CONCEPT
There are several different potential underlying causes of dry eye and the treatment for each is different. Before moving forward, lets watch this video about the different types of dry eye.
The purpose of the dry eye clinic is to pinpoint which of the different types of dry eye a patient has and determines a treatment regimen that is tailored to the patient. This is accomplished by completing additional testing which is not done at the exam.
WORKUP ORDER
The patient should have completed the dry eye questionnaire and the OSDI form prior to be called back (if not have the patient complete these while you go get the doctor; they can be found in the OA helpful things folder, subfolder Forms); create entries under the testing tab for each and scan in the completed forms. Potentially perform meibography on the topographer if the doctor requests. Complete visual acuity, expedited medical history. Inquire what the patient currently does to manage their dry eye and how effective they perceive that regimen to be.
CHARTING CHECKLIST
Layout: Intermediate.
Hx/Meds: Forward and update
Workup: Enter the patient’s dry eye diagnosis as the chief complaint. Fill in VAs, pupils, and EOMs. Past the OA dry eye evaluation template in the notes and fill each category out as the doctor indicates.
Exam: Forward anterior and posterior findings (delete the posterior findings if the doctor does not complete) and update based on the doctors findings. Forward the patient’s dry eye diagnosis in the plan and make it the #1 diagnosis for the appointment. Update plan to reflect all recommendations from that appointment.
Routing: Confirm with the doctor which office code they would like entered for the visit and under additional notes, indicate what and when the patient’s next appointment should be.
Determining Treatment
Depending on the outcome of the dry eye clinic, the doctor will recommend a treatment plan.
If symptoms are due to decreased aqueous layer production, the doctor may recommend artificial tears, punctal plugs, a procedure called Prokera, a prescription dry eye drop such as Restasis, Xiidra, or Cequa, and/or quality fish oil.
If symptoms are due to decreased oil layer production due to meibomian gland dysfunction, the doctor may prescribe a dry eye kit, quality fish oil, or procedure such as Arita, I-lux, or Blephex.
Sometimes their dry eye is due to a combination of factors and so treatment will take a multifaceted approach.
Procedures will be discussed in the following module. For now, lets review the dry eye kits and prescription eye drops/fish oil.
Dry Eye Kits
The dry eye kits are the base level of treatment for MGD and blepharitis related dry eye. Kit A includes a dry eye mask, hypochlor, preservative free artificial tears. Kit B includes everything from Kit A along with a foaming eyelid cleanser to be used in the shower.
dry eye mask
patient wearing a dry eye mask
hypochlor lid spray
Preservative free artificial tears
foaming lid cleanser
Please watch the following video on dry eye masks.
and Hypochlor.
Medicated Dry Eye Drops and Fish Oil
The primary function of medicated dry eye drops is to reduce corneal inflammation. Inflammation can cause a decrease in the production of the aqueous layer of the tear film, so by treating the underlying inflammation the body can start to produce a normal amount of tears again. There are three FDA approved dry eye medications to reduce inflammatory dry eye: Restasis, Cequa, and Xiidra.
Please watch the following video on dry eye treatments and prescription dry eye drops.
Quality fish oil can also be used to help treat dry eye. The primary fish oil we recommend is DE3 from a company called PRN.
Please watch the following video from PRN.
Medications with Partnering PHarmacies
Some pharmaceutical companies, like PRN, partner with specific pharmacies to provide their medications to patient’s at a reduced cost which may or may not be better than if they use their medical insurance. These partnerships have been compiled into an excel doc in the OA helpful things folder (subfolder cheat sheets) titled Medication. This lists the medication and how to search for it in New Crop, the partnering pharmacy and how to search for it, along with any additional special instructions for prescribing the medication.
