Beginning my sixth year of practice focused on dry eye and ocular surface disease, I have reached pinnacles of clinical success that I never considered possible. The overwhelming majority of my patients are doing well—often life-changingly “well,” while the number of patients I struggle with has become miniscule. In turn, my understanding of the disease state and functional ocular surface physiology has exploded. I find each day an adventure in learning.

I attribute a good deal of my success to having figured out what works and what doesn’t. Managing “dry eye” is like putting together a huge jigsaw puzzle with many pieces. Over the coming months I will highlight some of the things that have made a difference in how I practice. For the cynical among you, I am not being paid to write this. These are my opinions and clinical experience.

Meibomian gland disease and resulting tear dysfunction are finally being recognized as the primary cause, or a major contributor, to what we typically call “dry eye.” Like most aspects of the human body, the physiology and pathophysiology of the lids are far more complex than they might seem. The cause and effect of lid disease is often overlooked. However, we can all agree that healthy lids play a critical role in maintaining ocular surface homeostasis.

I first met Jim Rynerson several years ago. Passionate and visionary, Jim is a practicing ophthalmologist and the inventor of BlephEx. Along with my long-time mentor, Dr. Hank Perry, Jim has dramatically expanded our understanding of the role the lids play in ocular surface disease. The work of these two individuals is worth reading. BlephEx has been a game changer for me.

When I first received my BlephEx, I had it pigeonholed as an automated lid and lash cleaner for patients with run-of-the-mill anterior blepharitis. While it remains a gold standard for blepharitis treatment, I quickly discovered that it held even greater value for debridement of the lid margins, removing tenacious biofilm and reducing staph overpopulation—all critical elements in the dry eye equation. Virtually all of my MGD patients receive BlephEx treatments. This tool has also become standard of care prior to Lipiflow or other manual expression. The difference it makes in outcomes is substantial.

We are increasingly scheduling repeat procedures every six months as part of an ongoing “dry eye” care regimen. We sometimes refer to this recurring care model as the “dental model,” since dentists pioneered regular oral hygiene and cleaning. As a result, patient acceptance of regular BlephEx treatments as preventative care is high. Based on my experience, if you are serious about dry eye, BlephEx should be part of your patient care algorithm.

Arthur B. Epstein, OD, FAAO Chief Medical Editor artepstein@optometricphysician.com