Advancements in managing dry eye disease

Consultant ophthalmologist, Sharmina Khan, discussed current and emerging approaches to managing dry eye disease during her 100% Optical presentation Drop the drops (28 February, Excel London).

She outlined the different types of interventions that can be used to manage dry eye disease – such as education and environmental control, lid hygiene, lubrication and anti-inflammatory or immunomodulating agents.

Device-based interventions include vector thermal pulsation, intense pulsed light treatment (IPL), lid margin exfoliation and low level red light therapy. Khan added that dietary advice can also form part of dry eye management.

“An underutilised element of dry eye treatment is talking more holistically about your diet,” Khan said.

She added that endogenously produced cortisol levels and sleep can also influence dry eye disease.

“Demodex mites can detect melatonin levels on our skin, and they know when to come out and clean our pores,” Khan highlighted.

“If there is a dysregulation in your melatonin levels because you’re not going to sleep at the same time every day, then that can aggravate your eyes,” she said.

“I know my blepharitis can be affected if I don’t sleep,” Khan added.

The Moorfields Eye Hospital consultant ophthalmologist shared that IPL is safe and effective – causing a reduction in pro-inflammatory cytokines.

However, she added that there are a range of contraindications, including children, patients who are pregnant or breastfeeding, those with a pacemaker or cardiac defibrillator, and those who are experiencing eye inflammation or infection.

Khan added that IPL is not suitable for patients with a very dark skin tone (Fitzpatrick scale Type VI) as it may cause areas of depigmentation.

Turning to the management of demodex mites, Khan highlighted that a Delphi panel has concluded that complete eradication is not necessary.

“If you are going to treat demodex, then your endpoints, or the outcome measures that we're looking for, are a relief in itchy symptoms and a reduction in collarettes, which are dandruff type deposits,” Khan said.

Dropless cataract surgery update

Khan provided an update on guidance that has been published by the United Kingdom and Ireland Society of Cataract and Refractive Surgeons on dropless cataract surgery.

She highlighted that requiring patients to administer postoperative eye drops is costly, inconvenient and has an environmental impact.

“Patients struggle with it and so do their carers so there are compliance issues,” Khan said.

The approach would see surgeons administer intraocular or periocular medications during the surgery – eliminating or significantly reducing the need to postoperative drops.

Khan told delegates she was in favour of the guidelines when she heard about the new approach.

“There is a need for careful patient selection. We need to start with routine cases and audit the outcomes,” she said.