The Hill of Sorrow: Understanding the symptom curve in the treatment of dry eye

“No pain, no gain” is a lousy philosophy in physical fitness, and it is particularly difficult to sell it in any medical setting. Yet this is exactly what we must do when we are treating the most severe cases of dry eye.I am on record as stating that the single most important metric in the treatment of dry eye syndrome (DES) is patient symptoms. Indeed, this is a major flash point between ophthalmologists in the community and our academic brethren. Once trained to identify the clinical signs of any disease, it is nearly impossible to resist the temptation to treat them, even in the absence of symptoms. “You can’t make an asymptomatic patient feel better” is an apt motto for our DES world, as I have noted.