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Dry-eye management
Ross Henderson PhD DipTP (IP) MC Optom and Louise Madden PhD BSc(Hons)
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1
WJ Henderson Optometrist, Perth
2
Glasgow Caledonian University, Glasgow
EV-16423 C-34297
1 CET point for UK optometrists
Date of acceptance: 10 October 2013. Address for correspondence: R Henderson, WJ Henderson Optometrist, 59 South Methven Street, Perth PH1 5NX, UK.
Email address: rossathome@btinternet.com.
2013 The College of Optometrists 137
R Henderson and L Madden
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The questionnaire is available from http://www.dryeyezone.com/encyclopedia/osdi.html
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Dry-eye management
As this article was going to print, the Tear Film and Ocular Surface
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Table 3. Five most common NHS prescriptions dispensed (prescription cost analysis) for tear supplements (including
preservative and preservative-free formulations)
England 2012 items dispensed Scotland 20122013 items dispensed Wales 2012 items dispensed
Hypromellose 2 332 618 Carbomer 278 194 Carbomer 200 668
Carbomer 1 900 913 Hypromellose 239 990 Hypromellose 185 651
Liquid paraffin 805 216 Liquid paraffin 117 227 Liquid paraffin 75 751
Carmellose sodium 622 124 Polyvinyl alcohol 52 871 Carmellose sodium 43 558
Polyvinyl alcohol 458 816 Carmellose sodium 39 007 Polyvinyl alcohol 23 941
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Lee SY, Tong L (2012) Lipid-containing lubricants for dry eye: Pan Q, Angelina A, Zambrano A et al. (2013) Autologous serum
a systematic review. Optom Vis Sci 89, 165461 eye drops for dry eye. Cochrane Database Syst Rev 8, CD009327
Lee SY, Petznick A, Tong L (2012) Associations of systemic Pflugfelder SC, Baudouin C (2011) Challenges in the clinical
diseases, smoking and contact lens wear with severity of dry eye. measurement of ocular surface disease in glaucoma patients.
Ophthal Physiol Opt 32, 51826 Clin Ophthalmol 5, 157583
Lemp MA, Crews LA, Bron AJ et al. (2012) Distribution of Pult H, Murphy PJ, Purslow C (2009) A novel method to predict
aqueous-deficient and evaporative dry eye in a clinic-based the dry eye symptoms in new contact lens wearers. Optom Vis Sci
patient cohort: a retrospective study. Cornea 31, 4728 86, E104250
Li M, Gong L, Chapin WJ et al. (2012) Assessment of Purslow C (2010) The ocular surface in contact lens wear. Optom
vision-related quality of life in dry eye patients. Invest Today 26 March
Ophthalmol Vis Sci 53, 57227
Ridder WH 3rd, Tomlinson A, Huang JF et al. (2011) Impaired
Macsai MS (2008) The role of omega-3 dietary supplementation visual performance in patients with dry eye. Ocul Surf 9, 4255
in blepharitis and meibomian gland dysfunction (an AOS thesis).
Rohit A, Willcox M, Stapleton F (2013) Tear lipid layer and
Trans Am Ophthalmol Soc 106, 3366
contact lens comfort: a review. Eye Contact Lens 39, 24753
Madden RK, Paugh JR, Wang C (1994) Comparative study of two
Schaumberg DA, Nichols JJ, Papas EB et al. (2011) The
non-invasive tear film stability techniques. Curr Eye Res 13, 2639
international workshop on meibomian gland dysfunction: report
McCulley JP, Aronowicz JD, Uchiyama E et al. (2006) Correlations of the subcommittee on the epidemiology of, and associated
in a change in aqueous tear evaporation with a change in relative risk factors for, MGD. Invest Ophthalmol Vis Sci 52, 19942005
humidity and the impact. Am J Ophthalmol 141, 75860
Schiffman RM, Christianson MD, Jacobsen G et al. (2000)
McGill JI (2004) A review of the use of olopatadine in allergic Reliability and validity of the Ocular Surface Disease Index.
conjunctivitis. Int Ophthalmol 25, 1719 Arch Ophthalmol 118, 61521
McMonnies CW, Korb DR, Blackie CA (2012) The role of heat in Schiffman RM, Walt JG, Jacobsen G et al. (2003) Utility
rubbing and massage-related corneal deformation. Contact Lens among patients with dry eye disease. Ophthalmology 110,
Anterior Eye 35, 14854 141219
Meller D, Tseng SC (1998) Conjunctivochalasis: literature review Schmier JK, Covert DW (2009) Characteristics of respondents
and possible pathophysiology. Surv Ophthalmol 43, 22532 with glaucoma and dry eye in a national panel survey.
Clin Ophthalmol 3, 64550
Miljanovic B, Dana R, Sullivan DA et al. (2007) Impact of dry
eye syndrome on vision-related quality of life. Am J Ophthalmol Sibley D, Norris JH, Malhotra R (2012) Management and
143, 40915 outcomes of patients with epiphora referred to a specialist
ophthalmic plastic unit. Clin Exp Ophthalmol 41, 2318
Miller KL, Walt JG, Mink DR et al. (2010) Minimal clinically
important difference for the ocular surface disease index. Sullivan BD, Whitmer D, Nichols KK et al. (2010) An objective
Arch Ophthalmol 128, 94101 approach to dry eye disease severity. Invest Ophthalmol Vis
Sci 51, 612530
Moss SE, Klein R, Klein BE (2000) Prevalence of and risk factors
for dry eye syndrome. Arch Ophthalmol 118, 12648 Suzuki S, Goto E, Dogru M et al. (2006) Tear film lipid layer
alterations in allergic conjunctivitis. Cornea 25, 27780
Nemeth J, Fodor E, Lang Z et al. (2012) Lid-parallel conjunctival
folds (LIPCOF) and dry eye: a multicentre study. Br J Ophthalmol Tilia D, Lazon de la Jara P, Peng N et al. (2013) Effect of lens
96, 13805 and solution choice on the comfort of contact lens wearers.
Optom Vis Sci 90, 41118
NHS Choices (2013) Fish oil supplements linked to prostate
cancer. Available online at: http://www.nhs.uk/news/2013/ Tomlinson A, Bron AJ, Korb DR et al. (2011) The international
07July/Pages/fish-oil-supplements-linked-to-prostate-cancer. workshop on meibomian gland dysfunction: report of the
aspx (accessed 11 July 2013) diagnosis subcommittee. Invest Ophthalmol Vis Sci 52, 200649
Nichols KK, Nichols JJ, Mitchell GL (2004a) The lack of Tomlinson A, Madden LC, Simmons PA (2013) Effectiveness of
association between signs and symptoms in patients with dry eye therapy under conditions of environmental stress.
dry eye disease. Cornea 23, 76270 Curr Eye Res 38, 22936
Nichols KK, Mitchell GL, Zadnik K (2004b) The repeatability of Tressler CS, Beatty R, Lemp MA (2011) Preservative use in topical
clinical measurements of dry eye. Cornea 23, 27285 glaucoma medications. Ocul Surf 9, 14058
Nichols KK, Foulks GN, Bron AJ et al. (2011) The international Tsubota K, Yamada M, Urayama K (1994) Spectacle side panels
workshop on meibomian gland dysfunction: executive summary. and moist inserts for the treatment of dry-eye patients. Cornea
Invest Ophthalmol Vis Sci 52, 19229 13, 197201
Olson MC, Korb DR, Greiner JV (2003) Increase in tear film Uchiyama E, Aronowicz JD, Butovich IA et al. (2007) Increased
lipid layer thickness following treatment with warm compresses evaporative rates in laboratory testing conditions simulating
in patients with meibomian gland dysfunction. Eye Contact Lens airplane cabin relative humidity: an important factor for dry eye
29, 969 syndrome. Eye Contact Lens 33, 1746
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Walsh NP, Fortes MB, Raymond-Barker P et al. (2012) Is 3. Common clinical techniques used to assess dry eye
whole-body hydration an important consideration in dry eye?
4. Common causes of increased tear film evaporation
Invest Ophthalmol Vis Sci 53, 66227
5. Appropriate treatment in severe (grade 4) dry eye
Wlodarczyk J, Fairchild C (2009) United States cost-effectiveness
study of two dry eye ophthalmic lubricants. Ophthal Epidemiol 6. How to improve a dry-eye problem for patients with
16, 2230 open-angle glaucoma
Wong J, Lan W, Ong LM et al. (2011) Non-hormonal systemic
medications and dry eye. Ocul Surf 9, 21226
CPD Exercise
CET multiple choice questions After reading this article can you identify areas in
This article has been approved for one non-interactive which your knowledge of dry-eye management has
point under the GOCs Enchanced CET Scheme. The reference been enhanced?
and relevant competencies are stated at the head of How do you feel you can use this knowledge to offer
the article. To gain your point visit the Colleges website better patient advice?
www.college-optometrists.org/oip and complete the multiple
Are there any areas you still feel you need to study
choice questions online. The deadline for completion is
and how might you do this?
31 October 2014. To enable readers to prepare for the quiz,
below are the topics which the questions address. Which areas outlined in this article would you benefit
from reading in more depth, and why?
1. Typical symptoms of dry eye
2. Techniques that are difficult to use in the diagnosis of
mild dry eye
Signs (but note None No signs/zero to Unstable tear film Marked corneal Severe corneal stain
that signs are Lid/conjunctival signs mild conjunctival (TBUT <7s) punctate stain Conjunctival
often highly of ocular allergic staining Zero to mild corneal Central cornea scarring
variable: response Variable TBUT punctate staining staining Schirmer
see text)
Variable TBUT time Variable Schirmer Mild to moderate May have 2mm/5min
Variable Schirmer conjunctival filamentary keratitis
staining Schirmer
Schirmer 5mm/5min
10mm/5min
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R Henderson and L Madden
Fortunately most people can manage their dry eye with the
following advice.
4. Eyedrops and sprays may help but the effects are often
transient. Gels last longer and ointments longer still but they
do tend to blur. Some eyedrops contain oils that can help if
2. How might you assess/measure this impact?
your eyes are sensitive to low humidity. If you are using your
eyedrops more than four to six times a day, you may benefit
from preservative-free drops.
5. Plugs: If you are using drops more than every 2 hours, you
may benefit from punctal plugs inserted into the tear ducts.
This is a reversible procedure that an optometrist, specialist
nurse or ophthalmologist can do.
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