REMEMBER THE NON-PHARMACEUTICAL INTERVENTIONS FOR DED IN YOUR TOOLKIT
WITH CUTTING-EDGE therapies building a more robust dry eye disease (DED) treatment toolkit for doctors, it’s easy to forget the non- pharmaceutical options that have also greatly benefitted and continue to benefit these patients.
Artificial tears are still the mainstay of palliative DED treatment. They act to wash away metabolic by-products, as well as foreign bodies and other antigens. Recommending a condition-spe-cific tear designed to treat the specific form of DED can not only increase patient compliance, but also differentiate you as one who is more “in tune” with DED management vs. the “other doctor” down the street.
For example, recommending a lipid-based tear to a DED sufferer or a preservative-free tear to a frequent user may elicit a, “No doctor has ever told me that before,” response, especially if he or she is educated on why the specificity of the tear matters. Suddenly, an artificial tear recommendation has become relevant to the patient and made you, the practitioner, a valuable resource. Utilizing a doctor’s advice is more effective than scanning the pharmacy shelves for what might work.
Patients who have mild to moderate symptoms can find relief from the proper use of warm compresses. Unfortunately, many of these patients often guess at the correct regimen, leaving them with little result from their efforts. To change this, provide patients with explicit instruction regarding warm compress frequency, duration, temperature and adjunctive therapy. An example:
“Use the silicone-beaded mask twice per day for 10 minutes. Heat according to package instruction. When finished, massage lids for 5 minutes, as discussed.”
Written instructions, or digital directions available on your practice’s website, can streamline the education process, while also maintaining direction uniformity. Without consistency of education, compliant patients will be discouraged and won’t appreciate hearing, “you haven’t been doing it right.” In the end, if your treatment doesn’t work, it will be your fault in the patient’s eyes.
Though plugs are further down the treatment progression, aqueous-deficient DED patients, specifically, may find great relief with punctal plugs, as they increase the tear volume. Additionally, long-acting, absorbable punctal plugs can be used as an alternative to the classic permanent and semi-permanent versions.
A caveat: As inflammation plays a pivotal role in DED, test for inflammation, and treat it in advance of punctal plug insertion, because trapping an inflamed tear in the eye only breeds more inflammation and perpetuates the progression of the disease process. OM