Case study: Dry eye disease - a soap opera?

Bubbling of the tears, usually noticed around the canthi, is a familiar sight on slit lamp, especially in those patients with meibomian gland dysfunction (figure 1). These present as a result of saponification, a term used to describe the creation of soaps.

Saponification is thought to indicate poor quality meibum and is a result of enzymes reacting with tear lipids. When combined, they create a foamy, soapy material, that feels like soap in the eyes; hence the name. Saponification can occur when there are demodex mites present, either at the roots of the lashes or in the meibomian glands.

The following case will highlight a recent patient I saw in my clinic facing exacerbated ocular surface issues and dry eye disease with an associated saponification.

A 65-year-old female, MR, first attended my clinic in May 2021 having had issues with watery eyes, especially problematic in windy conditions. She complained of an occasional gritty sensation, equally in both eyes, and noticed her symptoms had gradually worsened over the last year or so. She had used warm compresses, albeit sporadically.