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SPECIAL FEATURE: DRY EYE Diagnosing and treating dry eye disease in a specialist setting BY THE DRY EYE & ALLERGY SPECIALISTS AT EYE INSTITUTE* Diagnosis and management of dry eye disease (DED) has improved in recent years because of advances in understanding the underlying causes. Tests and equipment once considered research tools have found their way into specialist dry eye clinics here and overseas. There is no single test that is sufficiently sensitive or specific to diagnose dry eye. An accurate diagnosis of the causes of a particular patient’s DED needs to be derived from investigating several aspects of the health and integrity of the ocular surface. HISTORY AND SYMPTOMS The usual history-taking process includes asking about environmental and occupational factors, as well as noting any allergies or medications that may relate to dry eyes. Normal history-taking can be enhanced by using special questionnaires designed to detect clinically significant DED and to grade the severity of symptoms. Using validated and repeatable questionnaires also helps eliminate variability between visits and examiners. McMonnies is a good screening tool and guide to what questions to ask a patient about their dry eyes. The Ocular Surface Disease Index is suited to monitoring change over time, and SPEED evaluates both the frequency and severity of symptoms in just eight questions. After a careful history check, it is good clinical practice to continue with the least invasive tests first. Assessments of tear quality should be performed before anything is added to the tear film or the tear flow is stimulated by bright lights or eyelid manipulations. It is important to measure each eye separately, as differences between them can help in the diagnosis. Common symptoms of dry eye disease • Dry, gritty, sore eyes • Tired or heavy eyes • Foreign body sensation ‘feels like sand in my eyes’ • Stinging • Burning—often associated with ocular surface or lid margin inflammation • Itching—this is more often associated with allergic eye problems, but due to languages differences a person may use this term for symptoms related to dryness • Smeared or blurry vision that improves with blinking • Light sensitivity, for example sore and watery eyes in bright sunlight • Red eyes • Not able to wear contact lenses as long as in the past • Intermittent paradoxical watering of the eyes (for example, in dry windy conditions)—this is reflex tearing in reponse to an irritated cornea, which can happen if the eyes are dry. This is a more common cause of watery eyes than blocked tear drainage. CLINICAL ASSESSMENT A simple but important part of the examination is to observe the patient’s blinking, noting if it is complete or partial, and the length of time between blinks. This should be assessed before the patient is aware they are being examined to avoid conscious alterations to the blink pattern. Analysis of the tear film lipid layer is based upon the observation of colour interference effects in zones of specular reflection at the air-lipid layer boundary. Thin lipid layers (Eye story). IN SUMMARY Once the clinical information has been gathered in a standardised way, a decision on the optimal treatment plan can follow. This will vary from patient to patient depending on the identified contributing factors and the relative contributions to the dry eye state from aqueous deficiency or excessive evaporation. O * The Eye Institute in Auckland is a provider of eye surgery and ophthalmic care, employing a team of 10 ophthalmologists and 50 dedicated staff. Dry eye research at New Zealand’s Ocular Surface Laboratory CONTINUED FROM P8 Donations welcome for the Ocular Surface Research Fund Running in parallel with the Ocular Surface Laboratory is the Ocular Surface Clinic, where a limited number of patients (distinct from research participants) are reviewed and treated for their ocular surface conditions. The clinic is supported by donations from patients and others to the Ocular Surface Research Fund, managed by the School of Medicine Foundation. All donations go directly towards staffing the research facility and funding activities such as upgrading and purchasing equipment and funding smaller research projects such as those conducted by Honours and summer students. Further information about the Ocular Surface Research Fund and options for donation can be found at www.givingtoauckland.org.nz/osr. O 12 NEW ZEALAND OPTICS September 2015
Get to the main cause of dry, irritated eyes* 4UP TO HOURS RELIEF 2 CLINICALLY PROVEN Optrex ActiMist – clinically proven to work How does Optrex ActiMist work? ActiMist liposomes Natural lipids Optrex ActiMist contains liposomes (tiny bubbles fi lled with moisture) that migrate across the surface of the eyelid and collect at the edges of the eye. These liposomes mix with natural lipids on the eyelid. When the eyes are open the new lipid mixture spreads over the whole tear fi lm, and helps fi ll the gaps to restore the damaged lipid layer. Hygienic. Can be used by multiple people Lasts 6 months after opening Won’t smudge make-up Convenient and portable Suitable for use with contact lenses Order stock for your practice today FREE CALL 0800 EYELOGIC (0800 393 564) www.optrex.co.nz optrex@eyelogic.com.au Always read the label. Use only as directed. If symptoms persist, see your healthcare professional. †When wearing make-up, it is recommended to apply from 20cm. *Due to disturbed lipid layer of the tear fi lm. References: 1. Lee S et al. Klin Monatsbl Augenheilkd 2004; 221:1–12. 2. Khaireddin R, Schmidt KG. Klin Monatsbl Augenheilkd. 2010; 227: 128-134. 3. Pult H et al. Contact Lens Anterior Eye 2012, 35:203-207. September Reckitt Benckiser, 2015 NEW Auckland. ZEALAND TAPS DA1541 OPTICS 13
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