Many patients develop sensitivities to preserved tears, and many over-the-counter products contain vasoconstrictors that are deleterious in both the short- and long-term. To replace the tears in a beneficial way, I use preservative-free tears or a vanishing preservative such as Refresh Tears or Optive with Purite. In the patient with aqueous deficiency, treatment can involve managing environmental factors and tear conservation efforts such as punctal occlusion. This can also lead to tightened supervision by the patient's internist and improved oral regimens.Īlternately, a patient's dry eye may be due either to an aqueous or mucin deficiency, or a problem with the eye's lipid layer due to blepharitis-a surprisingly common etiology. Treatments directed at systemic factors, particularly for anticipated elective eye surgery, may provide relatively rapid results. In classifying the preoperative dry-eye patient, you must first determine whether the condition is associated with a systemic disease such as arthritis, a coexisting ocular surface condition, or with oral medications that can cause or exacerbate dry-eye symptoms. If elective surgery is indicated, adequate surface recovery is essential to an optimal outcome. Concomitant ocular surface conditions and irrevocable environmental factors may interact to delay recovery despite appropriate therapy. Thus, determining the underlying etiology is critical in analyzing a patient's potential for improvement. So many different classification systems exist for these conditions, as well as for dry eye itself, that developing a treatment plan can be difficult. The most common ocular surface diseases we see in our clinic are allergy, blepharitis, dry eye and infectious conjunctivitis, in that order. This disorder is the source of thousands of visits each year in our clinics and untold disruptions of our patients' lives. Ocular surface disease can wreak havoc on our surgical patients.
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