Managing Unique Dry Eye Disease Subtypes in Patients

In this segment, the expert panel explores two of the most challenging dry eye subgroups: patients with neurotrophic keratitis and individuals with persistent symptoms following refractive surgery. The faculty note that many post-refractive patients develop neuropathic pain syndromes and often would not have been ideal surgical candidates in the first place. They emphasize the importance of routinely checking corneal sensation—even with simple tools such as a cotton-tipped applicator—to identify occult nerve damage.

The panel also highlights the complexities of long-term contact lens wearers, stressing the need to rehabilitate the cornea through strategies such as ocular-sparing lubricants or, when necessary, scleral lenses. They describe evolving approaches to assessing corneal nerve function, including multi-point sensation testing to avoid misdiagnosing neurotrophic disease as severe dry eye.

The experts further discuss managing neuropathic pain, differentiating peripheral from central mechanisms, validating patients’ symptoms, and using imaging technologies to enhance education and track progress. They emphasize that effective care relies more on clinical skill and thoughtful examination than on expensive equipment.