December 2020


Dry eye during the COVID-19 pandemic

by Ellen Stodola Editorial Co-Director

This photograph demonstrates the utility of cell phone cameras in augmenting the telehealth dry eye experience. As demonstrated, the quality of the image is enough to see that the patient has diffuse collarettes (cylindrical dandruff at base of upper lid margin), indicative of severe Demodex blepharitis. There is significant misdirection of lashes as a result as well.
Source: Elizabeth Yeu, MD

With the COVID-19 pandemic temporarily closing practices around the country, many ophthalmologists had to figure out how to still communicate with and treat their patients. Several physicians commented on how the pandemic has affected their dry eye patient population and trends they have seen.
During the pandemic, access to patients was limited, said Preeya Gupta, MD. Now, it’s hard to see the same number of patients as before due to social distancing and cleaning protocols. “Time and space have become a scarce resource,” she said.
Robert Latkany, MD, noted that, though he closed his practice for a period of time, it was his patients who ultimately encouraged him to open back up as soon as possible. “There were enough complaining dry eye patients that it got me back to the office,” he said.
He said he has a steady number of moderate to severe dry eye patients in both of his offices, though he noted that his practice in the suburbs is busier than in New York City.
Dr. Latkany also noted that in the period between May and Labor Day, he generally gets fewer complaints from patients because of the humidity and weather. “They’re more miserable from November to March 1,” he said, adding that he thinks that helped some dry eye patients to not be as desperate in this time period. However, he did note that for those with moderate to severe dry eye, the weather doesn’t necessarily help them, and they’re still miserable. These patients had no problem coming in to be treated. Dr. Latkany said he saw a large number of patients with styes presenting as well.
During the pandemic, causes of acute dry eye flare-ups have included seasonal allergies, mask-related dry eye symptoms, and difficulty following up, said Elizabeth Yeu, MD. She added that, earlier in the year, she did not perform any thermal therapies for the lids or microblepharoexfoliation because of the proximity to the patient that these procedures require. “Needless to say, dry eye disease flare-ups do occur, and the most important part of my clinical care has been to spend greater time listening to my patients and stabilizing the ocular surface,” Dr. Yeu said, adding that since practices have reopened, she has noticed an uptick of patients in general, including greater diagnosis of dry eye disease with surgical evaluation patients.
Unfortunately, a lot of times, dry eye patients are labeled as “non-urgent,” Dr. Gupta said.
“Despite the access issue, telehealth has been a good resource for my dry eye patients because it allows us to connect and talk about what their issues are,” she said, adding that this works better for patients with already established care compared to new patients.
Dr. Gupta noted that from April through early June, her clinic was using more telehealth options. Now that clinic volume has begun to pick up, Dr. Gupta has noticed that dry eye is being treated a bit differently. “For a lot of my patients who weren’t on a prescription therapy, they were more open to trying it,” she said. They no longer want to start by trying to do things on their own at home with over-the-counter treatments.
Dr. Gupta added that with many people working remotely, this has caused more eye strain, as well as more stress on the ocular surface. “The dry eye patient will be disproportionally affected,” she said. “I’ve been writing more prescription therapy for dry eye disease because they are safe medications but also because patients have become more symptomatic in the pandemic.”
The other big shift that Dr. Gupta has noticed is dry eye patients coming in for MGD treatment or in-office procedures. There has been an uptick in interest in procedural therapy because these patients want to try to get to the root of the problem. “Patients have become more open to procedural treatments because they understand the potential benefits but are also trying to take better care of themselves,” she said.
Dr. Latkany also offered a telehealth option for patients during the pandemic. He said he often uses punctal plugs, but if this isn’t possible or if patients aren’t willing to leave their homes, he has found prescription medication options such as Cequa (cyclosporine, Sun Ophthalmics), Restasis (cyclosporine, Allergan), and Xiidra (lifitegrast, Novartis) are helpful.
“While eyecare is considered elective, patients deem their ocular health and vision to be essential components to their overall health,” Dr. Yeu said. “In conjunction, we have made significant efforts to help support patient care in the COVID era, including greater automation of pre-visit paperwork, social distancing throughout the clinic, mask requirements for all patients/staff, and limitation of people within the facility.”
This has allowed patients to feel comfortable presenting to their appointments, Dr. Yeu said. Others who are not comfortable have been triaged or seen through telehealth appointments with one of the ODs within her practice.
Dr. Yeu has also found that she’s been using more dry eye disease anti-inflammatory treatments. She said her practice is back to offering lid margin in-office treatments, which has been welcomed by both patients and clinicians. “Approximately 25% of my cataract surgery evaluation patients undergo some in-office lid margin therapy, most often being biofilm blepharoexfoliation in the blepharitis and MGD patients,” Dr. Yeu said.

About the physicians

Preeya Gupta, MD

Duke Eye Center
Durham, North Carolina

Robert Latkany, MD
Center for Ocular Film
Tear Disorders
New York, New York

Elizabeth Yeu, MD
Virginia Eye Consultants
Norfolk, Virginia

Relevant disclosures

: None
Latkany: None
Yeu: None



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