Eyelid and tear function
Eyecare providers can dive deeper into investigating symptoms of DED by first looking at the eyelid function. Assessing the eyelid margins and blink status, as well as investigating the meibomian gland (MG) function and tear quality, can help to grasp the severity of DED.
In patients having trouble with dry eye symptoms, observing the eyelids often reveals incomplete blinks and/or MG dysfunction and dropout. Spending a few extra minutes with these patients to help educate them about their dry eye condition has shown to be beneficial to patients and their overall satisfaction with surgical outcomes.
For symptomatic post-refractive dry eye patients, I often recommend preservative-free artificial tear lubrication such as Refresh Mega-3 (Allergan), which fortifies the lipid layer and helps to prevent tear evaporation.
Systane Complete (Alcon) is another option known for its nano-droplet technology, which may help target all three layers of the tear film to hydrate and add tear evaporation protection.
Other options to improve MG function include TearCare (Sight Sciences) and LipiFlow (Johnson & Johnson Vision)—devices that apply heat to the meibomian glands so the glands can be more easily expressed, thus helping to increase tear break-up time (TBUT) and reduce dry eye symptoms.1
Inferior corneal staining
I often see post-refractive patients also affected by common environmental factors that cause intermittent blur, glare, and symptoms of DED.
Whether due to a continuous positive airway pressure (CPAP) machine, living in a high-altitude area with low humidity, extended computer use, riding in an arid airplane, poorly placed vents at home/work—all of which cause dry eyes—it is important to identify and treat these likely culprits of chronic environmental dryness.
In addition to artificial tears, punctal plugs can also be inserted bilaterally to delay tear drainage and improve the amount of time tears stay on the ocular surface.
Other dry eye treatment for post-refractive surgery patients include Xiidra (lifitegrast, Novartis) to improve DED signs and symptoms and Restasis (cyclosporin, Allergan), an immunomodulator to help increase tear production. Note that Cequa (cyclosporin, Sun Pharma) is hitting the market as well.
1. Cohen E, Spierer O. Dry Eye Post-Laser-Assisted In Situ Keratomileusis: Major Review and Latest Updates. J Ophthalmol. 2018 Jan 28;2018:4903831.
2. Yu EY, Leung A, Rao S, Lam DS. Effect of laser in situ keratomileusis on tear stability. Ophthalmology. 2000 Dec;107(12):2131-5.
3. Solomon R, Donnenfeld ED, Perry HD. The effects of LASIK on the ocular surface. Ocul Surf. 2004 Jan;2(1):34-44.
4. Edwards JD, Burka JM, Bower KS. Effect of brimonidine tartrate 0.15% on night-vision difficulty and contrast testing after refractive surgery. 2008 Sep;34(9):1538-41.