Dry Eye Pearls 101

By Vipul Shah, MD

For most ophthalmologists, the words “dry eyes” produce the same kind of nausea as phrases like “IRS audit” or “Do you know how fast you were going?” These patients tend to be very uncomfortable and the disease is difficult to treat. Throw in typical noncompliance and the rising impatience of our general population and it’s enough to make you start looking up law school applications.

But dry eye syndrome has become increasingly prevalent and remains relatively undiagnosed, and is therefore an area where we can truly be of service to suffering patients. While everyone has a different protocol to deal with dryness, here are some pearls that help me in my practice:

- Reassure the patient that their problem is real. Many patients feel that their doctor is blowing them off by saying “You just have dry eyes.” It helps to reassure them that dryness is a serious disease that you will be taking seriously.

- Not all artificial tears are the same. Various tears have different viscosities and properties, and while the patient may feel that “artificial tears don’t help,” it is often useful to try another tear with more or less thickness, depending on the patient’s needs.

- Use a layered approach. I tend to apply each treatment in addition to the one before it. This way I can adequately gauge the response of each therapy, and limit the number of drops or treatments to only what is necessary. This aids with compliance by reducing the number of drops, the expense, and the number of things for the patient to remember at each visit.

- Be flexible. While I typically follow the same protocol, I often change it to match the patient’s condition, requests, or past experiences.

- Signs and symptoms rarely correlate. Many patients have either horrible symptoms and clear corneas, or no discomfort at all and severe staining, but rarely have both. I use either symptoms or signs equally as a marker for improvement.

- Remember to address the whole ocular surface. Dry eye syndrome is commonly associated with other surface disorders like blepharitis, meibomitis, or conjunctivochalasis. One of these may be the primary cause of discomfort, so remember to treat them concurrently.

While treating dry eyes can be difficult, it can be a truly rewarding experience to help your patients get some relief from what can be a debilitating condition.