Aqueous deficient dry eye (ADDE) can be easily overlooked when much of the clinical focus falls on meibomian gland dysfunction (MGD). At a recent Cornea and Contact Lens Society of Australia (CCLSA) continuing education evening for the New South Wales Chapter, optometrist Mark Koszek urged clinicians to look more closely – because “if you don’t look, you don’t find”.
The CCLSA NSW Chapter drew another full house for a continuing education evening on 9 September at Rydges Sydney Central.
Chapter President Sujan Hong opened with a virtual welcome, committee member Margaret Lam served as master of ceremonies, and optometrist and committee member Mark Koszek delivered an engaging, evidence-based session.
Mr Koszek’s central message was that ADDE is not simply a matter of the eyes “not making enough tears”. It is a complex inflammatory condition in which reduced tear volume, rising osmolarity and ocular surface inflammation feed a self-perpetuating cycle: less tear production drives higher osmolarity, which drives inflammation, which further damages the lacrimal gland and reduces tear production again. Although dry eye is divided into aqueous deficient and evaporative categories, the two commonly overlap, with some degree of aqueous deficiency present in up to 50% of patients with dry eye patients, Mr Koszek said.
Autoimmune Associations
Mr Koszek said that inflammatory component also explains why autoimmune disease can produce severe ADDE. T lymphocytes attack the body’s moisture-producing tissues, including the lacrimal glands. Sjögren syndrome is the classic example, while rheumatoid arthritis and lupus are important associations. Dry eye plus dry mouth, M Koszek noted, should immediately raise the possibility of Sjögren syndrome.
His key point was that ADDE cannot be diagnosed from symptoms alone. Simple, accessible clinical signs do much of the work: a low tear meniscus height, a reduced Schirmer result, and ocular surface staining. Conjunctival staining may precede corneal involvement and can point beyond the eye to systemic disease. A practical highlight was direct inspection of the palpebral lobe of the lacrimal gland – something Mr Koszek said many clinicians rarely examine.
Beyond Artificial Tears
Treatment, Mr Koszek stressed, requires more than another bottle of artificial tears. Where inflammation is driving the disease, options include topical corticosteroid for quick control and ciclosporin for longer term management, alongside omega-3 supplementation, punctal occlusion to conserve tears, platelet-rich growth factor preparations, and scleral lenses in severe cases.
The overarching message was that clinicans should actively look for ADDE. Optometrists play a key role in diagnosis, management, and triage, with many patients also requiring referral to an immunologist or rheumatologist. As Mr Koszek put it: “if you don’t look, you don’t find.”
CCLSA Chief Executive Officer Alan Saks closed the evening, and one lucky delegate took home an Anatomy of the Eye poster courtesy of mivision.
Industry Presentations
The evening was supported by a number of industry partners, each of which presented its approach to managing dry eye.
Alcon showcased the Systane dry eye range, built on a shared hydroxypropyl guar (HP-Guar) and borate technology across the portfolio, with different active ingredients for different types of dry eye. The drop stays fluid in the bottle, then, on contact with the ocular surface and its different pH, the HP-Guar and borate interact to form a soft, viscoelastic gel-like matrix in the eye to help retain the active ingredients on the eye.
Bausch + Lomb presented its Blink dry eye range, including Blink Intensive Tears and a minim formulation delivering a high dose of 0.2% hyaluronic acid, offering options from everyday lubrication through to more intensive, preservative-free relief for the ocular surface.
Sun Pharma discussed the progression from inflammation to restoration. Cequa is indicated to increase tear production in patients with moderate to severe dry eye disease where prior use of artificial tears has not been sufficient.
Good Optical presented Hylo Forte, a preservative-free eye lubricant formulated with long-chain hyaluronic acid of high molecular weight and viscosity.
OphthalmoPro presented OptiChoice, available in 0.2% and 0.4% sodium hyaluronate formulations. The different viscosities are intended on to meet the varying lubrication needs of dry eye patients.
Optopol ANZ presented ophthalmic equipment from Optopol Technology, along with brands including Mediworks, Norlase, Rexxam, Thermaeye, and Blephadex, positioning itself as a one-stop equipment supplier for optometry practices.
One More for the Year
CCLSA’s flagship still lies ahead: the 20th anniversary International Cornea and Contact Lens Congress (ICCLC), The Art of Possibility, in Hobart from 16–18 October, a celebration of innovation, collaboration, and community bringing together contact lens and ocular surface professionals from across Australia and beyond.
