Dry eye syndrome (DES), also known as keratoconjunctivitis sicca (KCS), is the condition of having dry eyes. Other associated symptoms include irritation, redness, discharge, and easily fatigued eyes.
Other associated symptoms include irritation, redness, discharge, and easily fatigued eyes. Blurred vision may also occur. The symptoms can range from mild and occasional to severe and continuous. Scarring of the cornea may occur in some cases without treatment.
Dry eye occurs when either the eye does not produce enough tears or when the tears evaporate too quickly.
This can result from contact lens use, meibomian gland dysfunction, pregnancy, Sjögren syndrome, vitamin A deficiency, omega-3 fatty acid deficiency, LASIK surgery, and certain medications such as antihistamines, some blood pressure medication, hormone replacement therapy, and antidepressants.
Chronic conjunctivitis such as from tobacco smoke exposure or infection may also lead to the condition. Diagnosis is mostly based on the symptoms, though some other tests may be used.
In managing the dry eye patient, the doctor may select a therapeutic regimen that includes prescription medications, artificial tears, masks and compresses, goggles, lid cleansing wipes and sprays, nutritional products, and lid hygiene devices, as well as treatments offered in the office.
To support the doctor’s plan, ophthalmic professionals face a challenge, especially during the pandemic.
How do we effectively educate patients, who are constantly bombarded with information, with the guidance and direction they need to understand dry eye and comply with their therapeutic plan once they leave the office?
Guidance comes first and foremost. The patient education we provide must be medically appropriate.
We should review the language to be used with patients. Review what, specifically, they would like discussed between a staff member and patient versus those topics that are more appropriate to be discussed between the doctor and patient.
Some doctors are completely open to having their technicians explain what contributes to dry eye and how to manage it before they see the patient, while other physicians would rather examine the patient first and then offer tailored treatment recommendations.
When technicians discuss treatment options, such as a device used once a day to reduce signs and symptoms associated with blepharitis and dry eye, they are planting a seed and watering it with information.
When the doctor finishes the exam and then mentions the device, the seed is nurtured and grown with factual information; that is, the patient now firmly associates the device with the treatment of blepharitis and dry eye.
People relate better to a goal-driven discussion than they do when they feel they are being lectured. If you sound condescending, the patient may become defensive, and instead of retaining the information, they think about how they didn’t like your tone versus the information given.
If you are engaging and maintain eye contact while smiling through that constant mint-flavored fog that obscures your vision (if you are like those of us who wear glasses and masks 10 hours a day), your patient is more likely to hang on your every word and be more compliant with their treatment.
How do you get patients to be compliant? We have a variety of tools at our disposal including one-on-one discussions, patient handouts, waiting room videos, after-visit summaries, websites, portal messages, slideshows patients can watch while dilating, and flyers or posters displayed in the exam lane.
There are even point-of-care presentations that can be accessed through touch screen displays. While these tools work in one way or another for a variety of patients, our answer to the compliance question is this; Engage with your patients.
For example, by appealing to their sense of humor, when appropriate, you may also satisfy their curiosity regarding their condition. You don’t have to hit yourself in the face with a pie. Conduct a guided discussion.
Speak in terms appropriate for the patient and be mindful of cultural respect. Remember, too, that each patient is different. Some people learn extremely well from clinical information presented the first time.
Some learn better by seeing and others by hearing. But, like many others, we learn most effectively when we are emotionally engaged. Here are two examples where your teaching skills and engagement come into glorious play:
He gets that this causes his eyes to flood with those pesky poor-quality tears—as a means to help the cornea—instead of the nice fatty lubricating tears, our eyes maintain when we blink routinely. The “20- 20-20” rule, taking a break for at least 20 seconds, every 20 minutes, and looking 20 feet away, is something he can easily remember and easily comply with.
Now, add a drop of artificial tears every time he takes one of those breaks? That is the icing on the cake.
Simply suggesting they clean off the residue of the medication or after every dose will help them clean their eyelids in the process.
They can do it at home with minimal effort. Direct the discussion making sure the patient knows the why, what, how, and what’s next for every issue you have addressed. Let’s take one and try it out:
This reassures patients that you are going to celebrate along with them when they return and have shown improvement. As professionals, we have the information. We know which topics are easily understood but we also know which topics our patients struggle with easy understanding.
We know the types and brands of artificial tears that demonstrate consistent results. We understand which methods of warm compress work and which should not have been recommended. This is the information we can share freely, but with purpose.