An expert underscores the importance of a comprehensive dry eye examination and offers insights on distinguishing it from neurotrophic keratitis.
Sheri Rowen, MD, FACS: The reason I brought this case forward was that it was such a young patient. It was a male patient. He was a contact lens wearer. We know that that gives us dry eye and dry eye risks. Again, as in the first case, there’ll be a multifactorial issue here with why someone might have dry eye, and we should be thinking about their evaporation. We should be thinking about the aqueous formations. So there you have potentially the immunomodulators, the cyclosporines, and the lifitegrast. You can use the varenicline…for the nasal spray. If you want to increase tear production, you can use Meibo for evaporation, you can use nerve growth factors for patients. And I think if you consider all of this, optimize your ocular surfaces before you do surgery, make sure that you’ve tested, you’ve looked at their fluorescein staining. That is the critical thing that a lot of people don’t do. Just take a fluorescein strip, put it in a drop a BSS [intraocular irrigating solution], and look at that cornea. Look at your breakup time, look for epithelial-based membrane dystrophies, look for staining patterns. Just get a feel of what that surface looks like. If you see more going to lissamine staining—I do lissamine staining on all of my patients. I want to see sometimes the cornea, the conjunctiva stains and the little margin stains, and if the cornea hasn’t stained with fluorescein, I’ll pick up some of these [patients with] dry eye I might have missed. So, a questionnaire, fluorescein stain, lissamine stain, an expression of the meibum will give you a beautiful way if you have nothing else, no other technology in your practices to diagnose dry eye. You will not miss most of your [patients with] dry eye with these 4 things I’ve just mentioned, and I just wanted to bring it in so you can understand all aspects of dry eye in 2 easy cases to think about. Thank you very much.
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