Scattered routines have ocular surface consequences

Increased time on digital devices and erratic schedules have disrupted patients’ management of their MGD and dry eye disease.

Special to Ophthalmology Times®

The COVID-19 pandemic has wreaked havoc on many measures of health care, including such unexpected areas as “quarantine dry eye.”

As I previously discussed, mask wearing tends to increase airflow over the ocular surface, worsening dry eye symptoms.

Additionally, people of all ages have spent dramatically more time on digital devices because Zoom calls replaced in-person gatherings and courses moved online.

One recent report found that 93.6% of respondents have increased their screen time during the pandemic, spending nearly 5 more hours per day on devices.

Related: Mask up ... and dry out?

Not surprisingly, large numbers of people said their sleep has been affected (62.4%) and that digital device-related symptoms (eye dryness, watering, headache, etc.) have worsened (56.5%) because of the increased screen time.1

On top of this, more erratic schedules have caused previously well-established routines to be thrown out the window.

People who kept their vitamins and supplements in a drawer at the office have forgotten to take them at home. Women who had a lid hygiene regimen after removing makeup in the evening stopped putting on their makeup and left the lid hygiene by the wayside, too. Working parents with young kids are under enormous stress.

I have a patient who found that he could no longer comply with his normal regimen for managing meibomian gland disease (MGD) and dry eye.

His wife is a physician and doesn’t have the flexibility to work from home. When schools closed, my patient became chef, teacher, and tutor for their three young daughters, while trying to maintain a normal workload for his own high-pressure job in finance.

Related: Caring for dry eye patients through the coronavirus pandemic


After spending most evenings staring at spreadsheets, he said he just didn’t have the time or energy to use his heated Bruder eye mask or consistently use his immunomodulator drops twice daily as prescribed.

For this patient, I recommended a thermal pulsation treatment (LipiFlow, Johnson & Johnson). A single in-office treatment should provide a lasting effect for 1 year or more.

We have felt comfortable performing these in my office throughout the pandemic because the procedure requires only brief close contact between doctor and patient.

Once the activators are inserted, the technician can keep 6 feet from the patient during the 12-minute procedure.

In an ideal world, I prefer to treat multifactorial conditions like MGD and dry eye with a layered approach: LipiFlow and immunomodulators and at-home therapies like the heated mask, lid scrubs, and omega-3 fatty acid supplements.

Related: The MGD patient journey: diagnosis + initial treatment

However, if patients cannot or will not comply with all these measures, I feel better knowing that at least their glands have been evacuated and they have a chance of improving their symptoms and tear film quality.

As more people get vaccinated and return to school and offices, some of their routines will gradually be reinstated and compliance will hopefully improve again.

But it’s always worth remembering the advantage of one-time procedures—such as thermal pulsation for our patients with MGD, or even selective laser trabeculoplasty (SLT) or minimally invasive glaucoma surgery (MIGS) for our patients with glaucoma—in relieving the burden of daily compliance.

This pandemic is just one of many situations that can overwhelm patients and deter them from perfect compliance.

Read more by Dr. Matossian

Reference
  1. Bahkir FA, Grandee SS. Impact of the COVID-19 lockdown on digital device-related ocular health. Ind J Ophthalmol. 2020;68(11):2378-83.