Dry eye: steps to success

Allan Slomovic, University of Toronto, Canada, speaking at a continuing education symposium on dry eye diagnosis and management, outlined a five-step diagnostic algorithm for dry eye.

The first step is to obtain a history of dry eye symptoms, including both ocular and medical histories. Next, determine tear break-up time, values below 10 seconds are suspect and values below one second are abnormal. The third step is to conduct the Schirmer's test, preferably without anaesthesia. In the fourth step, the clinician performs diagnostic eye staining with fluorescein, lissamine green, or rose bengal. Fifth, test for serum antibodies, which is particularly helpful if Sjogrens Syndrome aqueous tear deficiency dry eye (ATD) is suspected. The last step is meibomian gland evaluation.

"With this algorithm, you can reliably diagnose a dry eye and determine if it is caused by ATD or evaporative dry eye tear deficiency (ETD) or both," Dr Slomovic said. The algorithm results also help the clinician evaluate severity, which in turn drives the choice of treatment.

Among the dry eye treatment options, lubricants are the first choice, said Alejandro Aguilar, MD, director of the ocular surface department, Grupo Medico Las Lomas in Martinez, Argentina, and associate professor of ophthalmology, Universidad del Salvador, Buenos Aires. Lubricants provide a protective epithelial shield, integrate with the tear film, are long-lasting and comfortable, facilitate restoration and cellular replacement, maintain ocular surface health and prevent future damage, Dr Aguilar said.

Maurizio Rolando, MD, associate professor in the department of neurosciences, ophthalmology, and genetics at the University of Genoa, Italy, advises clinicians to be dynamic, adjusting patients' therapy to changing conditions and to teach preventive measures such as increasing humidity in the home and wearing protective glasses.