encouragement to patients suffering from DED.
Photos from baseline compared with photos after treatment can give encouragement to patients suffering from DED.
3. Don’t forget natural interventions
In addition to the many prescription interventions that offer both symptomatic and clinical sign relief, it makes sense to also consider offering natural interventions. This is because some patients desire a non-pharmaceutical approach. Natural interventions include blepharoexfoliation, intense light therapy (IPL), low light therapy (LLLT), radiofrequency (RF) therapy, thermal pulsation, lid hygiene, and ocular nutritional supplements.
Blepharoexfoliation removes debris, lid margin biofilm, and scurf. IPL heats the meibomian glands to open them and clear stagnant secretions. RF uses high-frequency electrical currents to melt thick oil secretions and improves tear quality. RF can also reduce inflammation around the eyes, which can worsen DED symptoms. LLLT applies light to the periorbital and cheekbone areas of the face, warming the eyelids, so the meibomian glands unclog and release oils, thus reducing the rapid evaporation of tears typically associated with MGD. Thermal pulsation enables the release of lipids from clogged meibomian glands.
4. Address aesthetic product use
Because many skin care and eye cosmetics contain ingredients that can induce and exacerbate DED symptoms, it makes sense to educate patients about how easily the homeostasis of the tear film can be thrown off by the use of these items. As an example, they should be told that products containing retinol, tretinoin, parabens, benzoyl peroxide, salicylic acid, and certain oils may be great for improving the appearance of the skin, but in high concentrations may impact meibomian gland health. OM
