Monday, May 16, 2016

Five Common MISperceptions about the Care of a Dry Eye Patient

By: Jillian F. Meadows, OD, MS, FAAO with UAB Eye Care

Do you see patients who complain of dry eyes? Or perhaps you personally experience dry eyes? Regardless of whether you are a provider or a patient, you likely hold at least one, if not all, of these common misperceptions about dry eye disease (DED).

1. Dry eye is not important.

Up to 1 out of every 3 individuals has DED.1 Although highly prevalent as is, these values are thought to be increasing due to the aging population and the surge in smartphone, tablet, and computer use. On a yearly basis, $3.84 billion are spent on dry eye alone. 2 Beyond economic burden, the quality of life of those with severe dry eye has been reported to be equivalent to moderate to severe angina.3 Patients with the most severe forms of dry eye disease (requiring surgery) were affected more than those who reported a disabling hip fracture.3 In other words, dry eye is a prevalent disease, is costly to manage, and is often associated with a poor quality of life. This is why UAB Eye Care is committed to providing focused care to all dry eye patients.

2. All dry eye is the same.

Many think that dry eye is as simple as it sounds—dryness of the eyes. In reality, there are many different types of DED. There could be deficiency of the lacrimal glands that make the watery portion of the tears or dysfunction of the meibomian glands that make the oily portion of the tears. There could be anomalous blink patterns, excessive exposure and drying of the eyes, microbial build-up along the eyelids, or systemic immunologic disease. Due to the broad possibilities, all patients reporting dry eyes deserve a dry eye work-up to rule out systemic immunologic diseases and medication-induced dry eye. Only through a targeted dry eye work-up, one of the services we offer at UAB Eye Care, can the exact type of DED be diagnosed and a personalized treatment plan developed.

3. Only severe complaints of dry eye need to be evaluated by an eye care provider (ECP).

Symptoms of DED have been shown to progress throughout the lifetime,4 and severe disease can often be recalcitrant to treatment. It is important to intervene in DED early to stay ahead of the natural history of the disease. While patients with severe DED will benefit from a dry eye work-up, those with milder versions likely will too.

4. A dry eye exam is the same as a routine eye examination.

Although routine eye examinations are important for everyone, those with dry eye need an additional type of evaluation, a “dry eye work-up.” This series of non-invasive testing helps ECPs rule out systemic diseases, determine a patient’s type of dry eye, determine the severity level, and develop a personalized treatment plan. During a dry eye work-up at UAB Eye Care, medical history will be thoroughly reviewed, paying attention to possible undiagnosed conditions. The osmolarity of the tears can be measured to assess severity, and InflammaDry® may be used to test for inflammation on the eye’s surface. Many additional dry eye tests, including specialty imaging of the blinking patterns, oily portion of the tears, and meibomian glands with either the Keratograph or LipiView II, can aid in assessing dry eye type and severity. These evaluations are critical for understanding a patient’s specific type of DED and how to best manage his or her condition.

5. There are no good treatment options for dry eye. Over a decade ago, this statement may have been true, but many advancements have improved existing options or led to the development of new ones. Lubrication with artificial tears, thermal therapy with warm compresses, and eyelid hygiene with specialty products often help with many forms of mild dry eye. Moderate to severe dry eye, however, typically requires medical intervention, such as topical steroids or cyclosporine (Restasis®, Allergan). There may even be a new pharmaceutical for DED being released this year! Details to come.

A plethora of in-office treatments are also now available. Punctal plugs can be inserted to reduce drainage of the tears and prolong contact time on the eye. Microblepharoexfoliation can be performed to remove eyelid debris that is often associated with DED. Amniotic membrane grafts can be applied to the eye to promote health and regeneration of the eye’s surface. Further, LipiFlow can be used as a soothing, in-office treatment that targets the meibomian glands, one of the major problems in DED, to promote better production of the oily component of the tears. Excitedly, we have more treatment options now than we have ever had before.

While it may be common to have dry eye, it is definitely not normal to have dry eyes. Help your patients (or yourself) get to a state where they feel better. To schedule a dry eye work-up, call UAB Eye Care at 975-2020.


1. Gayton JL. Etiology, prevalence, and treatment of dry eye disease. Clin Ophthalmol. 2009; 3: 405-12.
2. McDonald M, Patel DA, Keith MS, Snedecor SJ. Economic and humanistic burden of dry eye disease in Europe, North America, and Asia: a systematic literature review. Ocul Surf. 2016; 14(2):144-67.
3. Schiffman RM, Walt JG, Jacobsen G, Doyle JJ, Lebovics G, Sumner W. Utility assessment among patients with dry eye disease. Ophthalmology. 2003; 110(7): 1412-9.
4. Lienert JP, Tarko L, Uchino M, Christen WG, Schaumberg DA. Long-term natural history of dry eye disease from the patient’s perspective. Ophthalmology. 2016; 123(2): 425-33.

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