Click to view article: Ocular Surface Insight, Winter 2020 issue: https://osimag.co.uk/wp-content/uploads/2020/11/OSI-Magazine-Issue-10-Winter-2020.pdf
The perplexing task of treating the ocular surface occurs when countless conditions attack the cornea concomitantly. Clinicians may diagnose Dry Eye Disease (DED) initially by observing superficial punctate staining via the slit lamp, then complications may follow with persistent epithelial defects or recurrent corneal erosions. These issues could lead to neurotrophic ulcers which can become even more difficult to handle. Accordingly, treating at the earliest onset of ocular surface inflammation can mitigate further destruction of the corneal surface.
Ocular surface disease can be divided into aqueous or lipid deficiencies. These classifications can be further separated into the component layers of the tear film: the lipid layer may be reduced due to poorly functioning meibomian glands, while, the aqueous layer may be impaired due to an inadequately performing lacrimal gland. If the doctor can recognize each of these elements, analyze each part, and accept that the problems can occur alone or together, then the practitioner will be able to manage the cornea in a more systematic way. Diagnostic testing can help detect levels of dry eye disease. Surveys can be used to measure patient’s baseline symptoms, such as the DEQ-5 (Dry Eye Questionnaire-5), a simple five question form used to determine if a patient suffers from aqueous and/or lipid deficiency. Objective tests that can also be implemented include: matrix metallopeptidases (MMPs), tear break up time (TBUT), Schirmer’s, and slit lamp evaluation of tear meniscus. Dry eye specialists prefer the MMP-9 test for its specific targeting of the inflammatory component in dry eyes.
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