My Dry Eye Clinic Saviours – What I Use Daily With My Patients

Dry eye, ocular surface and clinical management

Dry Eye Disease (DED) is one of the most common and complex challenges in modern optometric practice. Successful management depends on a layered, evidence-based approach, but also on consistency — the small things we do every day that transform patient outcomes.

In this article, I’ll share the key devices, products, and clinical habits that have become the saviours of my dry eye clinic. These are the tools I use daily in practice at Earlam & Christopher Optometrists and the technologies we distribute through SOS – Specialised Ophthalmic Services (https://sosophthalmic.co.uk) to other practitioners across the UK.

What does a typical Dry Eye consultation look like in your clinic?

A dry eye consultation at Earlam & Christopher begins long before the slit lamp. Every patient completes a validated symptom questionnaire such as the OSDI-6, which sets the tone for patient-centred care.

Then, using a structured TFOS DEWS III diagnostic framework, we combine subjective symptoms with objective clinical signs including:

• Non-invasive tear break-up time (NIBUT) using the Topcon MYAH
• Meibography to assess gland structure
• Tear meniscus height
• Corneal and conjunctival staining (Oxford scale)
• Blink analysis and lid dynamics
• Osmolarity
• Neurosensory assessment (cotton wisp test and anaesthetic challenge test)

These measurements help stratify disease into the primary mechanism — which then guides our treatment pathways using evidence-based resources including the new TFOS DEWS III management algorithms.

What equipment forms the backbone of your Dry Eye diagnostics?

Several devices have transformed the way we diagnose and monitor dry eye disease.

1. Automated tear film assessment

   The Topcon MYAH is my daily go-to device for subjective assessment including meibography and NIBUT. Its speed and repeatability make it ideal for integrating into busy clinics. The ability to track NIBUT with treatment and visualise gland loss in high-resolution greyscale images is a powerful communication tool — patients understand their condition instantly when they see it.

   Clinical tip: Always take a detailed look at the glands. Early truncation often precedes dropout and can be used to motivate compliance with at-home heat therapy.

2. Lid margin imaging and anterior segment photography

   We use a slit lamp camera system (SL-D701) supplied through Topcon to document ocular surface and adnexa pathology e.g. lid margin inflammation, Demodex collarettes, or punctate epithelial erosions. High-quality imaging supports longitudinal monitoring, but it also builds trust and engagement — patients love seeing their progress.

3. MG expression forceps and golf club spuds (Specialised Ophthalmic Services)

   We use reusable MG forceps and reusable golf club spuds supplied from Specialised Ophthalmic Services with virtually every dry eye patient. They are disinfected according to the College of Optometrists guidelines after every patient with a supplied system and protocol and we replace them approx. every 3 months. Given the positive evidence supporting gland expression, they are used as a therapeutic treatment but also as an essential part of our diagnostic work up. You REALLY can’t assess a gland without expression!

4. Light Therapies – Eye-Light® (Topcon/Espansione)

   This has become a true game-changer. The Eye-Light combines IPL (intense pulsed light) and LLLT (low-level light therapy) for treating meibomian gland dysfunction (MGD), ocular dysbiosis, rosacea, and even chalazia. We now use both the ocular and dermatology mask configurations daily in our clinics.

   Why it works: IPL reduces inflammation, coagulates abnormal telangiectasia, and decreases bacterial load. LLLT enhances mitochondrial activity, promoting gland function and periocular skin rejuvenation. The combination improves comfort, quality of life, and even aesthetic confidence.

What are your essential at-home treatment recommendations?

Patient education is the cornerstone of sustainable success. Every treatment plan we prescribe is matched with home-based maintenance. My clinic “saviours” are simple, evidence-backed devices, products and protocols that improve compliance and comfort, and have good evidence to support them.

1. Heat Therapy – The Right Way
   Most patients arrive using heat masks incorrectly — either too hot, too short, or inconsistently. We demonstrate proper technique in-practice:  mask set up and use, correct application for 10 minutes with gentle massage. Clinical pearl: Reinforce that gland obstruction is like butter in a blocked pipe — it must melt consistently to flow. Inconsistent heat is one of the top reasons for treatment failure.
2. Lid Hygiene – Less is More
   Lid hygiene has thankfully evolved way beyond baby shampoo. We recommend pH-balanced, preservative-free formulations with antimicrobial action that preserve skin microbiome balance. And don’t forget advice on cosmetics and their removal – good advice around this is essential too. Top tip: Patients with atopic tendencies benefit from gentle make-up removers and barrier-repair creams around the lids after cleansing to prevent irritation.

How do you approach lubrication and drop selection?

Lubricants are still the most commonly prescribed dry eye therapy, but the challenge is matching formulation to root cause. I categorise by osmolarity, viscosity, and mechanism.

My personal clinic favourites:

• Sodium hyaluronate as a great all round lubricant ideal for DED, preservative-free
• Osmoprotectant to stabilise epithelial cells against oxidative stress — brilliant for screen users
• Manuka honey for anti-inflammatory and antimicrobial action
• Perfluorohexyloctane to support lipid layer stability
• Ointment: for nocturnal lagophthalmos / recurrent erosions

Clinical tip: Always check for preservative overload. Encourage a prescriptive preservative-free drop regimen.

What role does photobiomodulation play in your clinic?

Photobiomodulation (PBM) is one of the most exciting frontiers in ocular surface and now aesthetic care. In the Ocular+ aesthetics clinic (our dedicated aesthetics arm), we use the Eye-Light LLLT masks for both ocular and dermatological indications.

Indications and effects:

• Dry eye / MGD: stimulates meibocyte metabolism and improves lipid secretion
• Periocular dermatitis: reduces inflammation and erythema
• Rosacea treatment: promotes anti-inflammatory healing
• Aesthetic rejuvenation: enhances skin luminosity, collagen and elastin and patient satisfaction

The non-contact, comfortable design makes it a non-invasive entry point for nervous patients or those not suitable for IPL. Sessions last 15 minutes and are typically delivered in courses of 4.

How do you incorporate nutrition and lifestyle into your management plans?

The TFOS Lifestyle Report (2023) highlights the impact of diet, environment, and digital behaviour on the ocular surface. We routinely discuss:

• Omega-3 supplementation: 1,000–2,000 mg EPA/DHA daily, ideally re-esterified triglyceride form
• Hydration and reduced alcohol intake (and the benefit of caffeine!)
• Environmental humidification – bedroom humidifiers, avoiding direct airflow
• Blink training for screen users – “20-20-20 and full blink” or blink drink rules
• Makeup hygiene – a list of top 10 nasties to avoid and monitoring expiry dates

Pearl: Keep sample “makeup hygiene and common nasties” cards alongside our make up and make up remover products in reception. Patients love a quick visual checklist.

What are your best tools for patient education and motivation?

Engaged patients get better results. We use a combination of digital visuals, printed treatment plans, and follow-up calls.

Daily clinic saviours for engagement:

• Printed “My Dry Eye Plan” cards with personalised plans for heat, hygiene, drops, and nutrition
• Before-and-after images to show objective progress
• Short follow-up review calls at 4–6 weeks to adjust compliance and reinforce education

We also stock a full range of key products so patients can purchase the right home management goody bag immediately — reducing drop-off between recommendation and use.

What are the most common patient mistakes you see and how do you prevent them?

Common Error	Why it Matters	How We Correct It
Inconsistent heat therapy	Leads to recurrent blockage and poor compliance	Demonstrate technique and schedule daily reminders / “mydryeye” a free app
Over-cleaning lids	Damages skin barrier, increases irritation	Educate: “clean, don’t scrub”; use gentle formulations
Preserved drops	Causes toxicity and paradoxical dryness	Rationalise to preservative-free system
Ignoring lifestyle	Digital, exercise, sleep, dietary triggers perpetuate inflammation	Provide lifestyle checklist and Omega-3 guidance
Stopping once symptoms improve	Disease recurs quickly	Reinforce that DED is chronic and maintenance is lifelong

What advice would you give to practitioners setting up or refreshing their dry eye clinic?

1. Start with consistency, not complexity: A small suite of dependable diagnostics (MG expression forceps, golf club spud, good slit lamp and educate yourself) is enough to begin.
2. Use validated questionnaires: They make reviews measurable and defensible.
3. Invest in imaging: Showing gland loss transforms patient understanding — and compliance.
4. Use the evidence – TFOS DEWS III algorithms: Gain a good understanding of the current array of options and evidence.
5. Train your team: Staff-led education ensures consistency across every appointment.
6. Power of Light: Integrate IPL and PBM, and even skin-friendly periocular care — it broadens your demographic and enhances patient confidence.

Remember: A successful dry eye clinic isn’t just about treating symptoms — it’s about building trust, demonstrating science, and showing visible improvement.

How do you measure success in your dry eye patients?

Success is a blend of subjective improvement and objective change. I reassess amongst others:

• Symptom score (OSDI-6)
• TBUT and staining
• Gland function (expressibility and quality)
• Patient satisfaction and lifestyle impact

Even a 20–30% improvement in symptom score can be life-changing for chronic sufferers. The key is setting expectations early: dryness may never vanish, but control and comfort are achievable.

What new innovations excite you most?

The future of ocular surface care lies in truly personalised and targeted therapy.

• Artificial intelligence imaging will soon detect early MGD patterns and recommend targeted interventions.
• PBM and aesthetics evolving to proactively be more holistic in our options to reduce inflammation and improve periocular skin.
• Regenerative therapies (e.g. neurotrophic focussed and peptide-based pro-healing drops) are on the horizon, aiming to restore ocular surface homeostasis and regenerate corneal nerves rather than just replace tears.

The next era of dry eye care will merge optometry ophthalmology, dermatology, and aesthetics — treating the whole periocular ecosystem.

Summary Table: My Dry Eye Clinic Saviours

Category	Product/Device	Why I Love It
Diagnostic	Topcon MYAH	Meibography, NIBUT, axial length in one platform
Treatment Device	Eye-Light IPL + LLLT	Dual-mode therapy for MGD and periocular rejuvenation
Heat Therapy	USB/ microwave pad	Reliable, safe, reusable masks
Lid Hygiene	Lid wipes, hypochlorous, specific make-up and make up remover	Gentle antimicrobial cleansing and skin barrier repair
Lubrication	Wide range covering all bases	Preservative-free comfort
Procedures	BlephEx, manual expression	Removes biofilm, improves lipid flow
Adjunct	Omega-3, blink training, humidification	Supports tear film balance
Aesthetic/Regenerative	Full face derma LLLT	Enhances mitochondrial and dermal function

Key Take-Home Points

• Evidence + empathy = success. Combine objective diagnostics with patient-centred listening.
• Heat, hygiene, and habit form the foundation — compliance is everything.
• Show, don’t tell: Imaging and education are your strongest motivators.
• PBM and IPL bridge the gap between medical and aesthetic dry eye care.
• Stock what you trust: Using and demonstrating products you personally believe in enhances authenticity and revenue.
• Dry eye clinics thrive on consistency, not complexity. Master a few core tools, and results will follow.

Disclosure

Ms. Farrant is the co-founder of SOS: Specialised Ophthalmic Services, a UK distributor of reusable and single use diagnostic equipment for ocular surface and acute schemes delivery in practice. She also operates the Dry Eye Clinic at Earlam & Christopher Optometrists in Somerset.