How to treat Ocular Surface Disease in the 21st Century?

1) Demodex Blepharitis

At-Home Product(s): Tea Tree Oil (TTO) wipe/gel, Avenova spray, Zocular Zocushield Gel. Consideration of Optimel Manuka eye drop (or gel).

Office-Based Procedure(s): BlephEx/ZEST, OptiLight IPL, Low Level Light Therapy (LLLT)

Topical/Oral Medication(s): Xdemvy eye drop (to treat Demodex blepharitis)

2) Chalazion/Hordeolum/Stye

At-Home Product(s): Omega-3 supplements (PRN DE3, HydroEye, MaxiTears Dry Eye formula, Nordic Naturals ProOmega), heat compress (Ocusci/Optase/Bruder eye mask, Dry Eye Mask, TearRestore eye mask, TranquilEyes goggle), Eyelid Hygiene (Avenova spray, Zoria Platinum foam, Optase wipe/gel, Zocular Zocushield Gel)

Office-Based Procedure(s): BlephEx/ZEST, OptiLight IPL, Low Level Light Therapy (LLLT), Thermal (Heat) Expression/Pulsation (Radiofrequency, TearCare, iLux, Lipiflow), Meibomian Gland Probing

Topical/Oral Medication(s): Azithromycin, Doxycycline (Oracea or Targadox), Minocycline, Maxitrol eye drop/ointment, Tobradex eye drop/ointment.

Surgical Intervention: Steroid injection vs Vertical Incision/Drainage

3) Ocular/Facial Rosacea

At-Home Product(s): Omega-3 supplements (PRN DE3, HydroEye, MaxiTears Dry Eye formula, Nordic Naturals ProOmega), Eyelid Hygiene (Zoria Platinum foam, Zocular ZocuShield Gel, Avenova Spray), cold compress (Optase cooling eye mask)

Office-Based Procedure(s): BlephEx/ZEST, OptiLight IPL, Low Level Light Therapy (LLLT), Meibomian Gland Probing.

Topical Creams/Gels (external use): Ivermectin 1%, Oxymetazoline 1%, Azelaic Acid 10% or 15%, MetroGel, Zilxi (Minocycline gel), Zoria AR Cream.

Oral Medication(s): Azithromycin, Doxycycline (Oracea or Targadox), Minocycline

4) Meibomian Gland Dysfunction (MGD)

At-Home Product(s): Omega-3 supplements (PRN DE3, HydroEye, MaxiTears Dry Eye formula, Nordic Naturals ProOmega), heat compress (Ocusci/Optase/Bruder eye mask, Dry Eye Mask, TearRestore eye mask, TranquilEyes goggle), Eyelid Hygiene (Avenova spray, Zoria Platinum foam, Optase wipe/gel, Zocular Zocushield Gel), preservative-free artificial tear (Optase MGD, Oasis Tears, iVizia, Retaine MGD)

Office-Based Procedure(s): BlephEx/ZEST, OptiLight IPL, Low Level Light Therapy (LLLT), Thermal (Heat) Expression/Pulsation (Radiofrequency, TearCare, iLux, Lipiflow), Meibomian Gland Probing

Topical Medication(s); MIEBO to treat signs and symptoms of dry eye disease associated with MGD. Consideration of steroid eye drops (Lotemax, Eysuvis, Flarex, FML, Klarity-L, Pred Forte)

5) Epiphora/Watery Eyes

At-Home Product(s): Omega-3 supplements (PRN DE3, HydroEye, MaxiTears Dry Eye formula, Nordic Naturals ProOmega), heat/cold compress (Ocusci, Optase, Bruder eye mask), Eyelid Hygiene (Avenova spray, Zoria Platinum foam, Optase wipe/gel, Zocular Zocushield Gel), preservative-free artificial tear (Optase MGD, Oasis Tears, iVizia, Retaine MGD)

Office-Based Procedure(s): Dilation & Irrigation (D&I), BlephEx, OptiLight IPL, LLLT, Thermal (Heat) Expression (Radiofrequency, Lipiflow, TearCare, iLux)

Topical Medication(s): Flonase/Budesonide

Surgical Intervention: Dacryocystorhinostomy (DCR)

6) Ocular Allergies

At-Home Product(s): Optase cooling eye mask, eyelid hygiene (Optase wipe vs Avenova spray), eye drops (Optase Allegro, Always PF, Pataday)

Office-Based Procedure(s): OptiLight IPL (for itchy eyes) & BlephEx/ZEST

7) Filamentary Keratitis (FK)

Office-Based Procedure(s): Removal by jeweler’s forceps, bandage contact lens, Prokera Amniotic Membrane, OptiLight IPL

Topical Medication(s): Mucomyst eye drop, Autologous Serum Tears, RegenerEyes PRO/LITE, Immunomodulators (ie Cyclosporine), Tyrvaya Nasal Spray

8) Neurotrophic Keratitis (NK)

Office-Based Procedure(s): Prokera Amniotic Membrane

Topical Medication(s): Oxervate (6x daily for 8 weeks), RegenerEyes PRO/LITE, consider Tyrvaya nasal spray