Diagnosing Dry Eye

Dry eye continues to present a challenge to refractive surgeons. Although many patients with dry eye should be excluded from corneal refractive surgery, “many dry eye patients can be good candidates for surgery” as long as they are appropriately screened, said Michael B. Raizman, MD, during his talk at Refractive Surgery Subspecialty Day on Friday.

While a number of new diagnostic tests have been introduced, Dr. Raizman said, “Unfortunately, none of them can stand alone as an indicator of candidacy. There is no single test—or even pair of tests—that is appropriate.” Even so, some tests can be used to exclude patients, he said.

In terms of clinical signs, Dr. Raizman said that he relies primarily on the results of conjunctival and corneal staining and on his evaluation of the tear meniscus at the slit lamp. Other tests—such as tear osmolarity, OCT of the tear film and tear meniscus, tear film reflectivity and regularity—can be used to corroborate those initial findings.

But, even more important, he noted that he relies on the medical history. “Ask, ‘How often do you use artificial tears? Are your eyes dry when you don’t wear contact lenses?’” Questions such as these will weed out potentially problematic cases, he said.

Before proceeding with surgery, “You want no symptoms of dry eye, minimal use of artificial tears, and no staining,” Dr. Raizman said. The bottom line: “When in doubt, don’t treat. Instead, consider a nonablative refractive procedure.”—Jean Shaw

Financial disclosures. Dr. Raizman—Alcon Laboratories: C; Allergan: C; Avedro: C,O; Bausch + Lomb: C; Beaver Visitec International: C; Boston Eye Surgery and Laser Center: O; Eleven: C; EyeGate Pharmaceuticals: C,O,S; Ocular Therapeutics: C,O; Omeros: C,O; Ophthalmic Consultants-Boston: O; Seattle Genetics: C; Shire: C; Stealth Bio: C; TearLab: C.

Disclosure key. C = Consultant/Advisor; E = Employee; L = Speakers bureau; O = Equity owner; P = Patents/Royalty; S = Grant support.