ocular surface disease
TRANSCRIPT
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