Dry eye treatment should be tailored to patient

February 15, 2009
Carol Patton

Dry eye is a chronic disease that requires adjustments to treatment, follow-up, re-testing, monitoring of progress, and changes of medication. Treatment should be tailored for each patient.

Key Points

Lexington, KY-One of the most common eye conditions also is among the most frequently ignored or overlooked: dry eye syndrome. According to some studies, keratoconjunctivitis sicca has been diagnosed in 14% of patients aged more than 40 years. Other research has found that as many as 80% of Americans experience symptoms related to dry eye. Many people do not do anything to address the symptoms, however, beyond using the least-expensive over-the-counter eye drops they can find on the shelves of a pharmacy.

Managing eyes that sometimes are irritated, red, burning, stinging, itching, dry, blurred, or overly sensitive to light requires consistent treatment, however, said Paul Karpecki, OD, Koffler Vision Group, Lexington, KY. Some physicians compare managing dry eye syndrome with managing other chronic conditions such as lipid disorder or hypertension, he said, in that it is not a condition that can be addressed in one visit. Treating dry eye usually involves a regimented approach that is tailored for each patient, he added.

"This is one of the most common pathologies that we deal with," Dr. Karpecki said. "We really try to diagnose dry eye in the early stages, but our treatment options are based on how severe it is, how long patients have had dry eye, and their symptoms."

Patient adherence to therapy can be complicated, he said, because some myths still surround the condition. Among the biggest myths, Dr. Karpecki said, is that physicians can properly diagnose the syndrome in its early stages, which is not exactly true because good diagnostic tests are not available. Although physicians can make educated guesses, Dr. Karpecki said, tests are not available to confirm the condition in all cases. Also, if a patient develops a severe case of dry eye, he said, it may be asymptomatic or neurotrophic, so a symptom test may not reveal advanced dry eye.

The opposite also is true, Dr. Karpecki said-some patients' eyes can become hypersensitive at certain stages of the disease, so test results may indicate that the condition is more advanced than it is.

"The symptoms don't always correlate with the stages of disease," he said. "The brain has a way of turning the nerves off. Also, since this is a progressive disease, when it finally does start to show signs, patients are obviously a lot further along."

Another myth, Dr. Karpecki said, is that artificial tears will cure dry eye. In reality, the drops are palliative and play an important role but will not stop the disease from progressing if it is in the advanced stages, he said.

As with most diseases, however, the earlier the diagnosis is made, the earlier the treatment can begin, and the higher the success rate will be, Dr. Karpecki said.

Treatment options

So how can physicians help patients who have dry eye syndrome? Dr. Karpecki said that he rarely treats anyone using just artificial tears because they don't address the crux of the disease.

"We really have differentiated how we start treating patients depending upon what they present with," he said. "We are also starting to differentiate between types of drops or artificial tears. We never did this before."

Dr. Karpecki said that the approaches he uses may include corticosteroids, cyclosporine (Restasis, Allergan), and, rarely, for patients who have more advanced disease, autologous serum or other compounded medications. Other times, he said, he inserts silicone plugs or implants extended collagen plugs for 6 months.

When it comes to suggesting artificial tears as part of the treatment regimen, one line (Refresh, Allergan) ranks at the top of his list, he said. What makes these drops so effective, Dr. Karpecki added, is that they're comfortable in the eye and have a good retention time. The basic ingredient, carboxymethylcellulose (CMC), assimilates the tear film to a high degree and has been tested in numerous patients for years, he said.

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