Dr. Michaud's #1 tip for managing dry eye

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Langis Michaud, OD, MSc, FAAO, FSLS, FBCLA, FEAOO, shares his number 1 tip for managing dry eye.

Langis Michaud, OD, MSc, FAAO, FSLS, FBCLA, FEAOO, professor at Université de Montréal, shares his number one tip for the management of dry eye.

This transcript has been lightly edited for clarity:

Tip number one for dry eye management... be patient and [it] takes a lot of chair time. And listen to their story, I think that this is tip number one: do a very thorough and complete case history.

The journey of these patients is unique, and you're probably the fifth or sixth practitioners they meet, because they didn't find a good answer to their problem previously. So you have to listen to their symptoms, their signs, what they went through, what is their behavior, what are their challenges, what are their visual needs, what they are struggling for? And what they really want, in fact. Because sometimes, you may be surprised ... we all know that, you know, signs and symptoms don't match. But in some cases, you know, their demand will be very different. And so we have to, again, customize our management approach based on patient needs.

So to understand very well the condition, I'll just give an example I have a lady referred to me for dry eye, she is suffering dry eye for the last 10 years. And she was referred to be fitted in scleral lenses. And so I did my complete work-up and I found almost nothing, really. Tear film was stable, tear film was, the volume was good enough. So there was no sign of real inflammation. And I began to question when this began, and to make a long story short, in fact, she moved to a new house 10 years ago, and she was allergic to some chemicals in the walls and she had the hair salon and she was doing that in her kind of garage, you know, close to the house. So the chemicals from her regular activity melted with the chemicals from the house [and that] was the main problem, in fact. And she she became intolerant to this toxicity, and this is why she developed symptoms, despite the fact that we didn't see any signs. So controlling her environment, you know, relieved her for 90% of her symptoms without touching the eye, without prescribing artificial tears or cortisone or something like that.

You know, again, listening to the patient and doing your Sherlock Holmes job, in fact, to find out what's it is really about, you know, I think that's my number one advice.