Louisville, KY—Recent advances in dry eye therapy based on improved understanding of disease pathophysiology are having a positive impact for successful contact lens wear, said Gary N. Foulks, MD, FACS.
Dr. Foulks, Keeney Professor of Ophthalmology, University of Louisville, KY, spoke on dry eye treatment during a symposium that was a combined meeting of the American Academy of Ophthalmology and the Contact Lens Association of Ophthalmologists. He told attendees that tear supplementation with artificial lubricants and use of devices to improve tear retention were the mainstays of management before 1970, based on the general conception that dry eye was a condition of insufficient tears. In recent years, however, treatment has evolved significantly beyond those approaches.
Management of meibomian gland dysfunction depends primarily on physical measures, including application of hot compresses, followed by stretching the lid taut, and applying pressure to the lid with the palmar surface of the finger in a lateral motion.
Tear supplementation is also a useful and effective option for helping patients continue contact lens wear. A variety of formulations exist, including polymeric preparations for lubrication, hypotonic products to decrease tear hypertonicity, the guar base agent (Systane, Alcon Laboratories) that helps coat and protect the ocular surface, and lipid emulsion products designed to mimic the lipid protection of the tear film and reduce evaporation (Refresh Endura, Allergan; Soothe, Alimera Sciences).
"These latter preparations are particularly helpful in patients who have tear instability due to meibomian gland dysfunction, in order to provide comfort until the underlying problem is controlled," Dr. Foulks noted.