Page 82 - August 2015 Life In Naples Magazine
P. 82
DRY EYE
DISEASE
Dby Allister Gibbons, MD increase patient comfort.
ry eye disease can be a very challenging and confusing Many patients will agree that these treatments, in the initial
diagnosis not only for patients; but also one that can be
challenging to make and treat. Often enough it can be phases of their disease brought them comfort. But over time
managed with over-the-counter medications and the their symptoms might increase so they can no longer keep their
patient’s life can go on as usual. But what happens when this same eyes open long enough to watch television, read or drive, which
patient arrives at our clinic after having previously tried multiple is quite debilitating, especially in an otherwise healthy and self-
therapies and seen multiple colleagues? They usually bring extensive dependent person.
printed medical records, a bag (or two) of ophthalmic drops, all
So, where do we go from here? Possible step-up treatments,
of which have failed include the use of blood derived products and surface protection
to bring comfort and with contact lenses. Scleral lenses offer a great alternative to
peace to our patient. treatment, acting as a “wind shield” over the surface of the eye
Accompanying this while maintaining the cornea moist in a pool of saline solution.
we can also find Older patients tend to express their concern about fitting these
frustration, anxiety, special lenses, which are a slightly larger version of regular contact
and sometimes a loss lenses, but with adequate training, especially if the patient has
of faith in traditional previous experience with contact lenses, this is something that can
medicine. be consistently achieved.
Usually, we address Blood derived products also offer an excellent treatment option
dry eye disease as we for patients, their serum, diluted from 20-50 percent can be used
would approach any chronic malady: a step-wise approach. We as any other ophthalmic drop, though it need refrigeration. Its
start with the simplest and safest forms of treatment, escalating special composition, including growth factors, antibodies and
in complexity and cost until the patient’s symptoms have abated other proteins certainly offer something that regular artificial tears
to a point they’re comfortable and able to go on with their normal cannot match.
lives. First line treatments include over the counter artificial tears
and eyelid hygiene. All this is subject to heated debate, and the When dry eye disease becomes resistant to treatment, usually
specific role or order in which something is tried will depend on this means a more severe form of disease exists, or that even
the severity of presentation, patient preference, and the specific though all symptoms point to dry eye it may be different disease
cause of the dry eye. altogether. More severe form of dry eye disease can sometimes
On our second step, we find multiple treatment modalities, be attributed to systemic diseases like Sjögren’s syndrome that
both medical and surgical. Adding anti-inflammatory drops such also causes dry mouth and other systemic findings; this can also
as steroids or cyclosporine, addressing the inflammation that be found frequently coexisting with rheumatoid arthritis. This
usually accompanies dry eyes can help alter the disease process. requires working in conjunction with a rheumatologist and starting
Other interventions include lacrimal punctum occlusion (either systemic therapy.
permanently or with removable plugs), thereby increasing the In complex dry eye cases one must always balance the needs and
retention of tears on the ocular surface. Also the prescription realities of the patient versus our own expectations of a pristine
of slow-release lubricants that are placed behind the eyelid or ocular surface. Sometimes taking on additional therapies after the
systemic medication that can augment tear production can patient is subjectively comfortable will only reduce the compliance
and quality of life of the patient.
82 Life in Naples | August • September • October 2015
