Back to the basics: The importance of treating inflammation AND obstruction for dry eye

Derek Cunningham, OD, FAAO, with Dell Laser Consultants in Austin, Texas, sat down with Optometry Times during the 2022 American Academy of Optometry meeting held in San Diego to share key takeaways from his presentation, "Back to the basics: The importance of treating inflammation AND obstruction for dry eye."

Editor's note: This transcript has been edited for clarity.

Hi, I'm Derrick Cunningham from Austin, Texas. I have a surgical referral practice and a large dry eye center.

One of the interesting things that we see when we're looking at a lot of the recent publications related to dry eye is the treatment algorithms. And they're excellent academic exercises in understanding the root causes of dryness. Unfortunately, they're so comprehensive, the roadmap they provide us to an effective treatment strategy is often varied. And if you combine all of these studies together, we see a couple of common interests.

We know that dry eye is an inflammatory disease, and our first priority in almost every case of dry eye is to stop the inflammation. And that's great in that it provides some type of immediate relief. The problem is that relief then has to be tied to reestablishment of function. And these functions are primarily based on my meibomian glands, which is the root cause of almost 90% of dry eye.

So for this reason, in a clinic like ours, we've been able to compile all of these academic studies and come down to two simple metrics: The first and most important thing is to treat inflammation, and then the second, long-term benefit you give a patient is to address obstruction. So when a patient comes in our clinic, we will always evaluate what we're going to do for the inflammation first, and then come up with a treatment plan for long-term obstruction reduction.

The goal with all treatments should be to reestablish normal cell function. There is no better product for the eye, and no absolute substitute than the body's natural mechanisms to protect and nourish your cornea. So although we have palliative treatments that can take care of symptoms, and also address short-term care, the only true goal in reestablishing true comfort for a patient, and also visual function, is to get the cells working the way that they were supposed to work. And that's where most of our treatment algorithms have gone. And again, breaking down all the great science that we've seen accumulate over the last decade, it really comes down to inflammation first, and then obstruction reduction next.