Author: Dr Jennifer Rayner, Optometrist, BAppSc(Optom), GradCertOcThere(UNSW), Alleve Eye Clinic, Adelaide, Australia
A 74-year-old female was referred by her ophthalmologist to our clinic with a 10-year history of extreme difficulty in opening her eyes in the mornings. The patient’s eyes “felt stuck together,” and she suffered gritty, sore, and red eyes and eyelids throughout the day. She was under the care of her eye specialist for bilateral ocular hypertension (OH) diagnosed in 2008, and her current treatment was a preserved prostaglandin analogue in both eyes at night. Her dry eye symptoms were attributed to her OH eyedrops and the current treatment was to use non-preserved single use carmellose sodium drops over a dozen times day, which offered little relief. Artificial gels at night blurred her vision. Oral supplements included calcium, glucosamine, vitamin C, zinc, and garlic; her only other prescription medication was perindopril arginine 5mg/amlodipine 10mg to control hypertension. She was diagnosed as gluten intolerant in 2005 and with rosacea in her fifties.
On presentation the patient’s tear break-up time (TBUT) was recorded as 1-2 seconds in each eye. No corneal staining was noted in her right eye but moderate staining was seen in her left – a misdirected eyelash was epilated and attributed to the corneal staining (see Figure 1). Mild madarosis with significant anterior blepharitis and lid margin telangiectasia was noted along all lid margins. Meibum was very inspissated in all glands. An in-rooms lid heating and expression was performed, and she was instructed to continue with daily 10-minute warm lid compresses at home. Due to the collarette appearance on the lashes and her history of rosacea, Demodex mites were attributed to be the cause of her anterior blepharitis and she was recommended to use a tea tree oil wipe at night time to repel their activity. She was also prescribed medical grade manuka honey eyedrops twice daily – an antibacterial and anti-inflammatory agent that is proving to be a useful tool in the treatment of dry eye and is not contra-indicated in the management of glaucoma and OH.
Follow Up The patient was reviewed twice over the following 6 weeks with further in-rooms heat and lid expressions performed. The meibum quality slowly improved and she reported improvement in her symptoms on waking. Her persistent redness was still a concern for her, so the plan was to discuss with her ophthalmologist the use of a 3-6 months course of oral doxycycline 50 mg, to decrease the ocular rosacea and lid margin redness, and possibly a course of IPL.
An oil-based non-preserved artificial tear was introduced to her regime during the day to supplement the tear film until it improved naturally, and redness imaging was to be done each subsequent visit to monitor the effectiveness of the doxycycline and our treatment regime (see fig. 3).
Conclusion This case study aims to demonstrate how data from the JENVIS Pro Dry Eye Report can be interpreted to form an individualized management plan for each patient based on their specific contributing factors. Aside from baseline diagnostics, the JENVIS Pro Dry Eye Report is an invaluable tool for ongoing quantitative and qualitative comparative data to measure improvement, for clinician (see fig. 8).
