Keeping up with dry eye: Approaches to treatment plans, patient education, and clinical developments

Celeste Ferreira, OD; Sabrina Gaan, OD; Chandler Mann, OD; and Nishi Mehdiratta, OD, sat down with Optometry Times to discuss how they approach dry eye at their practices. Image credit: AdobeStock/JoPanuwatD

Dry eye has solidified itself as one of the fastest-developing and highly prevalent specialties in eye care. From nuanced approaches to headway being made in clinical and technological developments, the dry eye space is unveiling more about symptoms, patient education, and more. Dry eye specialists Celeste Ferreira, OD; Sabrina Gaan, OD; Chandler Mann, OD; and Nishi Mehdiratta, OD, sat down with Optometry Times to discuss how they approach dry eye in their practices.

Q: What is your general philosophy regarding dry eye management? Are you more proactive or reactive?

Ferreira: I’m fiercely proactive when it comes to dry eye. Waiting until symptoms spiral out of control just delays healing and puts patients through unnecessary discomfort. I believe dry eye is often a sign of deeper dysfunction, such as inflammation, lid mechanics, and systemic health issues. My goal is to catch those signs early. Prevention and early intervention lead to better long-term outcomes and, frankly, happier patients.

Gaan: I am very proactive when it comes to managing dry eye. Waiting too long can lead to meibomian gland loss, increased inflammation and rosacea, and reduced corneal sensitivity, to name a few examples. Treating early is not only important, but it’s also easier for the patient. For those with mild dry eye, it often means fewer visits, less maintenance, and, ultimately, patients are happier and are less miserable.

Mann: My philosophy centers on a proactive approach to dry eye management, emphasizing early detection and prevention to improve long-term patient outcomes and quality of life. Rather than waiting for symptoms to become severe, I screen every patient during routine exams—regardless of complaints—using tools like tear breakup time assessments and meibomian gland evaluations. This allows us to address underlying issues like meibomian gland dysfunction before they escalate, reducing the need for reactive interventions down the line. In my experience, proactive care not only halts progression but also builds stronger patient relationships, as it shows we’re invested in their overall ocular health.

Mehdiratta: I used to take a more conservative approach to dry eye, but now I tell all my patients that I prefer to be proactive rather than reactive, because treating the condition after inflammation has worsened is markedly tougher to combat. This message really resonates with them, as most don’t want to let a health issue go untreated and worsen.

Q: How do you personalize treatment plans for patients?

Ferreira: Every patient’s dry eye story is different, and so is their care plan. We dive deep into lifestyle factors, hormone changes, skin care routines, systemic conditions, and even stress levels. I don’t believe in a one-size-fits-all solution. A patient with ocular rosacea receives a very different approach than someone dealing with only ocular surface disease. My toolbox includes everything from my first-line treatment of intense pulsed light [IPL] and lift technology to amniotic membranes and radiofrequency. I treat based on root cause, not just surface symptoms.

Gaan: It starts with identifying what the problem is. Is it their meibomian glands? Is it related to gut health? Is it their floppy eyelids? Or is it a combination of factors, which is often the case? Every patient is different and requires a different approach.

Mann: Personalization is key in dry eye care because no 2 patients are alike—their symptoms, underlying causes, lifestyles, and responses to therapy all vary. I start with a comprehensive evaluation, including questionnaires like the Ocular Surface Disease Index [OSDI], osmolarity testing, and imaging of the glands and tear film. From there, I classify the dry eye as evaporative, aqueous-deficient, or mixed, and factor in elements like age, medications, screen time, or environmental exposures. For instance, a contact lens wearer with evaporative dry eye might get a plan focused on lid hygiene, omega-3 supplements, and in-office IPL therapy, while those with lid laxity could benefit from dynamic muscle stimulation to improve blink mechanics. On the contrary, someone with autoimmune-related aqueous deficiency could prioritize anti-inflammatory drops and punctal plugs. Follow-ups are scheduled to adjust based on progress, ensuring the plan evolves with the patient for optimal adherence and relief.

Mehdiratta: Dry eye is never one-size-fits-all. I assess each patient's symptoms and clinical signs independently and then walk them through a game plan with me, outlining what I think are our next best steps. It may be a combination of in-office and at-home treatments, but I always take a solid amount of time to thoroughly discuss my clinical findings and what I intend to do to remedy their symptoms in the best possible way.

Q: Are there any buzzwords you’ve heard patients use lately that drive you to look closer at the ocular surface for dryness?

Ferreira: Absolutely. If I hear words like “vision fluctuations,” “irritation first thing in the morning,” “tired eyes,” “watery eyes,” or even “my eyes feel heavy,” that’s a full stop for me. Even if they don’t mention “dryness” explicitly, I know to dig deeper. Lately, patients are also describing symptoms like “glare when driving at night” or “contacts not feeling right,” which are often overlooked signs of early ocular surface dysfunction.

Gaan: Buzzwords I listen for include vision fluctuations; burning, scratchy, or watery eyes; redness, and comments like “I have to blink harder to see.”

Mann: Absolutely—patients often use casual terms that hint at dry eye without realizing it, prompting me to dive deeper into ocular surface exams. Lately, I’ve heard a lot of “screen fatigue” or “tired eyes” from those glued to devices all day, which often signals evaporative dry eye from reduced blink rates. Other buzzwords like “gritty” or “scratchy” sensations, “blurry vision that comes and goes,” or “burning when driving or outside” are red flags for me to check tear film stability and gland function. With the rise in digital device use post pandemic, patients discussing visual fluctuations and tired eyes have become common triggers for proactive screening, as they frequently uncover subclinical dryness that patients dismiss as normal.

Mehdiratta: Screen time is always the most common. Patients are aware that screen time can contribute to dry eye. So, while they may not yet be symptomatic, they mention their excessive screen time usage in order to be proactive about what they can do to maintain the health of their ocular surface.

Q: How do you approach patient education for dry eye disease?

Ferreira: Education is everything. Patients need to understand that dry eye is a chronic, often progressive condition, not just an occasional nuisance fixed by drops, which is often the misconception. I use meibography images, diagnostic testing and reports, and analogies that make the condition relatable and understandable. I also explain how treatments work with the body, not just on the surface. We always want to be proactive and not reactive with dry eye disease. We don’t want to wait for the symptoms to surface, because then the issue is going to be far more challenging to contain. Once they get the “why,” they’re empowered to commit to long-term care, and that’s where real transformation happens and real trust is built.

Gaan: I spend a few minutes speaking directly with each patient and provide them with a handout they can take home. I explain their specific problem and what needs to be done to fix it—even if it’s not what they’d prefer—and make it clear that if they don’t do it, the situation will worsen.

Mann: Patient education is foundational to successful dry eye management—I aim to empower patients with clear, actionable knowledge so they become active partners in their care. I start by explaining the disease in simple terms: it’s often a chronic imbalance in tear production or evaporation, influenced by factors like age, hormones, or environment. Using visuals like gland imaging or tear film diagrams helps demystify it. We discuss lifestyle tweaks—such as the 20-20-20 rule for screen breaks, humidifiers, and nutrition—alongside treatments like drops or in-office procedures. I provide printed or digital resources for home reference and schedule follow-ups to reinforce adherence. The goal is ongoing dialogue; I frame it as a manageable condition, not a cure-all, to set realistic expectations and boost [adherence].

Mehdiratta: Quality time is vital for dry eye patients, many of whom are used to being dismissed and told just to use artificial tears. My initial consultation with a new dry eye patient typically lasts about 45 minutes to an hour. I gather an in-depth patient history, which makes them feel seen and understood. Then, I walk them through all of my clinical findings step by step and map out how I intend to treat each finding I have uncovered.

Q: How does dry eye care fit within the broader scope of your practice?

Ferreira: Dry eye care is the foundation of how I practice medical optometry. It is truly my passion and my purpose. With the incredible technology I have in office, we can expand into aesthetic and facial wellness too. It’s connected to everything: vision quality, contact lens success, surgical outcomes, and even self-confidence. As we've expanded into ocular aesthetics, I’ve seen firsthand how addressing inflammation, lid health, and skin barrier function improves both comfort and appearance. We don’t just treat eyes, we elevate how people feel in their skin.

Gaan: I talk about dry eye with at least half of my patients. Most people have some symptom or sign worth discussing. Sometimes all they need is to make a minor adjustment to their life, and they truly appreciate the advice—that’s why they come to you. Telling someone to blink more when they’re on screens is one of the most impactful tips I give, and it creates such loyalty. That little piece of advice, which costs nothing, makes them feel like the trip was worth it because no one has ever told them that before.

Mann: Dry eye care is integral to my practice—it’s not a niche service but a core component that intersects with nearly every aspect of optometry, from routine exams to specialty contact lenses and presurgical evaluations. With dry eye affecting up to 40% of patients (I have found it, anecdotally, to be significantly higher), addressing it enhances overall outcomes, like better vision stability or reduced complications in other ocular disease management. Tools like Lumenis OptiLIGHT for inflammation/MGD and OptiLIFT for lid laxity allow me to manage complex cases in house, strengthening my role as a primary eye care provider. Dedicated dry eye clinics also build patient loyalty and referrals, while collaboration with ophthalmologists ensures comprehensive care for severe cases. This focus underscores my commitment to preventive, patient-centered optometry.

Mehdiratta: Dry eye is our niche—it is the backbone of our practice's revenue. It brings me so much joy to see these patients' quality of life improve dramatically.

Q: Are there any devices or in-office treatments you’ve adopted recently that have changed your approach to care?

Ferreira: Yes. The [dynamic muscle stimulation, or] DMSt feature on our Lumenis platform has been a game changer. It’s allowed us to get even more targeted with results that pair beautifully with IPL, especially for patients with sensitive skin or mild rosacea. We’ve also seen incredible results combining IPL with radiofrequency and microneedling for those who want aesthetic rejuvenation and dry eye relief. It’s that dual-purpose care that has elevated the entire patient experience.

Gaan: I have a slit lamp camera with video and meibography capabilities, as well as Lumenis’ OptiLIGHT, OptiPLUS, and I have recently added OptiLIFT. I now check every dry eye patient for lower lid laxity by gently pulling on the lids, which informs my decision-making and allows me to create a stronger treatment plan for each patient. Addressing eyelid laxity has been a real benefit for those dry eye patients who were improving but still dealing with lingering issues.

Mann: Incorporating advanced diagnostics and treatments like Lumenis OptiLIGHT and OptiLIFT has refined my approach to dry eye. OptiLIGHT, which uses intense pulsed light to target meibomian gland dysfunction, has improved tear quality and reduced symptoms in patients with evaporative dry eye, often within a few sessions. Similarly, OptiLIFT’s Dynamic Muscle Stimulation technology addresses lid laxity, enhancing blink completeness and tear film stability, which is critical for patients with incomplete blinking. These tools complement traditional therapies like warm compresses and drops, allowing me to offer more targeted, efficient care and manage moderate-to-severe cases without immediate referrals, ultimately improving patient satisfaction and clinical outcomes.

Mehdiratta: Our workhorse has always been OptiLIGHT. [IPL] is the focal point of our office in terms of dry eye treatments. We recently brought in OptiLIFT, which has really changed the scope of how I can treat my dry eye patients, especially for those struggling with lower lid laxity and impaired blinking.

Q: Are there any emerging technologies or innovations that you’re particularly excited about?

Ferreira: I’m really excited about the growing intersection between eye care and aesthetics. Devices like triLift are giving us tools to treat both structure and function; improving circulation, collagen, and skin health while also addressing periocular inflammation. I’m also keeping a close eye on AI-powered diagnostics and more technology that can bridge the gap of ocular and facial wellness. Anything that helps us get more precise, more personalized, and more preventive for our patients, I’m here for it.

Gaan: I’m excited to hear more success stories from combining treatments. I’m working on developing which combo packages to implement that will best serve my patients. OptiLIFT is still relatively new, and I’m in the process of gathering before-and-after photos and patient testimonials. I believe that by combining OptiLIGHT’s intense pulsed light therapy and OptiLIFT’s dynamic muscle stimulation technology for most dry eye patients, I can achieve even better outcomes.

Mann: I’m particularly excited about advancements in AI-driven diagnostics and novel drug deliveries for dry eye, which promise more precise, patient-specific care in 2025 and beyond. AI tools for analyzing tear film and gland images could streamline screenings, predicting progression before symptoms worsen. On the treatment side, new agents like reproxalap—a reactive aldehyde species inhibitor—for acute and chronic relief, and the continued advancement of devices for evaporative dry eye, are game-changers. Gene therapies and immunoglobulin-based drops from pooled donors also show potential for addressing root causes. These innovations align with my proactive philosophy, potentially reducing reliance on frequent drops and enhancing outcomes for tough cases, and in turn, bettering our patients’ lives.

Mehdiratta: OptiLIFT, hands down. I have been nothing short of amazed by this device, which utilizes DMSt and radiofrequency [RF] technologies. Never before have we had the ability to alleviate morning dry eye symptoms due to lagophthalmos or end-of-day dryness from incomplete blinking. This technology is truly poised to be the next big thing in the dry eye stratosphere—we’ve never had anything like it before.