Understanding meibomian gland dysfunction, neuropathic pain, and the evolving dry eye patient

The evolving dry eye patient

In recognition of Dry Eye Awareness Month, Ping Moore, OD, assistant professor of ophthalmology at the Emory Eye Center in Atlanta, Georgia, discussed the changing profile of dry eye patients, the growing role of meibomian gland dysfunction (MGD) in clinical practice, and how emerging therapies are reshaping management. Moore noted that her exposure to dry eye-related complaints dates to the late 1990s, when patients presenting with ocular discomfort, burning, and difficulty sustaining screen use were often diagnosed with computer vision syndrome rather than dry eye. She attributed the shift in understanding to research demonstrating that blink rate is significantly reduced during screen use, and observed that as digital device use has expanded to younger populations—including school-age children using Chromebooks—the prevalence of dry eye in clinical practice has increased substantially over her nearly 20 years in the field.

Workup and MGD evaluation

Moore described her dry eye workup as beginning with a thorough case history, noting that patients do not always self-identify as having dry eye. Key questions include when symptoms occur, what the patient is doing at the time, and what treatments have already been tried, including over-the-counter drops, warm compresses, or systemic medications that may themselves contribute to dryness. At the slit lamp, Moore evaluates the eyelid margin before the ocular surface, specifically assessing for collarettes, mucus deposits, lid thickening, inflammation, and capped glands. She noted that this assessment takes only seconds but yields critical diagnostic information. Regarding MGD, Moore emphasized that gland expression—evaluating the quality and quantity of oil expressed with lid pressure—is central to understanding the stage of dysfunction, from early capped glands amenable to warm compresses to more advanced atrophy or inflammation requiring targeted intervention. Moore stressed the importance of identifying MGD before symptoms develop, allowing for early hygiene-based management.

Treatment approach and emerging therapies

Moore described treatment selection as etiology-driven, citing the TFOS DEWS III report as a comprehensive and well-regarded framework for categorizing dry eye subtypes and guiding management. She identified cyclosporine ophthalmic formulations as among the most impactful therapies for chronic inflammatory dry eye, noting that newer, higher-concentration products have demonstrated a favorable safety profile. For patients with neuropathic pain, Moore noted that clinical signs may be absent even when significant symptoms persist, and that this patient population is among the most challenging to manage. Treatment options discussed for this subset include bandage contact lenses, scleral lenses, low-dose steroids, and cyclosporine.

Interprofessional collaboration

Moore described the collaborative model at the Emory Eye Center as central to comprehensive dry eye care. She noted that her MD colleagues, who are primarily surgeons, often refer patients for dry eye management due to time constraints, and that post-surgical dry eye—following cataract surgery or LASIK—represents a significant portion of her patient panel. She also highlighted the value of co-management with oculoplastic surgeons for patients with Graves' disease, entropion, or ectropion, in whom structural eyelid abnormalities are the primary driver of chronic dry eye.