Chronic Dry Eye Disease: Treatments
Laura Periman, MD
Laura Periman, MD
Originally Published on Ophthalmology Management
Part V: Pharmaceuticals, interventions and procedures for Ocular Surface Disease, as seen through lessons learned on the Montana ranch.
Back to installment 1 in this cliff notes series: #PutYourBootsOn…The Dry Eye definition by TFOS DEWS II talks about hyperosmolarity, inflammation, loss of homeostasis and neuro-sensory abnormalities. And this is how I organize my interventions. Speaking of loss of homeostasis, my ultimate goal is #PhysiologicRestoration. This is the Golden Ring on the bull’s nose. Mighty tough to anchor it in to a moving, angry target but totally worth it if you can achieve it.
Photo 3. Used with permission from www.tearlab.com
Loss of Homeostasis and Neurosensory Abnormalities
Let’s say you’ve diligently cleaned up the inflammation and returned osmolarity to physiologic levels. You’ve buffed up the meibomian gland function, the goblet cell density and the lacrimal gland function. You’ve tuned up the Lacrimal Functional Unit (LFU) instruments, now come along and conduct the song. That’s where neural stimulation (TrueTear®) comes in handy. I’ve been impressed at how neural stimulation appears especially useful in patients who have compromised corneal nerves (disease, surgery, injury, inflammation-induced and hyperosmolarity-induced sub basal plexus damage, etc).
Neural stimulation to the nasociliary nerve is a back-gate approach to triggering the neural reflex arc from environmental sampling and sensation to the brainstem and command impulses to the LFU tear producing apparatus. When all is well, the neurosensory part of homeostatic tears is like a two-lane country highway on a sunny day. When the road is damaged by inflammation, osmolarity or injury, you’re as stuck as if driving on pothole-riddled, rush hour-congested big city streets. So, grab your lasso, jump in the truck and ease on down the road.
The entire TFOS DEWS II report is available to all for free at www.TearFilm.org.
Laura M. Periman, MD is Director of Dry Eye Services and Clinical Research at Evergreen Eye Center in Seattle, WA. Relevant to this series, she discloses relationships with Allergan, Bio-Tissue, Eyedetec, Lumenis, Science Based Health, Sun Pharmaceuticals, TearLab, Topcon and Visant.