Recently a patient complained to me: ‘Doc, my eyes still hurt.’
I asked: ‘have you tried the artificial tears I recommended to you?
‘Yes, it doesn’t do any good.’
‘How many times did you put in a day?’
‘I just did that once and it did not work.’
‘I see. How about the warm compress?’
‘Not working either.’
‘How long did you do it and how many times a day?
‘Once or twice, I forgot.’
‘Are you taking the fish oil supplement?’
‘Yes. Did not feel any different.’
Here I have a patient who two months ago came to me for dry eye. He reported trying restasis from his previous eye doctor for months but no relief at all. Eye exam showed typical meibomian gland dysfunction (MGD) and poor tear film quality, without blepharitis or corneal staining. So this is a case of MGD-induced dry eye, that’s why I started him on eyelid warm compress 5 min x 2, and fish oil 1000 mg x 2 daily, with artificial tears as needed, up to 4 times daily. I asked him to follow up in 1 month. At which time he was not doing any of the things I asked, and of course his dry eye symptoms continued. After re-education, I asked him to do these consistently and follow up again in 1 month. He has probably done some of this now, but not consistently, and given up very quickly.
Rather than drilling him again for being more compliant with the treatment regimen, I offered him an alternative, which he clearly came looking for. I would like to refer him for a lipiflow treatment. I explained what it is, how it is done, and why it works. Then I told him that it’s not covered by insurance and may cost $1-2,000 for one session.
After a short moment of silence, he told me that he would like to give warm compress another try. And that he just started taking fish oil last week and would like to see if doing this for longer may help. I agreed, and asked him to return in 6 weeks to evaluate on progress.
No one likes having the dryness, foreign body sensation, redness, burning and tearing caused by dry eye. Fortunately there are effective treatments such as warm compress and artificial tears, and often these are enough to control dry eye symptoms. Unfortunately these treatments require consistent and long-term use. There is no cure for dry eye, which is a chronic condition and may require life-long management. When it comes to dry eye treatment, compliance is key. There are certainly those unlucky people who despite doing everything right still suffers from dry eye. But fortunately those are the minority.
For more information on dry eye and treatment, you can visit my previous posts and video.