The proper management of potential LASIK patients with dry eye requires a clear understanding of their medical history, including previous remedies for dry eye the patients have attempted, says a panel of experts convened by Ocular Surgery News (OSN).
The panel of prominent ophthalmologists and LASIK surgeons was instructed to consider how they would counsel and manage the following patient: a 58-year-old woman visiting their office for a fourth opinion on how to relieve her dry eye symptoms.
- She complains of a foreign body sensation and tearing when reading.
- She has tried three different brands of artificial tears recommended by three different eye doctors, but has found no relief from any of them.
- She has no contributory medical history and reports that her eyes feel worse in the evening.
The panel members offered these comments and recommendations:
- As a general rule, when eye discomfort symptoms are worse in the evening, the problem is usually dry eyes. When symptoms are worse in the morning, the problem may be lid disease, such as blepharitis or Meibomitis.
- Many things must be examined and considered to accurately assess the severity of dry eye—including lid position, blink rate, tear quantity and quality, and corneal sensation.
- A new generation of artificial tear products have an "anti-evaporative" effect that may be more effective than other artificial tears and should be considered in the treatment of dry eye. These products include: Soothe (Bausch & Lomb), Refresh Endura (Allergan), and Systane (Alcon).
- In addition to artificial tears, a prescription topical steroid such as Alrex or Lotemax (Bausch & Lomb) is also helpful initially to reduce redness caused by dry eye.
- Though corticosteroid eye drops will make the patient feel better quickly because it treats both dry eye disease and lid disease, steroid treatment can create problems long-term. As an alternative, the prescription eye drop Restasis (Allergan) has been shown to increase tear flow and reduce meibomian gland disease without the problems steroids can cause long-term.
- It's important for dry eye patients to know that it usually takes 4 to 6 weeks before they will see significant benefit from Restasis therapy, and 3 months before they will really know how effective Restasis will be for them.
- Mild to moderate cases of dry eye respond well to Restasis. Many mild dry eye patients who are experiencing contact lens discomfort can get back to wearing their contact lenses comfortably after Restasis therapy.
- Some patients who start Restasis therapy will experience a burning sensation on their eyes from the drop in the first month of treatment, but this tends to go away within 6 months of treatment.
- Short-term use of corticosteroid eye drops may help reduce the initial stinging from the Restasis drops.
- Keeping the Restasis drops chilled in the refrigerator will reduce the potential for stinging. It also helps to use an artificial tear about five minutes before Restasis.
- Depending on the patient, Restasis drops may sting for 5 to 10 minutes, but the stinging usually stops within 3 to 4 weeks of use.
LSN Editor's Note: For a good LASIK outcome, it's essential that you to have adequate tears and no dry eye problems prior to surgery. If you have mild or moderate dry eye, your eye doctor may prescribe Restasis or recommend some other dry eye treatment prior to your LASIK surgery.
SOURCE: Panel: Understanding patient symptoms, history critical for dry eye management. Ocular Surgery News 2007; Vol 25, No 6. pp.1,49-50
