Clinical Scorecard: Dry Eye Dx and Tx
At a Glance
| Category | Detail |
|---|---|
| Condition | Dry Eye Disease |
| Key Mechanisms | Evaporation, peripheral exposure, eyelid friction |
| Target Population | Patients with dry eye, particularly those using scleral lenses |
| Care Setting | Optometry and ophthalmology clinics |
Key Highlights
- Scleral lenses (SLs) can improve ocular surface protection but may still cause discomfort.
- Key factors for discomfort include evaporation, eyelid friction, and peripheral exposure.
- Lid wiper epitheliopathy (LWE) is a significant contributor to discomfort in scleral lens wearers.
- Incomplete blinking exacerbates tear film instability and discomfort.
- Optimizing tear film and minimizing friction are essential for comfortable SL wear.
Guideline-Based Recommendations
Diagnosis
- Assess corneal staining and patient-reported symptoms of dryness.
Management
- Consider scleral lenses for dry eye treatment, ensuring optimal fit and lubrication.
Monitoring & Follow-up
- Regularly evaluate tear film stability and lid wiper health in patients using SLs.
Risks
- Potential for conjunctival desiccation and mechanical irritation from lens edge.
Patient & Prescribing Data
Dry eye patients, particularly those with preexisting conditions like conjunctivochalasis.
Addressing lens fit alone may not suffice; focus on tear film optimization and reducing friction.
Clinical Best Practices
- Ensure proper lens fitting and assess eyelid anatomy.
- Educate patients on the importance of adequate lubrication.
- Monitor for signs of lid wiper epitheliopathy and adjust management accordingly.
References
- Andrzejewski T. Scleral Lens Consensus
- Craig JP et al. The TFOS International Workshop on Contact Lens Discomfort
- Yokoi N et al. Clinical impact of conjunctivochalasis on the ocular surface
- Korb DR et al. Lid-wiper epitheliopathy and dry-eye symptoms in contact lens wearers
- Kunnen CME et al. Comparison of subjective grading of lid wiper epitheliopathy
- Yeniad B et al. Lid-Wiper Epitheliopathy in Contact Lens Users and Patients With Dry Eye
- McMonnies CW. Incomplete blinking: exposure keratopathy, lid wiper epitheliopathy
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