How would you describe your clinical approach to assessing and diagnosing Dry Eye Syndrome?
Dr. Lin: Whether a patient enters the exam with a dry eye complaint or not, I still screen each patient for signs and severity of dry eyes. Again, just because there are no complaints does not mean there isn’t already an impending ocular surface disorder already starting, and like most problems, catching and treating it early yields better resolution or management potential or avoidance of the condition getting worse and causing unfixable changes to ocular tissue and to vision. Either a questionnaire is completed prior to the exam or I will inquire more details during the exam. Based on complaints, the information gathered, and exam screening or testing results, I determine whether the dry eye syndrome is due to an evaporative disorder or an aqueous deficiency disorder, the former being more prevalent. Many people suffer from both, thus obtaining a complete and accurate background is essential in aiding in the decision for course of treatment. If signs of dry eye are discovered during a typical comprehensive exam, I will educate the patient on the importance of follow-up at a more complete dry eye evaluation scheduled at a later time. Our clinic has all the most up-to-date equipment that aid us in the diagnosis of dry eye as well as assess the efficacy of treatment once therapy is initiated. Treatment options for dry eye syndrome and treatment durations are dependent on the type, the severity, and the patient’s preferences. However, I always remind and stress to patients that dry eye syndrome will always be a chronic condition, much like allergies, diabetes, and hypertension. Treatment and medications will make the symptoms better, but it will never cure and eliminate dry eye syndrome completely. However, again, with early detection and intervention, ocular and visual complications can be avoided.
Are OTC artificial tears an acceptable treatment for dry eyes? What are the different levels of treatments for DES?
Dr. Lin: Treatment for dry eyes can start with artificial tears, but most will need to eventually employ other treatment modalities in order to manage symptoms that worsen over time. Over the counter options, such as Systane, Optive, and Refresh are great brands to start with for those in the early stages of dry eye. I do recommend staying away from generic brands and brands like Visine and ClearEye as they contain extra chemicals, such as vasoconstrictors, that not only do not address the source of the problem, but also usually exacerbates the symptoms. Education and understanding of the disorder and their potential for worsening is the first step in Dry Eye Syndrome therapy. Other therapies used in early to moderate dry eye treatment include other topical treatments such as gels and other lubricating ointments at bedtime, daily eyelid hygiene scrub procedures, dietary changes like drinking more water and supplements like omega-3 essential fatty acids (fish, flaxseed, krill), and modifications in lifestyle or behaviors leading to dry eyes. Once into the moderate stages, punctual occlusion of the eyelid will be performed and other prescription topical eyedrops will be prescribed. A soft steroid to control inflammation may be used alone or in conjunction with Restasis, an immunomodulator, which happens to be the only medication shown to decrease ocular surface inflammation and help produce more and better tears. Other therapy options may be reserved for more severe cases and may include meibomian gland expression, autologous serums, and other immunomodulatory treatments. To determine which stage you are in and what treatment options are most applicable to you, please make an appointment to be evaluated at our dry eye clinic.