Using Tear Osmolarity for Diagnosis and Treatment

Dr. Darrell White has been researching the best way to care for patients in Cleveland with Dry Eye since the mid-1990's. He was one of the first doctors to prescribe Restasis for inflammatory Dry Eye when it was approved some 10 years ago. Recently he began using a new medicine, AzaSite, in the treatment of Evaporative Dry Eye caused by inflammation in the eyelid glands that produce the oil part of our tears. Here is Dr. White talking about a TOTALLY NEW WAY to use the TearLab tear osmolarity measurement to diagnose and treat dry eye:

"Now that we have two very different, very effective treaments for dry eye it's very important that we make an accurate diagnosis about the TYPE  of dry eye that is present. Are there TOO FEW tears, or are the tears NOT WORKING PROPERLY? Not only that, but we need to try our very best to find out WHY the eye is dry, why the tear production is low or the tears aren't doing their job.

Skyvision Centers was the first eyecare practice in Cleveland to use the TearLab Osmolarity instrument. Not only has it helped us make the diagnosis of Dry Eye in difficult, confusing settings, but we are now using it to choose the most appropriate starting treatment for Dry Eye. As far as we know we are the ONLY eye doctors who are using this instrument to make this choice.

In a nutshell here is what we do: if you have a high, abnormal tear osmolarity, a reading greater than 308, we view this as a sign that your PRIMARY abnormality is in the microscopic glands that produce the salt water, or AQUEOUS portion of your tears. Treatment is directed at these glands and often involves Restasis. If your osmolarity measurement is between 300-308 we do not feel that it adds to the decision on how to treat, and that decision is made solely on other signs we see on your exam.

If your tear osmolarity is below 300 and you have other signs of an EVAPORATIVE Dry Eye, especially if you have some signs of inflammation in your tear oil (meibomian) glands, treatment is directed at these glands and often includes AzaSite."

Dr. White, Dr. Schlegel, and Dr. Kaye will be publishing their protocol in both the ophthalmic and optometric journals, as well as sharing the results of their pilot study when they are available.