Recently, I saw a 57-year-old woman with mild to moderate chronic dry eye disease. Her chief complaint was she was tired of her contact lenses becoming progressively more uncomfortable, resulting in decreased wearing time.
The patient reported her symptoms on my in-office dry eye questionnaire. After an exam, I noted she had vision fluctuations without contact lenses, and her best-corrected visual acuity varied between 20/25 and 20/40.
Other findings included:
* Decreased tear meniscus
* Poor meibomian gland expression
* Tear break-up time 6 to 8 seconds
* Superficial punctate keratitis, both eyes
* Irregular topography
* Schirmer test results of 7 mm in the right eye and 6 mm in the left eye.
These findings led me to diagnose the patient with blepharitis (ICD-9-CME 373.00) and with chronic dry eye disease or dry eye syndrome (ICD-9-CME 375.15). Armed with this diagnosis, I developed a comprehensive treatment regimen for her.
The treatment over 1 year included: Artificial tears; lid hygiene; warm compresses; a mild steroid four times a day for 2 weeks in both eyes; cyclosporine ophthalmic suspension 0.05% (Restasis) twice a day in both eyes; and punctal occlusion.
I saw this patient over the course of a year for follow-up visits and punctal occlusion. Treating her dry eye allowed a return to a healthier ocular surface.
She went on to have refractive surgery and is 20/25 OD and 20/20 OS and experiences dry eye symptoms only occasionally. Dry eye-related visits for this patient totaled $480 in revenue.
Copyright Boucher Communications, Inc. Nov 2005
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