With an advanced understanding of the ocular surface and inflammation levels, ODs can optimize the management of patients’ clinical outcomes and promote wellness of the ocular surface.
The views expressed here belong to the authors. They do not necessarily represent the views of Optometry Times or MJH Life Sciences.
Optometrists understand the importance of inflammation in medicine, respect its severity, and try to avoid it because of the potential long-term deleterious implications to human tissue. When someone has an autoimmune condition, ODs understand the potential long-term implications to his health.
Often, attempts at reducing inflammation with a rheumatologist’s close management is critical in long-term tissue damage of the affected organ. Additionally, patients are often placed on chronic medications in attempts to control inflammation. Ironically, some of these medications are known to have potential sight-threatening consequences.
Chronic inflammation in long term systemic diseases is respected and treated accordingly.
In eye care, there is a growing body of evidence that shows the link between Ocular Surface Disease (OSD) and chronic inflammation. The Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop II (DEWS) report defines dry eye as the following: “Dry eye is a multi-factorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface in-flammation and damage, and neurosen¬sory abnormalities play etiological roles.”1
Loss of homeostasis
In the DEWS II new definition of dry eye, there is the notable addition of the phrase, “loss of homeostasis” which re-calibrates the way ODs clinically think of dry eye. Clinically, dry eye used to be thought of simply as the absence of adequate tear production. Traditional wisdom would encourage lubrication to the ocular surface with the addition of an artificial tears or an attempt is made to retain tears on the eye through punctal occlusion. As opposed to thinking about dry eye as simply a reduced level of tear production, we now view it as a loss of homeostasis.
1. Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, Liu Z, Nelson JD, Nichols JJ, Tsubota K, Stapleton F. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017 Jul;15(3):276-283.
2. Brujic M, Kading DL. Making matrix metalloproteinase-9 levels more meaningful. Poster presented at Global Specialty Lens Symposium annual meeting; January 21-24, 2016; Las Vegas, NV.