Introduction
In Episode 17 of the Eye -Q Podcast, host Dr. Rudrani Banik delves into one of the most pervasive—and often underrecognized, ocular surface challenges: dry eye. Joining the conversation is Dr. Masako Chen, board-certified cornea surgeon at the New York Eye and Ear Infirmary of Mount Sinai and Associate Residency Program Director, whose expertise spans cataract and corneal transplant surgery as well as advanced dry eye management. Together, they unpack the complex anatomy of the tear film, explore the latest diagnostic tools (including point-of-care inflammation testing and emerging tear film imaging), and share practical strategies from eyelid hygiene to nutritional and environmental interventions that you can integrate into your practice. Whether you’re seeking to refine your approach to meibomian gland dysfunction or curious about personalized, layer-by-layer dry eye treatment, this episode delivers actionable insights to elevate patient care.

Topics Covered :Dry Eye Categories & Clinical AssessmentManagement of Meibomian Gland Dysfunction & DemodexLid Hygiene & Thermal TherapiesTherapeutic StrategiesContact Lens–Related Dry EyeNutritional & Lifestyle AdjunctsDemographics & Special PopulationsImplementing a Multilayered Assessment Protocol Dry Eye Categories & Clinical Assessment 1. Evaporative Dry Eye

When the lipid layer is compromised—often due to meibomian gland dysfunction—tears evaporate rapidly. Digital device users frequently report blur after prolonged screen time. On examination, expressibility of meibomian glands and gland dropout on meibography confirm evaporative dry eye.

2. Aqueous-Deficient Dry Eye

Insufficient tear production, linked to lacrimal gland hypofunction, autoimmune disease, or age, leads to persistent dryness and ocular staining. Schirmer testing quantifies tear volume, guiding therapies that boost aqueous secretion.

3. Inflammatory Dry Eye

Inflammation underlies many dry eye cases. Dr. Chen highlights point-of-care MMP-9 testing: “A tear test can reveal inflammatory markers guiding targeted anti-inflammatory therapy.” Positive results prompt initiation of cyclosporine A or lifitegrast to quell surface inflammation.

Management of Meibomian Gland Dysfunction & Demodex Lid Hygiene & Thermal Therapies

Dr. Chen emphasizes nightly lid cleansing to maintain meibomian gland health. Warm compresses or in-office thermal pulsation (e.g., LipiFlow) liquefy inspissated secretions. Tea-tree oil–based cleansers reduce Demodex mite load—common inflammatory contributors.

• Tip: Replace mascara monthly and avoid oil-based eye makeup to minimize mite proliferation.

Therapeutic Strategies

Anti-Inflammatory Drops

• Cyclosporine A (Restasis) and Lifitegrast (Xiidra) reduce ocular surface inflammation and increase tear production.
• Short-term corticosteroid pulses address acute flares before transitioning to maintenance immunomodulators.

Tear Supplements & Devices

• Preservative-free artificial tears with hyaluronic acid or PEG/PG provide symptomatic relief.
• Regenerating ointments at bedtime protect overnight tear film.
• Intranasal varenicline nasal spray (Teevra) stimulates reflex tear production twice daily.

In-Office Procedures

• Intense Pulsed Light (IPL) treats eyelid telangiectasias and improves meibomian gland function.
• Microblepharoexfoliation removes biofilm and Demodex debris at the lash margin.

Contact Lens–Related Dry Eye

Contact lens wear often exacerbates evaporative dry eye. Dr. Chen advises:

Daily disposables to minimize protein and lipid deposits. Lens-compatible rewetting drops (e.g., Visine L) for on-wear relief. Periodic lens holidays to allow ocular surface recovery. Scleral lenses for severe ocular surface disease, creating a tear reservoir and shielding against evaporation. Nutritional & Lifestyle Adjuncts

• Omega-3 supplementation: Clinical experience supports ≥2,000 mg/day of EPA/DHA to improve meibomian gland secretions and reduce inflammation.
• Hydration: Aim for 1.5–2 L of water daily to maintain systemic and tear film hydration.
• Environmental controls: Maintain indoor humidity at 30–50 %. Position workstations away from vents or fans to reduce tear evaporation.
• Screen breaks: Encourage the 20-20-20 rule (every 20 minutes, look at something 20 feet away for 20 seconds) and use desktop humidifiers for heavy screen users.

Demographics & Special Populations

Dr. Chen observes that postmenopausal women constitute the largest dry eye demographic, but she also treats younger patients with evaporative dry eye linked to extensive screen time. Glaucoma patients on multiple preserved eyedrops often present with diffuse ocular surface inflammation; switching to preservative-free formulations or considering MIGS (minimally invasive glaucoma surgery) at the time of cataract extraction can reduce drop burden and alleviate dry eye symptoms.

Implementing a Multilayered Assessment Protocol Detailed History: Document symptom triggers, digital habits, and topical medication use. Functional Testing: Tear breakup time, osmolarity, and Schirmer testing. Inflammation Screening: MMP-9 point-of-care assay. Imaging: Meibography and, when available, tear film imaging. Customized Treatment Plan: Address each tear film layer deficiency and inflammation with targeted interventions. Follow-Up & Maintenance: Reinforce lid hygiene, device therapies, and nutritional/lifestyle modifications.

Conclusion
Dry eye is a complex, heterogeneous disease requiring a precise, etiology-driven approach. By leveraging point-of-care inflammation assays, advanced tear film imaging, and a spectrum of pharmacologic, procedural, and lifestyle therapies, eye care professionals can deliver personalized, effective relief. Implement this multilayered protocol in practice and stay tuned for future advances in ocular surface care.