On the surface, dry eye may seem like one of the most boring topics in eye care. It’s not as controversial as injectables; it doesn’t call for the use of pricy lasers; and, generally, when you treat it, your patients won’t be so impressed by the outcome that they leap into your arms and plant a big, fat kiss on your cheek (as all too many post-op cataract patients have been known to do).

Rather, many of us tend to think of dry eye as a nuisance—from both a treatment and an education standpoint. Yet, the prevalence of this disease requires optometrists and researchers to find new and better ways to address patient complaints and inspires corporations to forge ahead with research.

I vividly recall the first time I realized how important dry eye research is to eye care. It was in 2001 and I was invited to observe a roundtable discussion on the disparity between subjective and objective symptoms. It seemed too rudimentary to warrant a full day of debate. Yet, the meeting was led by some of the most well-respected researchers in eye care and, as I soon discovered, their research was careful, extensive and ahead of its time. Remember, in 2001, there wasn’t even a prescription medication available for dry eye. Nonetheless, this disease, for which the best you could offer was an over-the-counter drop, was garnering the attention of optometrists, ophthalmologists and the press.

The next big breakthrough for dry eye came in late 2002, with the approval of Restasis (cyclosporine, Allergan), the first prescription drug indicated for the disease. There was plenty to talk about there. Likewise, at the time, there was much to learn about dry eye as it related to LASIK because laser correction was a huge newsmaker then and the economic climate was not yet grim.

A few years later, in 2007, the very definition of dry eye disease was modified by the Definition and Classification Subcommittee of the International Dry Eye Workshop (DEWS). DEWS determined that dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance and tear film instability, with potential damage to the ocular surface. The DEWS definition also states that dry eye is accompanied by increased tear film osmolarity and ocular surface inflammation.

For several years, conversation about dry eye centered on identifying its cause—inadequate lacrimal layer production (aqueous tear deficiency) or excessive tear film evaporation (evaporative dry eye). This, the researchers said, should help dictate an appropriate treatment plan. But, as we are now learning, there is more to it than that.

Dry eye—particularly evaporative dry eye—is often associated with meibomian gland dysfunction (MGD), a topic that is foremost on the minds of everyone with an interest in contemporary dry eye management, including the author of this month’s ARVO Report on Cornea, Joseph P. Shovlin, O.D.

As you know, the International Workshop on Meibomian Gland Dysfunction concluded that MGD is now the leading cause of dry eye. This has spurred a tremendous amount of new research into dry eye in general and MGD in particular.

Dr. Shovlin reports on one study that looked at the effects of anti-inflammatory treatment in MGD. As you’ll see in the report, one of the study’s most interesting conclusions is that the clinical findings didn’t match the patients’ subjective ones.

Truly, there is never a dull moment in the world of dry eye management. In addition to this new knowledge of MGD, currently, many of your colleagues are debating more liberal use of steroids for dry eye—a topic on which Review will soon be hosting an online debate. (For more go to www.reviewofcontactlenses.com.)

And, next month, Review welcomes two special guest authors, Caroline A. Blackie, O.D. Ph.D., and Donald R. Korb, O.D. In their article, “MGD: Getting to the Root Cause of Dry Eye,” they call for a substantial shift in thinking with respect to dry eye.