Ocular Surface Disease ETIOLOGY AND MANAGEMENT DR. DWIGHT THIBODEAUX

OSD/Dry eye

25 million in USMost common eye disease seen$3.8 billion spent yearly Ocular discomfort and vision problemsCL intoleranceNew diagnostic techniques and

treatment options

Main Causes

Age > 50ClimateGenetics, genderWork environmentSmartphone useMedications, systemic diseaseLASIK

Secondary OSD

Sjogren’s syndrome RA, Lupus, etc. Reactive arthritis (triad of classic signs) Thyroid dysfunction Diabetes Rosacea Obstructive sleep apnea Oxygen use for pulmonary dysfunction Meds, CL wear, Lasik, fatigue, insomnia

Diagnosis - established techniques

Symptoms vs. signs – not always consistentQuestionnaire, medical and rx hx.Lacrimal river, lid margins, digital exp.NaFl, Lissamine GreenConjunctival chalasis, floppy eyelids testPingueculum and pterigium formationShirmer’s tests - phenol red thread testApposition of lids, blink freq. and quality

Diagnosis – new options

MG expression -Tearscience MGE MMP levels - Inflammadry Osmolarity - TearLab Meibography - Tearscience Lipoview, Oculus Interferometry – Oculus Keratograph, Lipoview Immunoassay (lactoferrin) – TearScan Sjogrens - Sjo

Diagnosis – common but effective

Questionnaire

Dyes and stains

Meibomian gland expression

Treatment – historical, generic

Lubrication - gtts and hs ungSteroids/Restasis/doxyPunctal PlugsSurgical canalicular closureRemoval of offending agent/preservativesAntihistaminesMoisture chambers, humidifiers

Current OSD management varies based on type of dry eye

Dx: lipid vs aqueous deficiency85% is MGD – lipid deficiency, DemodexMost aqueous deficiency is found in

females, immune disorders or with the use of opiods, Accutane, diuretics, beta blockers, anti-depressives, anti-anxiety meds and antihistamines

Aqueous deficiency treatments

Steroids followed by Restasis Lubrication – viscous Blink training Plugs, canalicular closure Moisture chamber glasses Workplace changes Scleral lenses Autogolous serum drops, Prokera

MGD/evaporative dry eye therapy

Lid/gland heat, MG expression, hygiene PF oil based lubricants, Omega 3 FA Blink training Z pack po +/-Azasite or Tobradex gtts Avenova and/or Cliradex Moisture chamber glasses and workplace

changes Plugs, Restasis, Maskin procedure

Meibomian Gland Dysfunction

LIPOFLOW - $1300 to $2000

MiBO - $500, three treatments over 6-8 wks

IPL – Intense Pulsed Light

Home therapy – Bruder hot mask/ massage/ hygiene

Keys to success in a dry eye practice

Manage expectations/patient education Long term therapy for a chronic progressive

disease Minimize worsening, maximize comfort and

vision Start with least expensive therapy not already

tried Give patients hope and options for advanced

care if needed