Dry Eye Corner Part 4

Observe the patient for visual clues that indicate dry eye disease

Traditionally, the diagnosis of dry eye disease (DED has been the sole preserve of the clinician, but in truth DED is a lifestyle condition, and its clues are often not overtly obvious during a routine eye examination or contact lens check.

Is the patient shielding their eyes from the air conditioning unit whilst trying on frames? Do they comment that their eyes are watery as it’s so windy outside, whilst making an appointment at the front desk? Do they mention that they wear their contact lenses less now due to discomfort during pre-screening?

A siloed approach to DED can miss these critical signals. A truly comprehensive dry eye clinic requires a ‘whole practice’ mindset, where the front of house (FOH) team is trained not just to greet, but to observe and listen whilst carrying out their normal duties.

In this article, we will encourage you to turn your FOH team into the first line of your clinical eyecare, not only saving chair time but improving patient outcomes and satisfaction, which will naturally lead to better patient retention.

Listening to the patient

Train staff to listen for the language of dry eye; listen out for any mention of tired or sore eyes, eyes that feel gritty especially in the mornings, heavy lids or even, paradoxically, eyes that profusely water especially when outside.

Listen out for any lifestyle clues, which can help identify any high-risk patients during check-in even, for example, heavy screen users, post refractive surgery patients or those mentioning the menopause or medications.

Pick up the silent contact lens drop-outs – patients who don’t mind telling the receptionist that they’re taking a break from lenses due to discomfort, but won’t necessarily tell the eyecare practitioner (ECP) for fear of being seen as a failure.

Observing the patient

Look out for patients in the waiting area who rub their eyes, blink a lot or are using over-the-counter eye drops.

Any of these observations can then be discreetly flagged to the ECP, who is conducting the examination, whether it’s a contact lens check or an eye examination, either personally or on the intake form.

Once the ECP has the FOH team’s observations, they can then diagnose what the problem is and recommend a solution. The FOH team isn’t prescribing – but importantly passing on critical observations for the ECP to consider.

Taking a dry eye questionnaire

It is possible to take this one step further and not only empower your staff to have that conversation with the patient but to then take it further and suggest a simple dry eye questionnaire to evaluate and quantify their symptoms before going in to see the ECP.

The recently published Tear Film & Ocular Surface Society Dry Eye Workshop: TFOS DEWS III recommends OSDI 6¹, which contains just six questions. It is very easy for the patient to complete in a short space of time, and equally easy to score.

Solutions through simple conversations

Many patients will play down their dry eye symptoms: “It’s part of getting older, nothing can be done” is a typical response that I hear in practice. When having this conversation with them, it is important to empathise that DED can have a negative impact on their quality of life² and there may well be things that we can do to improve it, and make everyday life more bearable.

Just a brief case history here, on the difference that this approach can make to patients..

Just a few of weeks ago, my receptionist booked in a patient who was unable to wear her contact lenses for more than a few hours and then needed a day without them for her eyes to recover. A simple slit lamp examination showed us what the problem was and, although she had a warm lid compress, her usage had dropped and her technique wasn’t the best. So a little revision on how to use it and a change in drops put her back on course, and she is now back to wearing contact lenses every day, all day.

Elevating the practice

For me, this whole team approach elevates the practice in the patient’s eyes (no pun intended). They feel cared for the moment they enter the practice and appreciate being ‘seen’ and ‘heard’; this will surely drive patient loyalty not only with appointments but also when it comes to buying products.

There is the ‘feel good factor’ for the team, spotting someone with issues which are then resolved – as well as the commercial benefits of recommending lid wipes, warm lid compress treatments, premium lubricating eyedrops or even in-house treatments.

Identifying the patient with dry eye problems is not just carried out in the consulting room, it is something that can, and I believe should, be a team effort.

Talking to patients whilst carrying out routine pre-screening, greeting or making appointments is not just being chatty, it is also a bit of detective work, making the day just a little bit more interesting.

References

1. Wolffsohn JS et al. TFOS DEWS III: Diagnostic Methodology American Journal of Ophthalmology 2025;279:387-450.
2. Schiffman RM et al. Utility assessment among patients with dry eye disease. Ophthalmology 2003 110;7:1412-9.

Next month, Keith will present a case study regarding scleral contact lenses and dry eye that resulted in a life-changing outcome for the patient.

Keith Tempany FBDO CL FBCLA qualified in 1976 and worked in both independent and multiple practice before opening a fee-based contact lens only practice in 2002. He is a fellow and a past president of the British Contact Lens Association (BCLA) and oversaw the development and launch of its Myopia Management Certificate. Keith is the store director of Leightons & Tempany Opticians & Hearing Care in Poole, and works as an independent consultant. He is an experienced author, lecturer and facilitator of contact lens and dry eye education both nationally and internationally.