Ocular surface disease and current treatments.

1. Ocular Surface
Disease
ETIOLOGY AND MANAGEMENT DR. DWIGHT THIBODEAUX

2. OSD/Dry eye
 25 million in US
 Most common eye disease seen
 $3.8 billion spent yearly
 Ocular discomfort and vision problems
 CL intolerance
 New diagnostic techniques and treatment
options

3. Main Causes
Age > 50
Climate
Genetics, gender
Work environment
Smartphone use
Medications, systemic disease
LASIK

4. 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

5. Diagnosis - established techniques
 Symptoms vs. signs – not always consistent
 Questionnaire, medical and rx hx.
 Lacrimal river, lid margins, digital exp.
 NaFl, Lissamine Green
 Conjunctival chalasis, floppy eyelids test
 Pingueculum and pterigium formation
 Shirmer’s tests - phenol red thread test
 Apposition of lids, blink freq. and quality

6. 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

7. Diagnosis – common but effective
 Questionnaire
 Dyes and stains
 Meibomian gland expression

8. Treatment – historical, generic
 Lubrication - gtts and hs ung
 Steroids/Restasis/doxy
 Punctal Plugs
 Surgical canalicular closure
 Removal of offending agent/preservatives
 Antihistamines
 Moisture chambers, humidifiers

9. Current OSD management varies
based on type of dry eye
 Dx: lipid vs aqueous deficiency
 85% is MGD – lipid deficiency, Demodex
 Most 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

10. 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

11. 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

12. 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

13. 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