Dry Eye Pearls with Dr. Jodi Luchs
Dry Eye Pearls with Dr. Jodi Luchs
In an interview with Dr. William Trattler, Jodi Luchs, M.D. discusses the diagnosis and management of dry eye. A clear tear-film and well hydrated eye are critical for successful outcomes in any kind of refractive or cataract surgery. Assessing signs and symptoms of tear insufficiency, Meibomian gland disease. The biggest challenge is the asymptomatic patient that may still have a tear film instability - by staining pattern, tear break-up time (TBUT), etc. Lid margin assessment: erythema, collarettes in lid margin and lashes, qualitative evaluation of Meibomian gland expression, glandular inflammation. TBUT can be rapid in regular dry-eye and in dry eye with poor tear-film quality. Inflammatory tear film from aqueous insufficiency. However, Meibomian gland disease, oil insufficiency, can still result in rapid TBUT. Dr Luchs then outlines a treatment plan for aqueous insufficiency patients, and Meibomian gland dysfunction patients. Artificial tears work well for most patients but does not treat the underlying pathophysiology. Restasis has worked quite well in the stabilization of inflammatory dry eye, improving aqueous flow and stabilizing the tear film. Topical steroids have a role in inflammatory dry eye; low dose for a few weeks, helps pts tolerate Restasis. Azasite, a topical azithromycin, can stabilize inflammation at the lid margins to improve the secretions of the Meibomian glands. Warm compresses and gentle lid massage is a mainstay treatment as well. There is also a role for combining Restasis and Azasite. Punctal plugs are very necessary as an adjunct to post refractive patients. Often Restasis and/or Azasite treatment may precede using a punctal plug.