Which factors can have an influence on the
CLD development?
Contact Lens
* Lens material
* Lens design
* Lens fit & wearing modality
& lens replacement
* Lens care system (if any)
Environment
* Inherent patient factors
* Modifiable patient factors
* Ocular environment
* External environmet
How can we manage CLD in the clinical
practice?
- CLs with thin and knifepoint edge design are better in terms of end of day comfort compared to round design
- The use of wetting drops (preservative-free) might help to reduce the ocular symptoms
- Some ingredients of the lens care solutions can produce hypersensitivity and toxicity (e.g. preservatives
4.CLs with higher modulus of elasticity (stiffer lenses) might increase the
awareness of the lens
5.Avoid adverse environments
6.Treat any underling condition that may produce dry eye!
What are the environmental causes of dry eye
- Chronic topical meds (contain preservatives)
- Systematic meds (antihistamines, antidepressants, beta blockers)
- Decreased/ incomplete blinks (using screens)
- Desiccating conditions and environmental pollutants (adverse environments such as low humidity, windy,extreme temp, UV)
- CL wear (material, fit, replacement)
How would you manage local environmental conditions in dry eye
Good hydration (drink water)
Use humidifiers at work
Blinking when using screens
Preservative free lubricants and topical meds
How would you manage dietary modifications in dry eye
Hydration
Fatty acids
= Healthy diet
What are the 2 types of treatment for tear insufficiency
- Artificial tear substitues- preservative free eye drops, high viscosity (thicker) for overnight and low viscosity for day time (gels and ointments have high viscosity)
- Biological tear substitutions - supports the proliferation and migration of epithelial cells. Enhances the epithelial viability by binding and neutralising inflammatory molecules.
Name some viscosity enhancing agents (part of artificial tears substitutions)
- Hyaluronic acid/ sodium hyaluronate- increases viscosity and provides enhanced lubrication. Wound healing ?
- Carboxymethyl cellulose/ carmellose sodium- increases viscosity and promotes epithelial cell healing.
- Hydroxypropyl methylcellulose- common ingredient
- Hydroxypropyl- guar - improves DED symptoms, increases mucous layer thickness, reduce inflammation and protect ocular surface
- Can get combinations of products
What do lipid supplemenations do
Lipids can be used to mimic the natural meibum.
Lipid contained drops are formulated as emulsions
Improves symptoms of DED
What is a tear conservative approach (part of biological tear substitutions)
- Punctal occlusion
Temporary (collagen and disposable plugs)
Semi-permanent (silicone removable plugs)
Permanent (cauterise punctum)
What is a tear stimulation approach
Several topical eye drops and oral drugs stimulate aqueous, mucin or lipid secretion - available in stores
What are the treatments for lid abnormalities
- Anterior eye blepharitis- lid hygiene to remove debris and reduce inflammation
- MGD—>warm compresses- external heat will increase the flow of secretion from the gland (approx 39 degrees for approx 5 minutes)
—> ocular lubricants for MGD
—> forceful expression of MG
—> Lipiflow- thermal pulsation tech that removes blockages from MG. - CLS - bandage soft CLS (SiHy) protects ocular surface. Scleral and mini- scleral RGPS CLS act as a tear reservoir
What anti-inflammatories are used in DED
Corticosteroids
NSAIDS
cyclosporine A
What are the surgical approaches of DED
- Blinking abnormalities and ocular exposure
- Ectropion
- Dermatochalasis
- Ptosis
- Pterygium
- Pinguecula
After DED treatment what should you do next
A careful follow up to assess if treatment is successful or consider another approach
What would you do for a mild DED px
-educate px
-modify local environment
-educate on dietary modification
-elimination of offending systematic/ topical meds
- lubricants
- lid hygiene
-warm compresses
What would you do to a moderate DED px
-non preservative ocular lubricants/ artificial tears
- Overnight treatments
-physical heating of MG
- temporary puntal occlusion
-drugs - topical antibiotics for anterior bleph and topical corticosteroids
What do you do with a px who has severe DED
- tear stimulator approaches
-autologous serum eye drops
-therapeutic/ bandage soft CLS/ scleral lenses
-topical corticosteroids for longer
-amniotic membrane grafts
-permanent punctual occlusion
