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.