The Most Basic Way to Treat Dry Eye

HOT TOPIC

Got Dry Eye? Find That Funny Bone

A recent study published in the British Medical Journal found that laughter exercise was noninferior to artificial tears in reducing symptoms of dry eye disease (DED) and improved tear stability, with no significant differences in other outcomes.

The two-arm, noninferiority randomized controlled trial included 299 participants who were between 18 and 45 years of age and had symptomatic DED, an ocular surface disease index score of 18 to 80, and a fluorescein tear break-up time of ≥ 8 seconds. Participants were randomly assigned (1:1) to either the laughter exercise group (n = 149) or the control group using 0.1% sodium hyaluronic acid eye drops (n = 150); both were administered four times daily for 8 weeks.

The mean change in ocular surface disease index score at 8 weeks was −10.5 points (95% confidence interval [CI] −13.1 to −7.82) in the laughter exercise group and −8.83 points (95% CI −11.7 to −6.02) in the control group. The upper boundary of the CI for the difference in change between groups was lower than the noninferiority margin (mean difference −1.45 points [95% CI −5.08 to 2.19]; P = .43), supporting noninferiority. Among secondary outcomes, the laughter exercise was better in improving noninvasive tear break up time (mean difference 2.30 seconds [95% CI 1.30 to 3.30], P < .001); other secondary outcomes showed no significant difference. No adverse events were noted in either study group. This study highlights the potential of nonpharmacological treatments for DED, offering simple and enjoyable alternatives to our traditional methods. (Read more here.)

My Two Cents

These findings could have significant implications for the millions of people worldwide who live with dry eye, suggesting that adding more laughter to our daily lives could be a nice way to improve symptoms. If your practice has social media, this would be a good link to share, as it’s an interesting and relatable topic!

OUTSIDE THE LANE

Hair Dye and Vision Loss

A recent case report published in JAMA Ophthalmology highlights a concerning incident, where a French woman experienced significant vision loss from an ingredient in her hair dye. The woman, who had no prior history of vision problems, developed progressively blurry vision in both eyes after using a hair dye containing aromatic amines, more specifically para-phenylenediamine. Upon dilated fundus examination, doctors found multiple retinal detachments and thickening of the neurosensory retina, which is typically associated with retinopathies linked to certain enzymes in the eye.

After ruling out all other potential causes, the medical team concluded that the hair dye ingredient was responsible for the retinal damage. Quite remarkably, her vision returned to normal within 1 month after she switched to a hair dye free of aromatic amines, and she stated that she has not had any recurrence in the 4 years since the incident. (Read more here.)

My Two Cents

Good sleuthing! Here’s yet another potential cause to consider when confronted with an unknown retinopathy. This case underscores the importance of reminding our patients to exercise caution when using certain chemical products.

CAN YOU RELATE

This past week, I encountered the type of patient I rarely see in my clinic: a young pediatric with an acute problem. The child’s mother, one of my dry eye patients, brought in her 3-year-old daughter because the “ocular allergies” her pediatrician had diagnosed her with weren’t getting any better.

As you can see, the little girl had a clear-cut case of preseptal cellulitis that, according to her mom, had taken a turn for the worse in the last day. I was the second opinion because the girl’s mom was worried it wasn’t allergies and the recommended antihistamines may not be the best course of action.

The treatment for preseptal cellulitis is typically an oral antibiotic. Simple enough, right? Well, I can’t remember the last time, if ever, I prescribed an oral antibiotic for a 3-year-old! So, what did I do? The same thing I always do when I’m stumped by something eyeball-related. No, I didn’t google it! I texted my friends Kyle Campion, OD; Paul Kimbro, OD; and Zachary Boeskool, OD, from optometry school. We’ve been on an 11-year-long thread, where we talk almost every day about different eye cases, sports, kids, and life. Within a half hour of asking my question I had sound advice on which antibiotic to prescribe (amoxicillin/clavulanic acid was the universal consensus), as well as the appropriate dosage and frequency.

Sometimes we have to realize we can’t do it alone, and who better to bounce ideas off of than our trusted friends? If you don’t have a group text message or email thread, consider finding a small group of optometrists you know, respect, and enjoy talking with and create one! One day, you’ll be glad you have their expertise to fall back on.

IMAGE OF THE WEEK

Severe glaucoma.

Paul Hammond, OD, FAAO, @kmkoptometrypro

QUOTE OF THE WEEK

“A true leader is measured by the loyalty of his subjects, not the fear they instill.”

— Augustus, Roman statesman and military leader