Interactive dry eye management – 2

LG Aged 38 years, female

LG presented to practice complaining of increasingly uncomfortable eyes towards the end of the day. She has noticed this getting worse lately, but is also aware that her sleeping patterns have been disrupted in recent weeks due to ‘a family crisis’. Her job entails daily periods spent in front of a laptop computer, in an air-conditioned office, and this may be from three up to seven hours depending on her work demands.

Her general health is good, and she uses no prescription medications, and, being close to emmetropic, has no refractive correction.

She has started to use some unidentified over-the-counter dry eye drops, but these only give temporary relief and she feels she might benefit from more specific remedial advice.

Clinical Findings (@10.00)

• OSDI score; 19
• Acuity; 6/5 N5 R and L
• Osmolarity (iPen); R 315, L 318 mOsm/L
• Blink analysis; 100% blink quality both eyes
• Non-invasive tear break-up time; R 8.1 seconds, L 7.8 seconds
• Fluorescein break-up time; R 6.2, L 6.8 seconds
• Conjunctival hyperaemia grade 1
• Interferometry; poor lipid layer (type A), R and L
• Meibography (lower lids only); Drop out R 11%, L 15%
• No significant staining or LIPCOF today
• Tear meniscus; 0.1mm R and L

Based on these findings, discuss with a colleague the following: What would be a sensible first approach to management of this patient?

Discussion