EyeWorld Asia-Pacific December 2015 Issue

50 EWAP CORNEA December 2015 by Vanessa Caceres EyeWorld Contributing Writer Diagnosing and treating OSD effectively Patient with limbal stem cell deficiency due to longstanding atopic disease A soup to nuts look at OSD conditions I t can be hard to keep up with the latest diagnosis and treatment pearls for various conditions associated with ocular surface disease (OSD). EyeWorld has rounded up some insight and advice from experts on topics ranging from dry eye to ocular pain to limbal stem cell deficiency (LSCD) to blepharokeratoconjunctivitis. Read on to get state-of-the-art guidance. Treating dry eye and blepharitis Anat Galor, MD , associate professor of clinical ophthalmology, Bascom Palmer Eye Institute, Miami, will examine both the eye anatomy and the tear film to try and get a better handle on the cause of a patient’s dry eye and blepharitis—realizing that “dry eye” is a broad term that can have many subcomponents. On the anatomy side, she would look for eyelid laxity, conjunctival chalasis, and pterygium, among other issues. For the tear film, she will evaluate the quality of oil, osmolarity, and tear volume. “I also have a lot of people come in who clearly have skin issues contributing to eye issues,” she said. In those patients, Dr. Galor would work with a dermatologist to help treat rosacea or seborrheic dermatitis. Usually, the treatment involves better lid hygiene, an antibiotic, and a low- dose steroid for 2–3 weeks. If Dr. Galor suspects that dry eye symptoms and signs indicate Sjögren’s syndrome (SS), she will test for SS-related antibodies and treat with topical anti-inflammatories, artificial tears, and topical cyclosporine (Restasis, Allergan, Dublin, Ireland). She’ll start the patient on fluorometholone for 1 month to prepare the eye for the use of cyclosporine. Neuropathic pain is often a problem in patients with OSD, and Dr. Galor has found successful treatment with autologous tears. The use of omega-3 fatty acid supplements are also part of the treatment plan to help fight inflammation. “I believe the eye is one piece of the puzzle for the rest of the body, and omega-3 fatty acids have a lot of benefits that go beyond eye health,” she said. She will also advocate for patients to eat a balanced diet and to think about possible environmental causes of their dry eye symptoms. Ocular pain It can be a tangled web to diagnose and treat ocular pain, said Kristin M. Hammersmith, MD , associate professor of ophthalmology, Jefferson Medical College and Wills Eye Institute, Philadelphia. Ocular pain is also underrecognized, she thinks. Although a clinician may initially look for symptoms or signs associated with pain—including foreign body sensation, burning, and light sensitivity—the cause of ocular pain is not always clear, Dr. Hammersmith said. “In cases where signs don’t match symptoms, we start to think about Patient with bilateral chemical injury who successfully underwent combined keratolimbal allograft and penetrating keratoplasty with systemic immunosup- pression using the Cincinnati protocol Patient with unilateral chemical injury at 5 years after conjunctival limbal autograft from the contralateral uninjured eye Source (all): Ali Djalilian, MD