Eyeworld Supplements

MAY 2019 | SUPPLEMENT TO EYEWORLD | 5 Figure 2. Five out of six ocular surface disease experts think that more than 75% of their dry eye patients experience dry eye flares. Tear osmolarity values might then demonstrate dysfunction of the osmolarity itself, thus an imbalance of the tear film," she said. Dr. Yeu pointed out that when examining a dry eye patient, she is looking for any source that could lead to an acute onset of symptom- atology. "Acute worsening of symptoms may occur from an actual breakdown of the oc- ular surface epithelium, such as an abrasion or a keratitis, thus the clinical correlation is essential. In the setting of subtle slit lamp differences in an established patient, overall symptom exacerbation may serve as the key difference in our diagnosis of that flare," she said. Preeya Gupta, MD, point- ed out that it is particularly important to ask about symp- toms when treating chronic dry eye patients who have been on an anti-inflamma- tory long term. "Sometimes we forget to listen to those patients. They have had dry eye for many years, so we ex- pect them to have symptoms. However, there are opportu- nities to make those patients who are on maintenance ther- apy happier and less symp- tomatic during those acute flares," she said. "When I talk to my patients about dry eye disease, I think it is important to make sure they understand that there is a chronic compo- nent and there is an episodic component, and as clinicians we need to listen not just for that chronic component, but also for that episodic com- ponent and intervene during those times." Ask about flares Even more to the point, Terry Kim, MD, recommends ask- ing specifically about flares. "I think we need to proactively ask them if they experience flares because a lot of these patients do not come to the office when they have a flare. In the case of a chronic dry eye, when the patient comes in for follow-up we should ask if they have had a flare in the past 1 to 3 months depending on the last time they were seen. Given that these flares occur 4 to 6 times a year, odds are that they experienced one since their last visit. This is among the reasons that I support adding a question about flares to whatever dry eye screening questionnaire is used in one's practice," he said. A thorough exam Eric Donnenfeld, MD, em- phasized the importance of a thorough eye exam. "There are many diagnoses that can mimic dry eye, such as entro- pion, ectropion, floppy eyelid syndrome, lid imbrication syndrome, and conjunctival chalasis. Interestingly those diseases very rarely have flares associated with them. Flares associated with dry eye are much more episodic and much more symptomatic, whereas these other diseases tend to be steadier. In many ways, dry eye flares are easier to diagnose than regular dry eye because the symptoms are so well defined." Dr. Holland described diagnosing a flare through discussion as follows: "If a baseline exam of a patient who has been on maintenance therapy shows conjunctival injection and minimal inferior staining, and they come in to see me and we don't see a change in their exam but they have a change in their symp- toms, that is by definition a dry eye flare. We have to listen to the patient, and you should adjust the treatment." n Five out of six ocular surface disease experts think that more than 75% of their dry eye patients experience dry eye flares. In your clinic, what percentage of your dry eye patients experience dry eye flares on a yearly basis? More than 75% 83% 17% 0% 50–75% Less than 50% Following their discussion, the physicians completed a survey on ocular surface disease. Their answers to the survey questions are located throughout this supplement.

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