Published in Research

What to rule out before diagnosing DED

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2 min read

In light of Vision Expo West (VEW) 2023, Glance’s Jackie Garlich, OD, FAAO, spoke with Mile Brujic, OD, FAAO, on a sneak peek of his session, “Rule these out before you diagnose it as dry eye.”

Editor’s note: The following interview has been edited for clarity.

Give us a quick highlights version of your talk.

We just ran into a slew of patients over the last 6 months who came in with dry eye complaints or were referred for dry eye, when in actuality they were other things that were causing the issue.

So I think it’s always important for us to rule these other things out before we start going both feet in a pool on a dry eye diagnosis and management plan.

Why is this an important topic for clinicians?

Part of it is if we go on that wrong path, we’re going to set incorrect expectations, even with the treatments that we’re performing.

And there’s a lot of things that we run into, as basic as blepharitis and allergic conjunctivitis that can sometimes get mixed in with that dry eye diagnosis.

All the way to things like floppy eyelid syndrome, undiagnosed thyroid eye disease, trichiasis, and distichiasis.

In addition to that, there’s other things like epithelial basement membrane dystrophy (EBMD), Kearn’s-Sayre Syndrome … so there’s a lot of things that run their gamut around what can present like dry eye that has a totally different management path.

Can you give us a few key takeaways?

  1. Make sure you’re assessing lids and lid structures.
    1. Every patient you see evert the lids, you can quickly rule out floppy eye syndrome.
  2. Make sure you’re looking for lid seal, which is one of those new things that we didn’t really pay attention to but can now do easily with a pen light or a transilluminator.
  3. Always make sure you’re looking at the lid margin at a high magnification because sometimes—especially with distichiasis or trichiasis— you’ll miss some of these fine lashes, either in the meibomian glands or a second row growing from other orifices or misdirected lashes.

VEW 2023 is being held September 27-30, 2023, in Las Vegas, Nevada, at the Venetian Convention & Expo Center.