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Dry eye comes in a variety of guises and, once diagnosed, may require various therapeutic options.
Individualized treatment is paramount for Dr. Schechter, director of cornea and external disease, Florida Eye Microsurgical Institute, Boynton Beach, FL.
"Based on the information from the OSDI, I gain an idea of the severity of the dry eye symptoms and can tailor treatment," he explained.
Patients who have mild dry eye usually begin treatment with instillation of preservative-free tears titrating up to three to four times daily. Dr. Schechter asks patients to report their progress and has them schedule their next appointment according to their response and needs.
He primarily relies on two easy-to-administer tests to measure the degree of dry eye. He first stains the ocular surface with lissamine green to determine the level of dry eye pathology. At times, corneal pathology might be minimal with more extensive findings on the conjunctiva, he noted.
The other important parameter to measure is the tear film break-up time (TFBUT) to get a sense of the health of the tear film. Dr. Schechter also asks patients to report the intensity of their dry eye symptoms using a scale of 0 to 4.
If artificial tears are insufficient, he considers inserting a collagen intracanalicular punctal plug (UltraPlug Extended Wear Synthetic Absorbable Punctal Plugs, Angiotech) that typically lasts 4 to 6 months. Use of this plug in younger patients with aqueous deficiency increases comfort and often allows the resumption of contact lens use.
"This plug provides the best value for patients if there is minimal ocular surface inflammation with no major associated complications," he said.
He prefers not to use permanent intracanalicular punctal plugs because of the possibility of canaliculitis, which often requires surgical intervention. In addition, semi-permanent soft plugs with "caps" cannot be used in all patients because of the possibility of the cap rubbing against the conjunctival surface based on the anatomy of the eyelid.