Ocular surface disease: One physician’s approach to testing, examining and making a diagnosis

One or another form of ocular surface disease, usually dry eye syndrome, blepharitis, meibomian gland dysfunction, ocular allergy or conjunctivitis, accounts for nearly 40% of patient visits to a comprehensive ophthalmologist. DES and blepharitis/MGD with associated evaporative DES are the leading diagnoses made, and in various studies, as much as 15% of the population suffers from at least mild DES.The accompanying cover story is quite interesting and highlights opinions from prominent actively practicing clinicians from around the world. I have found that the definition of dry eye, the diagnostics employed, and the treatments available and utilized vary significantly as I travel the world interacting with my colleagues. In this commentary, I will give a few thoughts as to how my approach to the diagnosis and treatment of DES and blepharitis/MGD has evolved and is evolving in a high-tech/high-touch integrated MD/OD care delivery model in Minneapolis. Of note, I consult widely in this field with industry and, as a fellowship-trained corneal specialist, see a diverse group of patients. Over the last 10 years, the way I manage patients with DES has changed dramatically. I am sure some of my approaches will be controversial, but they will represent an accurate portrayal of what currently works for me.