It is important to proactively consider night-time dryness as its own separate entity. An effective lid hygiene regime will minimise the risk of build-up of deposits on compromised lid margins and thus optimise long term success and tolerance in these patients.
By Mr Saj H. Khan
The awareness of the high incidence, impact on daily life and challenges of treating dry eye disease (DED) has increased exponentially over the past 2-3 decades. Significant progress towards achieving consistency in understanding the fundamental causes of the condition, the systematic strategies used for diagnosis and stepwise treatment approaches have undoubtedly come from the two landmark Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop – DEWS I and II – reports.1,2
However, with such strength of guidance, it is also easier for some practitioners to fall into a generic blanket approach. This can result in patients’ history being taken in a less focused manner, and the more subtle clinical findings receiving too little attention.
Due to the robustness of the fundamental recommended treatment steps, the majority of patients are still likely to experience significant benefit, often accepting the improved but residual symptoms as inevitable. However, this is not the same as providing the most comprehensive and appropriate care.
A proportion of DED patients will experience worsening of symptoms overnight or on waking, even with effective warm compresses, lid massage/cleaning, preservative free lubricants and oral omega-3 supplements. Although this may just be an unavoidable component of their dry eye condition, it is imperative to proactively consider night-time dryness as a separate entity.
Saj H. Khan, M.B.B.S (London), FRCSEd (Ophth)
E: [email protected]
Mr Khan is a consultant ophthalmic surgeon. He consults in Caterham, Croydon, Epsom/Ashtead as well as in Harley Street, London, UK. Mr Khan is a council member of United Kingdom & Ireland Society of Cataract and Refractive Surgeons (UKISCRS) and the British Society of Refractive Surgery (BSRS). He is also a member of European Society of Cataract and Refractive Surgeons (ESCRS).
He has financial interests with Scope and BVI.
3. Sharma S, Kavuru M. Sleep and metabolism: an overview. Int J Endocrinol. 2010;270832. doi:10.1155/2010/270832