iOpeners with Nicole Bajic, MD: Nikolina Budimlija, MD, on building a multidisciplinary dry eye clinic in Ireland

In this episode of iOpeners from Ophthalmology Times, host Nicole Bajic, MD, comprehensive ophthalmologist at the Cole Eye Institute, Cleveland Clinic, sits down with Nikolina Budimlija, MD, consultant oculoplastic surgeon and ocular surface specialist at the Institute of Eye Surgery, Ireland, at CroOphthaCon Solin 2026, the Croatian Ophthalmology Congress held June 4–7 in Solin, Croatia. Budimlija shares how she built an ocular surface clinic addressing complex dry eye and the multidisciplinary framework she advocates for managing it.

An oculoplastic surgeon’s path to dry eye care

Budimlija's focus on dry eye grew out of a gap in care she observed in Ireland, where patients with complex ocular surface disease were routinely underserved. "You would have anterior segment surgeons, corneal surgeons, cataract surgeons, but nobody wants to deal with the dry eye," she explained. Patients were often dismissed with advice to use lubricating drops and little else, leaving those with more complex presentations without appropriate management.

That unmet need prompted her to ask deeper questions about why patients were suffering, why diagnoses were not being established accurately, and how care could be improved. The result was the development of an ocular surface clinic now operating for nearly 8 years, focused not only on dry eye but on the full spectrum of complex ocular surface conditions.

Dry eye as a systemic condition

Central to Budimlija's approach is the recognition that dry eye frequently reflects underlying systemic disease. In her practice, she has seen a growing number of patients in Ireland presenting with ocular surface symptoms linked to autoimmune conditions such as Sjögren syndrome and rheumatoid arthritis, as well as hormonal changes in menopausal women. "We always like to say dry eyes, not only the dry eye," she noted, emphasizing that surface symptoms are often a manifestation of broader systemic factors.

Her response has been to build what she describes as a holistic framework, integrating input from dermatology, rheumatology, and specialists in hormonal health. The goal is to establish accurate diagnoses early and deliver treatment tailored to each patient's systemic profile, rather than addressing ocular surface findings in isolation.

Community optometry as a referral foundation

In Ireland, community optometrists serve as the primary point of contact for patients with visual complaints, but are not authorized to prescribe medications. This positions them as a critical referral source for more complex cases. Budimlija noted strong support from community optometrists, who channel patients with complicated dry eye presentations to her clinic—a pipeline that underpins the model's reach and sustainability.

Bajic observed that this multidisciplinary orientation differs meaningfully from how dry eye is typically managed in the US, where the cross-specialty collaboration Budimlija describes remains less common.

Looking ahead: Research and a new society

Budimlija is currently involved in a large ongoing clinical study in dry eye and expects it to generate new insights and broaden treatment options available in Europe, where the therapeutic landscape lags behind what is available in the US.

She is also active in dry eye advocacy at the society level, serving on the board of the European Dry Eye Society and helping to establish the Dry Eye Society of the Americas (DESA). DESA's inaugural conference is scheduled for July 10-11 in New York City, bringing together experts from around the world to exchange research and clinical experience.