Tailored Treatment for Dry Eye

I provide patients with fast-acting relief from their symptoms in the first couple of weeks – and many feel a whole lot better than they have in a long time. If a patient has blepharitis, that’s the first thing that needs to be addressed before other therapies or treatments can be effective in the long term.

If patients’ dry eye has an inflammatory component and has thus progressed to a moderate stage with corneal damage, I’ll be appropriately aggressive with a mild corticosteroid drop, such as Flarex (fluorometholone acetate ophthalmic suspension 0.1%; Eyevance Pharmaceuticals) or Lotemax SM (loteprednol etabonate ophthalmic gel 0.38%; Bausch + Lomb), and artificial tears. Optometrists should never simply give patients a free sample of tears and tell them to buy it at the pharmacy – patients could have done that themselves. Instead, they come to us for our expertise; patients expect us to prescribe a specific treatment or intervention.

Around half of patients also have an ocular allergy component that might be triggered by their inflammatory dry eye cycle. When that starts to disrupt the tear film – and if it is not eradicated – it restarts the cyclic pattern and continues to get worse until intervention – I tell patients, “We need to reset your tear film.”

Deeper dive

At the second visit, the inflammation has likely calmed down. I image the patients’ meibomian glands, express them, and assess the secretions. I use the S390L Firefly slit lamp and take pictures of the glands to show patients what their glands look like, the blockages, and explain why this is problematic. Patients often say their vision has been fluctuating, so I tell them that stabilizing the tear film improves vision.

At this point, I also talk to patients about using a specialized dry eye nutraceutical to help address inflammation and improve their secretions over time, working from the inside of their body. Patients are aware of their systemic and gut health, and often look for a more natural solution. I tell them HydroEye (ScienceBased Health) is designed specifically for dry eyes and combats inflammation via multiple pathways. The formula contains the fatty acid gamma-linolenic acid (GLA), derived from black currant seed oil, and helps modulate the body’s inflammatory response (1).

It can be challenging when patients say they already take an omega nutraceutical; they may have researched it and are very invested in a specific product. I may suggest that they bring in the product so that we can discuss the ingredients. Often, these products are not high quality and can be a waste of money. I tell patients that HydroEye is supported by clinical data – GLA has been shown to improve dry eye symptoms in a variety of studies (2–4) and HydroEye has been validated in a clinical trial (5). So, I feel confident in prescribing it.

For LASIK and cataract patients, I use dry eye kits and automatically put them on nutraceuticals to help with their recovery. I make sure my surgical patients understand that they cannot have a procedure until their dry eye has improved and the tear film is optimized; otherwise, they will not get the results they are expecting. Patients appreciate that I have their best interests in mind. I make it clear that I want to maximize their healing response in recovery.

Go with the (work)flow

To comprehensively treat dry eye patients, eye care specialists must set up their practice appropriately. They must establish a workflow and make sure their entire staff is educated and on board. Just like implementing a new technology, this takes planning and strategizing. Offering personalized treatment kits is a great way to streamline patients’ experience, gain their trust, and boost your practice.