Dry Eye

Summer is peak season for Environmental dry eye triggers

Is your practice warning dry eye patients about air conditioning, ceiling fans and other culprits?

Bill Kekevian, Senior Associate Editor

With a plethora of new diagnostic and treatment options, ophthalmologists have more tools than ever to manage the millions of patients who reportedly suffer from dry eye. Yet, according to some clinicians, one of the most basic fronts in the battle against dry eye is being overlooked: environmental triggers.

Dry eye is “hugely impacted by the environment, so that’s the first thing [ophthalmologists] can address before even talking about medications or other types of intervention.” explains cornea specialist Kendall Donaldson, MD, MS of the Bascom Palmer Eye Institute in Miami, Fla. “Patients need to know, they’re going to need to change their lifestyle.”

Air from the dashboard vents can exacerbate dry eye.

The dry eye discussion is key

The ophthalmology practice staff play a significant role in the education of patients who suffer from dry eye.

“Physicians don’t have to work faster, we have to work more efficiently,” says Clifford Salinger, MD, of VIP Laser Eye Center in Palm Beach Gardens, Fla. “It doesn’t mean we necessarily have to have discussions about environmental triggers with our patients, but it definitely means someone in our office has to have that discussion. One of our representatives, such as our technicians, has to have that discussion. I give patients a lot of handouts. I hope they’re going to read them, but we know better. We know maybe one in four will read the handout.

“If it’s not in the first two paragraphs, they probably won’t read it,” he continues. “In any instance, it takes repeated efforts to really make it sink in. Patients forget the overwhelming majority of what you tell them after 24 hours. We physicians are not going to take the time to discuss at great length all these factors. I’ll do it the first time and then the staff will bring it up the next time.”

He instructs support staff to ask, upon follow up exams, “are you being aware of your environment like Dr. Salinger said?” Nurses, PAs and technicians, he says, are the ones tasked with reminding patients about environmental threats.

However, some practices may be neglecting this conversation, according to Dr. Salinger. “I see many patients who have seen three, five, or even seven eye-care professionals,” he says. When he explains environmental triggers to them, “a light bulb goes on and they ask ‘why didn’t anybody else tell me about that?’”

Know the common triggers

“The car and bedroom environments can exacerbate dry eye,” says Dr. Donaldson. In particular, she’s referring to summertime and hot-weather amenities such as air conditioning and ceiling fan usage.

“I’m in Florida, where it’s use is constant,” says Dr. Salinger. He tells dry eye patients “to be more aware of the environment or else, no matter what we [doctors] do, you’re still going to be symptomatic.”

He and his staff tell patients to be most aware when “the dashboard vent in the car is blowing at you while you’re driving or if you’re in your favorite chair reading, watching television, doing other ‘near’ work and the fan or the air conditioner is blowing directly at you. [Because then], no matter what else we do, you’re not going to feel better.”

Even while asleep, ceiling fans can dry out eyes. Eyes are not 100% closed while asleep, according to Dr. Salinger, and this accounts for much of the early morning dry eye patients may complain of.

“A lot of patients are most symptomatic when they first wake up,” says Dr. Donaldson. “That seems to be the driest time of the day, because we’re not blinking all night long. I tell patients to turn off their fans over their bed at night and some patients even wear sleep goggles. Sometimes I have them use a humidifier in their bedroom. If they really must have the fan, they can put on a lubricant gel and wear sleep goggles or use a moisture chamber, which is a form of goggles.”

Dr. Salinger adds that sleep masks are another option in less severe cases.

Understand the practice benefits

“These patients are an annuity,” Dr. Salinger says. If arming them with the knowledge they need to avoid seasonal environmental triggers helps them control their symptoms, he says, “they’ll be singing your praises.” You can build a very significant practice “if you’re committed to serving the dry eye patient base.” OP