Effective new slit lamp techniques for tear hyperosmolarity in dry eye

Consider the familiar case of Mrs Smith – a polite but frustrated woman in her 50s. She has come to you complaining of her dry eye; she has been to all the specialists in town and found no answers or cures. You are her last hope. You put in fluorescein, look with your slit lamp and you heart begins to sink.

Just what is the culprit causing her symptoms? Is it her very obvious blepharitis? Or her smoking habit? Perhaps it is her conjunctival folds calling for your attention or are her symptoms solely due to her contact lenses? You want to wave your magic wand and help Mrs Smith restore her faith in optometric practice – and most especially your practice. But just where do you start?