Published in Ocular Surface

The Simple Dry Eye Workup for Primary Care Optometrists

Cory J. Lappin, OD, MS, FAAO

Cory J. Lappin, OD, MS, FAAO

This is editorially independent content
26 min read
Share
Copy Link

Consider these simple steps for primary care optometrists to incorporate dry eye and ocular surface disease (OSD) evaluations into routine eye exams.

The Simple Dry Eye Workup for Primary Care Optometrists
Dry eye and ocular surface disease are two of the greatest areas of interest in modern eyecare. Due to this attention, we now have more diagnostic and treatment options to manage dry eye disease (DED) and ocular surface disease (OSD) than ever before.
From meibomian gland imaging studies with meibography to treatments using intense pulsed light (IPL), the ability to diagnose and treat DED and OSD has reached new heights.

Getting started with a dry eye and OSD workup

That being said, this progress may have brought with it some unforeseen consequences. One thing I am hearing more and more from eyecare providers (ECPs) is that—considering all these advancements—they feel ill-equipped to manage DED if they don’t have the latest and greatest diagnostic and treatment devices. This is an unfortunate concern, but thankfully, one that can easily be alleviated.
Although advanced testing and in-office treatment procedures are helpful in managing dry eye, they are by no means a prerequisite to initiating dry eye treatment for the majority of patients. Even in our dedicated dry eye and ocular surface disease clinic, some of the most effective diagnostic testing and treatment options I routinely use are available to ECPs in nearly any setting.
This guide discusses a simple but effective dry eye and ocular surface disease workup that is accessible to all ECPs, whether they practice in an advanced dry eye center or a primary eyecare office.

It all starts with the patient

One of the most powerful diagnostic tools we have at our disposal requires no equipment at all. The late Dr. Art Epstein was fond of saying, “Our patient is the most sensitive instrument we have.” And from my early years in practice working alongside Dr. Epstein to today, I have found this statement to hold true time and time again.

Treating DED and OSD all starts with a thorough patient history:

If you listen closely to a patient’s specific signs and symptoms, they will often lead you directly to the underlying cause of their DED.

I recommend starting by asking open-ended and broad questions such as, “How are your eyes feeling in terms of comfort? Do your eyes ever feel dry, scratchy, or irritated?” Based on their initial response, my questions become more targeted to allow me to hone in on specific conditions such as meibomian gland dysfunction (MGD) or nocturnal lagophthalmos.
Additionally, dry eye questionnaires are readily available tools that also allow you to quantify a patient’s dry eye symptoms, providing objective testing data that requires no additional testing equipment.

Considerations for the exam

Diagnosis and assessment of DED and OSD can be easily carried out with equipment and items commonly found in any practice, including a slit lamp, vital dyes, a transilluminator, and a cotton-tipped applicator. After a patient provides their history, a careful slit lamp exam is largely all that is required to diagnose the vast majority of OSD.
When assessing a patient’s ocular surface health, I recommend taking a consistent, systematic approach to evaluating the ocular surface by looking specifically at each constitutive element.

1. The lids and lashes

Although they do not traditionally receive as much attention as the cornea and conjunctiva, the eyelids and lashes play a significant role in ocular surface homeostasis. It is recommended to assess both their structure and function.

Slit lamp exam findings

Evaluating the eyelids and lashes while having the patient look straight ahead and then down will allow for the detection of numerous OSDs. When the patient looks down, lash collarettes, which are waxy, cylindrical buildups found at the base of the lashes (as seen in Figure 1), serve as the hallmark sign of Demodex blepharitis and can easily be detected.1-4
The presence of spidery telangiectatic blood vessels, also seen in Figure 1, can be suggestive of ocular rosacea.5,6 Notching, keratinization, thickening of the lid margin, or lash loss can be indicative of chronic inflammation, and the presence of saponification or foamy/frothy tears can signal the presence of bacterial blepharitis.7
Further, having the patient blink while behind the slit lamp can aid in the assessment of lid function and blinking mechanics. As the patient blinks, pay close attention to partial or incomplete blinks since they can be potential contributing factors to a patient’s dryness, as incomplete blinks are associated with DED.8 Additionally, lid position can easily be evaluated and reveal ectropion, entropion, lower lid laxity, inferior scleral show, or trichiasis.
I also highly recommend gently lifting the upper lid while the patient is looking down, as this can reveal floppy eyelid syndrome (FES) if there is excessive laxity, effortless lid eversion, or the lid easily pulls away from the globe.9
Figure 1 highlights a patient with lash collarettes and spidery telangiectatic blood vessels, potentially indicative of Demodex blepharitis and ocular rosacea.
Demodex blepharitis
Figure 1: Courtesy of Cory Lappin, OD, MS, FAAO.

Transilluminator exam findings

Beyond a slit lamp evaluation, the use of a transilluminator to assess lid closure is a simple but incredibly valuable diagnostic test. To check for lagophthalmos, have the patient tilt their head back and gently close their eyes while shining the light of the transilluminator where the lids meet. If you see the white of the sclera, like in Figure 2, or a glint of light reflected back, this indicates incomplete lid closure.10,11
Additionally, the Korb-Blackie light test can be performed by dimming the lights, having the patient close their eyes, and then placing the transilluminator directly on the upper lid. If you see light shining through the interpalpebral area, this is evidence of a poor lid seal.12
Both of these findings can be significant contributors to DED, as they can lead to nocturnal exposure, discomfort upon waking, and recurrent corneal erosions (RCEs). These patients will often complain of nighttime and morning dryness while typically exhibiting inferior corneal staining in the exposed area.
Figure 2 features a patient with incomplete lid closure, as shown by an exam with a transilluminator.
Incomplete lid closure
Figure 2: Courtesy of Cory Lappin, OD, MS, FAAO.

2. The meibomian glands

Meibomian gland structure and function can be easily evaluated through slit lamp examination and the use of a transilluminator. Gland capping or an inflamed appearance of the glands, like that present in Figure 3, can be indicative of MGD.
The quality of the meibum can be assessed by applying gentle, sustained pressure to the eyelid with either a finger or cotton-tipped applicator. If the glands produce a cloudy, turbid, or thick, toothpaste-like secretion, this may be suggestive of MGD, as meibum will ideally have a clear, olive oil-like consistency. If there is no secretion at all, this may indicate the non-producing gland has atrophied.13
A simplistic way to assess meibomian gland structure in more detail is to evert the eyelid and then transilluminate the lid by placing a transilluminator against the external portion of the lid. This will allow visualization of the entire gland structure and reveal any potential structural disruptions such as tortuosity or dropout.13-15
Figure 3 demonstrates a patient with inflamed meibomian glands, likely caused by MGD.
Meibomian gland dysfunction
Figure 3: Courtesy of Cory Lappin, OD, MS, FAAO.

3. The tear film

The quality of the tear film provides vital information about the health of the ocular surface. Tear breakup time (TBUT) and tear meniscus height evaluation are both valuable and easily performed assessments that require only the use of sodium fluorescein dye and the cobalt blue filter of the slit lamp, as in Figure 4.

TBUT and tear meniscus height evaluation

A TBUT value of 10 seconds is generally considered normal, with any shorter time being suggestive of DED.16-17 While a reduced TBUT is traditionally associated with the premature tear film evaporation present in MGD and evaporative dry eye, it can also be reduced in aqueous deficient dry eye.18
Measuring tear meniscus height can provide vital information regarding tear production. The tear meniscus height is highly correlated with tear film volume, as the meniscus holds an estimated 70 to 90% of the total tear volume on the ocular surface.19-22
A height of ~0.3mm is considered normal, whereas a height of less than 0.2mm can be indicative of aqueous deficiency, and heights above 0.45 to 0.50mm are suggestive of possible overproduction of tears as a compensatory mechanism for dryness, which can lead to epiphora.23,24
Figure 4 shows a TBUT and tear meniscus height evaluation using a sodium fluorescein dye and cobalt blue filter at a slit lamp.
Tear meniscus
Figure 4: Courtesy of Cory Lappin, OD, MS, FAAO.

Schirmer strips

Though traditionally used to assess tear production, the use of Schirmer strips has inherent flaws that result in the test providing little real-world value in my clinical experience. When a test strip is inserted into the lower fornix, it stimulates reflex tearing, which is innately different from the basal tear production we are interested in when assessing dry eye.
If an anesthetic is instilled to prevent the stimulation of reflex tearing prior to strip insertion, the results are still altered due to the anesthetic blocking nerve sensation, which is vital to normal blinking and tear production. In fact, it has been shown that Schirmer testing, in general, has poor sensitivity, specificity, and reproducibility.19,21 Therefore, more noninvasive means of assessing tear production are recommended.

Slit lamp mirror reflection of the tear film

A lesser utilized but still helpful assessment of tear film quality can be performed by evaluating the quality of the reflection of the slit lamp mirror on the tear film. If the reflection appears crisp and clear, as shown in Figure 5, this indicates a healthy tear film, whereas a blurry or unstable reflection demonstrates tear film instability or poor quality. Likewise, the presence of debris or overly mucoid tears also signals tear film dysfunction associated with DED.
Figure 5 highlights a healthy tear film with a clear reflection from a slit lamp mirror reflection.
Slit lamp mirror reflection
Figure 5: Courtesy of Cory Lappin, OD, MS, FAAO.

4. The cornea and conjunctiva

The health of the cornea and conjunctiva are readily evaluated using sodium fluorescein and lissamine green vital dyes as well as direct observation. Areas that stain with sodium fluorescein—which is ideal for assessing the cornea—represent damaged and/or devitalized cells as well as epithelial defects.23,25 Lissamine green provides greater contrast, which makes it a better choice for evaluating the conjunctiva, and stains dead and devitalized cells.25

Corneal findings

The staining pattern itself also provides valuable information. An inferior band of staining, as displayed in Figure 6, is commonly seen in cases of lagophthalmos, especially where there is nocturnal exposure, while interpalpebral staining can represent incomplete blinking.23 Diffuse corneal staining can be due to inflammation and is often associated with aqueous deficiency and inflammatory conditions like Sjögren’s syndrome.26
Staining of the lid wiper region, which is adjacent and posterior to the line of Marx and is responsible for spreading tears over the ocular surface with each blink, represents lid wiper epitheliopathy (LWE) and is thought to result from mechanical friction between the lid wiper and the ocular surface due to dryness.27 Therefore, the presence of staining with either dye can represent ocular surface stress, damage, and/or inflammation.28
Figure 6 features an inferior band of staining with sodium fluorescein dye, which is often associated with lagophthalmos.
Corneal staining
Figure 6: Courtesy of Cory Lappin, OD, MS, FAAO.

Conjunctival findings

Although conjunctival hyperemia is often dismissed as a purely cosmetic concern, significant conjunctival injection can also represent ocular surface stress and inflammation as the conjunctival vessels dilate in response to a myriad of insults such as excess dryness or mechanical irritation.29-32 Therefore, ocular redness can be penciled in as another key indicator of DED and OSD.
The palpebral conjunctiva provides findings that are helpful in diagnosing both dryness and allergies. The presence of papillae, as shown in Figure 7, alongside stringy or ropey discharge and complaints of itching are hallmark findings of ocular allergy.33-45 Large papillae can be suggestive of mechanical friction induced by ocular surface dryness, especially in contact lens wearers, which manifests as giant papillary conjunctivitis (GPC).46-48
Figure 7 demonstrates a patient with papillae, which is usually indicative of ocular allergies.
Papillae
Figure 7: Courtesy of Cory Lappin, OD, MS, FAAO.

Corneal nerve findings

An often-overlooked component of the ocular surface is the corneal nerves. However, the health and function of the nerves can be tested by teasing and forming a wisp at the end of a cotton-tipped applicator.
The wisp can then be touched against the cornea in four quadrants and centrally to assess corneal sensation, as is demonstrated in Figure 8.49,50 If the patient displays reduced or absent sensitivity, this is indicative of nerve dysfunction and can represent neurotrophic keratitis (NK).51-53
While I recommend performing corneal sensitivity testing on all dry eye patients, it is especially important to perform on refractive surgery patients or patients with a history of herpetic infection as these are two common causes of NK.54,55 If you are unsure if a patient’s symptoms are due to direct ocular surface disruption or some other cause, the instillation of topical anesthetic can help aid in this differentiation.
Further, if the patient’s symptoms improve upon anesthetic instillation, this likely means the source of their discomfort is direct ocular surface disruption, whereas if the symptoms persist, this suggests the pain may stem from a different source, such as centralized neuropathic pain.56
Figure 8 shows a patient undergoing a corneal sensitivity examination with a cotton-tipped applicator.
Corneal sensitivity exam
Figure 8: Courtesy of Cory Lappin, OD, MS, FAAO.

Creating a foundational dry eye treatment regimen

Just as I recommend taking a systematic approach to evaluating the ocular surface, I likewise recommend creating a treatment plan that addresses DED and OSD in the same manner. We all know DED is multifactorial as it can stem from dysfunction of any component of the ocular surface, as each of its constitutive elements needs to work in concert to maintain homeostasis.57,58
Therefore, each contributing element of DED must be addressed to treat an individual patient’s DED completely. And, again, getting a patient started on a foundational DED treatment does not require any advanced treatment devices, just a targeted plan that addresses each element of their DED.

Treating the lids and lashes

Lid hygiene is a vital element of any foundational dry eye treatment regimen. Hypochlorous acid-based cleansers, such as HyClear (hypochlorous acid 0.01%, Contamac), Optase Protect (hypochlorous acid 0.015%, SCOPE), and NeutraWipes (hypochlorous acid 0.0125%, TearRestore), are excellent choices for controlling bacterial blepharitis.59
Tea tree oil (TTO), like Advanced Formula 2% Tea Tree Eyelid & Facial Cleanser (EyeEco), OPTASE TTO Eyelid Cleansing Gel (SCOPE), and Cliradex Light Foam (Cliradex), as well as okra-based cleansers like ZocuFoam Eyelid Cleanser and Moisturizer and ZocuWipes (Zocular) can also be utilized as they help reduce the number of Demodex mites present on the lids and lashes.60-65
Although TTO can be helpful in reducing Demodex populations, it is a relatively harsh treatment that can induce an increased amount of symptomatology, including irritation for some patients.66 However, for cases of Demodex blepharitis (DB), we now have the first and currently only FDA-approved medication specifically indicated for the treatment of DB with Xdemvy (lotilaner ophthalmic solution 0.25%, Tarsus Pharmaceuticals), which can successfully reduce mite population, collarette number, and redness.67-69
Blink exercises can promote proper blinking mechanics and reduce the number of incomplete blinks.70 Nocturnal gels and ointments, including Siccasan gel (AGEPHA Pharma) and HYLO Night ointment (SCOPE), can aid in protecting the ocular surface from drying out in cases of nocturnal exposure as well as employing sleep goggles, such as Eyeseals 4.0 (EyeEco), or adhesive eye patches, like SleepTite/SleepRite (Ophthalmic Resources Partners).

Treating the meibomian glands

Omega-3 fatty acid supplementation is a staple of dry eye treatment as it has been shown to improve the signs and symptoms of DED and MGD.71-73 In fact, one study found that 70% of dry eye patients became asymptomatic using only an omega-3 supplement and artificial tears.74
However, to get the maximum benefit of omega-3, it is recommended to use a supplement that includes a high quality, re-esterified, triglyceride-based omega-3 supplement with a 3:1 eicosapentaenoic acid (EPA) to docosahexaenoic acid (DHA) ratio and at least 2 grams of combined EPA and DHA, such as DE3 Omega Benefits (PRN Vision Group).71-73
Warm compresses can provide increased comfort by aiding in the melting of stagnant meibum in MGD.75,76 However, the use of a dedicated dry eye compress such as a Dry Eye Relief Mask (EyeEco), Bruder Moist Heat Eye Compress (Bruder Health), Open-Eye Thermal Mask (TearRestore), or Electric Heated Dry Eye Mask (Wizard Research), is recommended over the use of at-home compresses, such as washcloths, as they may retain a higher level of heat for a longer duration of time.76
The use of oral agents such as doxycycline and azithromycin can also be helpful in managing DED and OSD, as they have anti-inflammatory properties that are retained at even low doses and have been shown to be beneficial in the management of MGD and ocular rosacea.77-81 Additionally, topical azithromycin in the form of AzaSite (azithromycin ophthalmic solution 1%, Théa) has also been shown to be beneficial in the treatment of MGD.82-84

However, the use of doxycycline should be avoided in pregnant and nursing patients as well as children 12 years old and younger due to the side effect profile.77-80

Treating the tear film

While addressing the underlying causes of tear film instability, such as MGD, will intrinsically improve tear film quality, there are also treatments available to help bolster these effects. Artificial tears are the most commonly used treatment for DED; their impact is primarily palliative but still can provide quick symptom relief when needed.85-88
When choosing an artificial tear, it is recommended that a preservative-free (PF) formulation be used. A PF lipid-based artificial tear can be useful in cases of MGD, and a non-lipid PF artificial tear can be beneficial for use with contact lenses.
In terms of prescription treatments, MIEBO (100% perfluorohexyloctane ophthalmic solution, Bausch + Lomb) essentially acts as a tear film stabilizer as it mimics the function of natural meibum by forming a protective monolayer over the lipid layer, which reduces premature evaporation, making it a viable option for MGD treatment.89-91
Tyrvaya (varenicline solution nasal spray 0.03mg, Viatris) is a neurostimulatory agent that increases natural tear production via nasal stimulation of the trigeminal parasympathetic pathway, which can be particularly helpful in cases of aqueous deficient dry eye.92,93

Treating the cornea and conjunctiva

Ocular surface staining and injection are often signs of inflammation and, therefore, may require the use of anti-inflammatory agents. Although topical corticosteroids are the most effective anti-inflammatory treatment, they are not fit for long-term use due to potential side effects, including premature cataract formation, increased intraocular pressure, and glaucoma development.94-100

Topical treatments for DED and OSD

Therefore, an LFA-1 antagonist such as Xiidra (lifitegrast 5% ophthalmic solution, Bausch + Lomb) and immunomodulators including Cequa (cyclosporine 0.09% ophthalmic solution, Sun Pharmaceuticals), Vevye (cyclosporine 0.1% ophthalmic solution, Harrow), and Restasis (cyclosporine 0.05% ophthalmic emulsion, Allergan, An AbbVie Company), are more appropriate long-term treatment options as they tend to reduce inflammation without carrying the side effect profile associated with prolonged steroid use.
This does not mean, however, that topical steroids do not have a place in DED management. Topical steroids, like Eysuvis (loteprednol etabonate ophthalmic suspension 0.25%, Alcon), are well-suited for the short-term management of dry eye flares and, under proper ECP supervision, can be used sparingly as a “rescue” drop, similar to a rescue inhaler, to provide rapid relief when patients are experiencing a “bad eye day.”101

Biologic treatments such as autologous serum (AS) tears and platelet-rich plasma (PRP) drops can also be beneficial in treating DED, especially where there is significant inflammation and corneal surface disruption, as both have anti-inflammatory properties and encourage ocular surface healing.102-110

Targeting conjunctival hyperemia

If a patient is experiencing significant conjunctival hyperemia, the goal would be to address the underlying cause. However, patients often desire a drop that can provide quick cosmetic redness relief when needed, such as for special events or social outings.
In such cases, Lumify (brimonidine tartrate ophthalmic solution 0.025%, Bausch + Lomb) can be recommended as the rebound effect observed with the use of other redness relievers is less common with Lumify.111-113

Managing ocular allergies

For patients displaying signs of ocular allergy, which is a common comorbidity of DED, topical antihistamine/mast cell stabilizer combination drops, such as Pataday Once Daily Relief Extra Strength (olopatadine hydrochloride ophthalmic solution 0.7%, Alcon), Lastacaft (alcaftadine ophthalmic solution 0.25%, Allergan, An AbbVie Company), and Alaway Preservative Free (ketotifen fumarate ophthalmic solution 0.035%, Bausch + Lomb) are suitable treatment options.
These drops quickly relieve itching and inflammation by inhibiting the action of histamine and preventing further degranulation of histamine by blocking the binding of allergens to mast cells.33,39,40,114,115
Additionally, Optase Allegro (SCOPE) is another effective treatment option for ocular allergies. This product is composed of both a lubricating agent in the form of hydroxyethyl cellulose and an anti-allergy agent in the form of ectoin, which functions through the mechanism of preferential exclusion whereby water molecules are drawn close together by the ectoin forming a “water shield” that blocks allergens from reaching the ocular surface.116-118

Time to get started

While all the advancements in DED and OSD diagnostics and therapeutics have improved our ability to treat these conditions, managing DED does not require having a fully equipped dry eye center of excellence to get started.
A thorough patient history, careful slit lamp exam, and the use of other readily available tools such as vital dyes, a transilluminator, and cotton-tipped applicators are all that are needed to get started diagnosing and treating DED.
A patient’s answers to a few specific questions about their symptoms plus one or two clinical signs will allow you to diagnose the majority of DED and OSD effectively you will encounter in the course of routine patient care.

Conclusion

Once the diagnosis has been made, the majority of patients can potentially improve by leveraging basic, foundational treatments such as omega-3 supplementation, lid hygiene, blink exercises, warm compresses, and artificial tears, along with an immunomodulator, tear film stabilizer, steroid or neurostimulatory agents, when medically necessary.
Therefore, if you have been wanting to dive in and treat dry eye and ocular surface disease but feel like you lack the appropriate diagnostic equipment or treatment devices to do so, in actuality, you likely already have everything you need, so now is the time to get started!
  1. Nicholls SG, Oakley CL, Tan A, Vote BJ. Demodex species in human ocular disease: new clinicopathological aspects. Int Ophthalmol. 2017;37(1):303-312.
  2. Gao YY, Di Pascuale MA, Li W, et al. High prevalence of Demodex in eyelashes with cylindrical dandruff. Invest Ophthalmol Vis Sci. 2005;46(9):3089-3094.
  3. Liang L, Ding X, Tseng SC. High prevalence of demodex brevis infestation in chalazia. Am J Ophthalmol. 2014;157(2):342-348.e1.
  4. Bitton E, Aumond S. Demodex and eye disease: a review. Clin Exp Optom. 2021;104(3):285-294. doi:10.1111/cxo.13123
  5. Wilkin J, Dahl M, Detmar M, et al. Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea. J Am Acad Dermatol. 2002;46(4):584-587. doi:10.1067/mjd.2002.120625
  6. Vieira ACC, Höfling-Lima AL, Mannis MJ. Ocular rosacea--a review. Arq Bras Oftalmol. 2012;75(5):363-369.
  7. Putnam CM. Diagnosis and management of blepharitis: an optometrist's perspective. Clin Optom (Auckl). 2016;8:71-78. doi:10.2147/OPTO.S84795
  8. Hirota M, Uozato H, Kawamorita T, Shibata Y, Yamamoto S. Effect of incomplete blinking on tear film stability. Optom Vis Sci. 2013;90(7):650-657. doi:10.1097/OPX.0b013e31829962ec
  9. De Gregorio A, Cerini A, Scala A, et al. Floppy eyelid, an under-diagnosed syndrome: a review of demographics, pathogenesis, and treatment. Ther Adv Ophthalmol. 2021;13:25158414211059247. doi:10.1177/25158414211059247
  10. Tsai SH, Yeh SI, Chen LJ, et al. Nocturnal lagophthalmos. Int J Gerontol. 2009;3(2):89-95.
  11. Kabat A, Sowka J. Like Sandpaper in the Morning. Review of Optometry. Published April 16, 2012. Accessed September 16, 2023. https://www.reviewofoptometry.com/article/like-sandpaper-in-the-morning.
  12. Blackie CA, Korb DR. A novel lid seal evaluation: the Korb-Blackie light test. Eye Contact Lens. 2015;41(2):98-100. doi:10.1097/ICL.0000000000000072
  13. Tomlinson A, Bron AJ, Korb DR, et al. The international workshop on meibomian gland dysfunction: report of the diagnosis subcommittee. Invest Ophthalmol Vis Sci. 2011;52(4):2006-2049. doi:10.1167/iovs.10-6997f
  14. Hom MM. How to perform in-office Meibography. Review of Optometry. July 15, 2002. Accessed September 16, 2023. https://www.reviewofoptometry.com/article/how-to-perform-in-office-meibography.
  15. Fuller D. A better meibomian gland work-up: See what you’ve been missing. Review of Optometry. May 15, 2016. Accessed September 16, 2023. https://www.reviewofoptometry.com/article/a-better-meibomian-gland-workup-see-what-youve-been-missing.
  16. Vidas Pauk S, Petriček I, Jukić T, et al. Noninvasive Tear Film Break-up Time Assessment Using Handheld Lipid Layer Examination Instrument. Acta Clin Croat. 2019;58(1):63-71. doi:10.20471/acc.2019.58.01.09
  17. Pflugfelder SC, Tseng SC, Sanabria O, et al. Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation. Cornea. 1998;17(1):38-56. doi:10.1097/00003226-199801000-00007
  18. McMonnies CW. Aqueous deficiency is a contributor to evaporation-related dry eye disease. Eye Vis (Lond). 2020;7:6. doi:10.1186/s40662-019-0172-z
  19. Mainstone JC, Bruce AS, Golding TR. Tear meniscus measurement in the diagnosis of dry eye. Curr Eye Res. 1996;15(6):653-661. doi:10.3109/02713689609008906
  20. Pult H, Riede-Pult BH. Impact of conjunctival folds on central tear meniscus height. Invest Ophthalmol Vis Sci. 2015;56(3):1459-1466. doi:10.1167/iovs.14-15908
  21. Tung CI, Perin AF, Gumus K, et al. Tear meniscus dimensions in tear dysfunction and their correlation with clinical parameters. Am J Ophthalmol. 2014;157(2):301-310.e1. doi:10.1016/j.ajo.2013.09.024
  22. Shen M, Li J, Wang J, et al. Upper and lower tear menisci in the diagnosis of dry eye. Invest Ophthalmol Vis Sci. 2009;50(6):2722-2726. doi:10.1167/iovs.08-2704
  23. Zeev MS, Miller DD, Latkany R. Diagnosis of dry eye disease and emerging technologies. Clin Ophthalmol. 2014;8:581-590. doi:10.2147/OPTH.S45444
  24. Wang J, Palakuru JR, Aquavella JV. Correlations among upper and lower tear menisci, noninvasive tear break-up time, and the Schirmer test. Am J Ophthalmol. 2008;145(5):795-800. doi:10.1016/j.ajo.2007.12.035
  25. Rojas R. Vital dyes for Dry eyes. Review of Optometry. Published July 15, 2022. Accessed September 16, 2023. https://www.reviewofoptometry.com/article/vital-dyes-for-dry-eyes.
  26. Rasmussen A, Stone DU, Kaufman CE, et al. Reproducibility of Ocular Surface Staining in the Assessment of Sjögren Syndrome-Related Keratoconjunctivitis Sicca: Implications on Disease Classification. ACR Open Rheumatol. 2019;1(5):292-302. doi:10.1002/acr2.1033
  27. Efron N, Brennan NA, Morgan PB, et al. Lid wiper epitheliopathy. Prog Retin Eye Res. 2016;53:140-174. doi:10.1016/j.preteyeres.2016.04.004
  28. McKenzie M, Whitley W. A Closer Look at Corneal Inflammation. Review of Cornea and Contact Lenses. Published November 15, 2012. Accessed September 16, 2023. https://www.reviewofcontactlenses.com/article/a-closer-look-at-corneal-inflammation.
  29. Efron N. Conjunctival redness. Contact Lens Complications. 3rd ed. Elsevier/Saunders; 2012:113-121.
  30. Efron N. Limbal redness. Contact Lens Complications. 3rd ed. Elsevier/Saunders; 2012:133–139.
  31. Chao C, Richdale K, Jalbert I, et al. Non-invasive objective and contemporary methods for measuring ocular surface inflammation in soft contact lens wearers - A review. Cont Lens Anterior Eye. 2017;40(5):273-282. doi:10.1016/j.clae.2017.05.008
  32. Morgan PB, Murphy PJ, Gifford KL, et al. CLEAR - Effect of contact lens materials and designs on the anatomy and physiology of the eye. Cont Lens Anterior Eye. 2021;44(2):192-219. doi:10.1016/j.clae.2021.02.006
  33. La Rosa M, Lionetti E, Reibaldi M, et al. Allergic conjunctivitis: a comprehensive review of the literature. Ital J Pediatr. 2013;39:18. doi:10.1186/1824-7288-39-18
  34. Villegas BV, Benitez-Del-Castillo JM. Current Knowledge in Allergic Conjunctivitis. Turk J Ophthalmol. 2021;51(1):45-54. doi:10.4274/tjo.galenos.2020.11456
  35. Baab S, Le PH, Kinzer EE. Allergic Conjunctivitis. StatPearls. Treasure Island (FL): StatPearls Publishing. Published May 23, 2022. https://www.ncbi.nlm.nih.gov/books/NBK448118/.
  36. Ackerman S, Smith LM, Gomes PJ. Ocular itch associated with allergic conjunctivitis: latest evidence and clinical management. Ther Adv Chronic Dis. 2016;7(1):52-67. doi:10.1177/2040622315612745
  37. Bielory BP, O'Brien TP, Bielory L. Management of seasonal allergic conjunctivitis: guide to therapy. Acta Ophthalmol. 2012;90(5):399-407. doi:10.1111/j.1755-3768.2011.02272.x
  38. Leonardi A, Doan S, Fauquert JL, et al. Diagnostic tools in ocular allergy. Allergy. 2017;72(10):1485-1498. doi:10.1111/all.13178.
  39. Takamura E, Uchio E, Ebihara N, et al. Japanese guidelines for allergic conjunctival diseases 2017. Allergol Int. 2017;66(2):220-229. doi:10.1016/j.alit.2016.12.004
  40. Carr W, Schaeffer J, Donnenfeld E. Treating allergic conjunctivitis: A once-daily medication that provides 24-hour symptom relief. Allergy Rhinol (Providence). 2016;7(2):107-114. doi:10.2500/ar.2016.7.0158
  41. Gonzalez-Estrada A, Reddy K, Dimov V, et al. Olopatadine hydrochloride ophthalmic solution for the treatment of allergic conjunctivitis. Expert Opin Pharmacother. 2017;18(11):1137-1143. doi:10.1080/14656566.2017.1346085
  42. Schröder K, Finis D, Meller S, et al. Die saisonale und perenniale allergische Rhinokonjunktivitis [Seasonal and perennial allergic rhinoconjunctivitis]. Klin Monbl Augenheilkd. 2014;231(5):496-504. doi:10.1055/s-0034-1368397
  43. Golden MI, Meyer JJ, Patel BC. Dry Eye Syndrome. StatPearls. Treasure Island (FL): StatPearls Publishing. Published April 3, 2023. https://www.ncbi.nlm.nih.gov/books/NBK470411/.
  44. Mohamed HB, Abd El-Hamid BN, Fathalla D, et al. Current trends in pharmaceutical treatment of dry eye disease: A review. Eur J Pharm Sci. 2022;175:106206. doi:10.1016/j.ejps.2022.106206
  45. Zemanová M. Dry eye disease. A review. [Syndrom suchého oka. přehled.] Cesk Slov Oftalmol. 2021;77(3):107–119. doi:10.31348/2020/29
  46. Chin T. GPC: Don’t Call it An Allergic Reaction. Review of Optometry. 2006;143(11):10.
  47. Greiner JV. Giant Papillary Conjunctivitis. In: Abelson MB, ed. Allergic Diseases of the Eye. 1st ed. New York: W.B. Saunders Co.; 2001:140-160.
  48. Allansmith MR, Korb DR, Greiner JV, et al. Giant papillary conjunctivitis in contact lens wearers. Am J Ophthalmol. 1977;83(5):697-708. doi:10.1016/0002-9394(77)90137-4
  49. Faulkner WJ, Varley GA. Corneal diagnostic technique. In: Krachmer JH, Mannis MJ, Holland EJ (eds). Cornea: Fundamentals of Cornea and External Disease. Mosby: St Louis, MO, 1997:275–281.
  50. Dua HS, Said DG, Messmer EM, et al. Neurotrophic keratopathy. Prog Retin Eye Res. 2018;66:107-131. doi:10.1016/j.preteyeres.2018.04.003
  51. Bonini S, Rama P, Olzi D, et al. Neurotrophic keratitis. Eye (Lond). 2003;17(8):989-995. doi:10.1038/sj.eye.6700616
  52. Sacchetti M, Lambiase A. Diagnosis and management of neurotrophic keratitis. Clin Ophthalmol. 2014;8:571-579. doi:10.2147/OPTH.S45921
  53. Chang BH, Groos EB Jr: Neurotrophic keratitis; in Krachmer JH, Mannis MJ, Holland EJ eds. Cornea. London, Elsevier, 2011.
  54. Labetoulle M, Auquier P, Conrad H, et al. Incidence of herpes simplex virus keratitis in France. Ophthalmology. 2005;112(5):888-895.
  55. Dohlman TH, Lai EC, Ciralsky JB. Dry eye disease after refractive surgery. Int Ophthalmol Clin. 2016;56(2):101-110.
  56. Goyal S, Hamrah P. Understanding Neuropathic Corneal Pain--Gaps and Current Therapeutic Approaches. Semin Ophthalmol. 2016;31(1-2):59-70. doi:10.3109/08820538.2015.1114853
  57. Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017;15(3):276-283. doi:10.1016/j.jtos.2017.05.008
  58. Gipson IK. The ocular surface: the challenge to enable and protect vision: the Friedenwald lecture. Invest Ophthalmol Vis Sci. 2007;48(10):4390-4398. doi:10.1167/iovs.07-0770
  59. Epitropoulos AT. Lid hygiene product helps reduce blepharitis, MGD symptoms. Ophthalmology Times. Published November 15, 2015. Accessed September 16, 2023. https://www.ophthalmologytimes.com/view/lid-hygiene-product-helps-reduce-blepharitis-mgd-symptoms.
  60. Gao YY, Di Pascuale MA, Li W, et al. In vitro and in vivo killing of ocular Demodex by tea tree oil. Br J Ophthalmol. 2005;89(11):1468-73.
  61. Tighe S, Gao YY, Tseng SC. Terpinen-4-ol is the Most Active Ingredient of Tea Tree Oil to Kill Demodex Mites. Transl Vis Sci Technol. 2013;2(7):2.
  62. Halcón L, Milkus K. Staphylococcus aureus and wounds: a review of tea tree oil as a promising antimicrobial. Am J Infect Control. 2004;32(7):402-8.
  63. Hammer KA, Carson CF, Riley TV. Antifungal effects of Melaleuca alternifolia (tea tree) oil and its components on Candida albicans, Candida glabrata and Saccharomyces cerevisiae. J Antimicrob Chemother. 2004;53(6):1081-5.
  64. Caldefie-Chézet F, Guerry M, Chalchat JC, et al. Anti-inflammatory effects of Melaleuca alternifolia essential oil on human polymorphonuclear neutrophils and monocytes. Free Radic Res. 2004;38(8):805-11.
  65. Liu W, Gong L. Anti-demodectic effects of okra eyelid patch in Demodex blepharitis compared with tea tree oil. Exp Ther Med. 2021;21(4):338. doi:10.3892/etm.2021.9769
  66. Koo H, Kim TH, Kim KW, et al. Ocular surface discomfort and Demodex: effect of tea tree oil eyelid scrub in Demodex blepharitis. J Korean Med Sci. 2012;27(12):1574-1579. doi:10.3346/jkms.2012.27.12.1574.
  67. Yeu E, Wirta DL, Karpecki P, et al. Lotilaner Ophthalmic Solution, 0.25%, for the Treatment of Demodex Blepharitis: Results of a Prospective, Randomized, Vehicle-Controlled, Double-Masked, Pivotal Trial (Saturn-1). Cornea. 2023;42(4):435-443. doi:10.1097/ICO.0000000000003097
  68. Gaddie IB, Donnenfeld ED, Karpecki P, et al. Lotilaner Ophthalmic Solution 0.25% for Demodex Blepharitis: Randomized, Vehicle-Controlled, Multicenter, Phase 3 Trial (Saturn-2) [published online ahead of print, 2023 Jun 5]. Ophthalmology. 2023;S0161-6420(23)00392-5. doi:10.1016/j.ophtha.2023.05.030
  69. Yeu E, Mun JJ, Vollmer P, et al. Treatment of Demodex Blepharitis with Lotilaner Ophthalmic Solution, 0.25%: Combined Analysis of Two Pivotal Randomized, Vehicle-Controlled, Multicenter Trials. Invest Ophthalmol Vis Sci. 2023;64(8):1164.
  70. Collins M, Heron H, Larsen R, Lindner R. Blinking patterns in soft contact lens wearers can be altered with training. Am J Optom Physiol Opt. 1987;64(2):100-3.
  71. Macsai MS. The role of omega-3 dietary supplementation in blepharitis and meibomian gland dysfunction (An aos thesis). Trans Am Ophthalmol Soc. 2008;106:336-356.
  72. Oleñik A, Jiménez-Alfaro I, Alejandre-Alba N, Mahillo-Fernández I. A randomized, double-masked study to evaluate the effect of omega-3 fatty acids supplementation in meibomian gland dysfunction. Clin Interv Aging. 2013;8:1133-1138.
  73. Epitropoulos AT, Donnenfeld ED, Shah ZA, et al. Effect of oral re-esterified omega-3 nutritional supplementation on dry eyes. Cornea. 2016;35(9):1185-1191.
  74. Wojtowicz JC, Butovich I, Uchiyama E, et al. Pilot, prospective, randomized, double-masked, placebo-controlled clinical trial of an omega-3 supplement for dry eye [published correction appears in Cornea. 2011 Dec;30(12):1521]. Cornea. 2011;30(3):308-314. doi:10.1097/ICO.0b013e3181f22e03
  75. Zhou X, Shen Y, Shang J, Zhou X. Effects of warm compress on tear film, blink pattern and Meibomian gland function in dry eyes after corneal refractive surgery. BMC Ophthalmol. 2021;21(1):330. doi:10.1186/s12886-021-02091-2
  76. Murphy O, O' Dwyer V, Lloyd-Mckernan A. The Efficacy of Warm Compresses in the Treatment of Meibomian Gland Dysfunction and Demodex Folliculorum Blepharitis. Curr Eye Res. 2020;45(5):563-575. doi:10.1080/02713683.2019.1686153
  77. Yoo SE, Lee DC, Chang MH. The effect of low-dose doxycycline therapy in chronic meibomian gland dysfunction. Korean J Ophthalmol. 2005;19(4):258-263. doi:10.3341/kjo.2005.19.4.258
  78. Richardson M, Wong D, Lacroix S, et al. Inhibition by doxycycline of angiogenesis in the chicken chorioallantoic membrane (CAM). Cancer Chemother Pharmacol. 2005;56(1):1-9. doi:10.1007/s00280-004-0955-2
  79. Lee CZ, Xu B, Hashimoto T, et al. Doxycycline suppresses cerebral matrix metalloproteinase-9 and angiogenesis induced by focal hyperstimulation of vascular endothelial growth factor in a mouse model. Stroke. 2004;35(7):1715-1719. doi:10.1161/01.STR.0000129334.05181.b6
  80. Patel RS, Parmar M. Doxycycline Hyclate. In: StatPearls. Treasure Island (FL): StatPearls Publishing; May 22, 2023.
  81. Kashkouli MB, Fazel AJ, Kiavash V, et al. Oral azithromycin versus doxycycline in meibomian gland dysfunction: a randomised double-masked open-label clinical trial. Br J Ophthalmol. 2015;99(2):199-204. doi:10.1136/bjophthalmol-2014-305410
  82. Foulks GN, Borchman D, Yappert M, et al. Topical azithromycin therapy for meibomian gland dysfunction: clinical response and lipid alterations. Cornea. 2010;29(7):781-788. doi:10.1097/ICO.0b013e3181cda38f
  83. Arita R, Fukuoka S. Efficacy of Azithromycin Eyedrops for Individuals With Meibomian Gland Dysfunction-Associated Posterior Blepharitis. Eye Contact Lens. 2021;47(1):54-59. doi:10.1097/ICL.0000000000000729
  84. Foulks GN, Borchman D, Yappert M, et al. Topical azithromycin and oral doxycycline therapy of meibomian gland dysfunction: a comparative clinical and spectroscopic pilot study. Cornea. 2013;32(1):44-53. doi:10.1097/ICO.0b013e318254205f
  85. Kim M, Lee Y, Mehra D, et al. Dry eye: why artificial tears are not always the answer. BMJ Open Ophthalmol. 2021;6(1):e000697. doi:10.1136/bmjophth-2020-000697
  86. Lemp MA. Management of dry eye disease. Am J Manag Care. 2008;14(3 Suppl):S88-S101.
  87. Lin H, Yiu SC. Dry eye disease: A review of diagnostic approaches and treatments. Saudi J Ophthalmol. 2014;28(3):173-181. doi:10.1016/j.sjopt.2014.06.002
  88. Semp DA, Beeson D, Sheppard AL, et al. Artificial Tears: A Systematic Review. Clin Optom (Auckl). 2023;15:9-27. doi:10.2147/OPTO.S350185
  89. Sheppard JD, Nichols KK. Dry Eye Disease Associated with Meibomian Gland Dysfunction: Focus on Tear Film Characteristics and the Therapeutic Landscape. Ophthalmol Ther. 2023;12(3):1397-1418. doi:10.1007/s40123-023-00669-1
  90. Vittitow J, Kissling R, DeCory H, et al. In Vitro Inhibition of Evaporation with Perfluorohexyloctane, an Eye Drop for Dry Eye Disease. Curr Ther Res Clin Exp. 2023;98:100704. doi:10.1016/j.curtheres.2023.100704
  91. Liu X, Riess JG, Krafft MP. Self-Organization of Semifluorinated Alkanes and Related Compounds at Interfaces: Thin Films, Surface Domains and Two-Dimensional Spherulites. Bulletin of the Chemical Society of Japan. 2018;91(5):846-857. doi:10.1246/bcsj.20170431
  92. Epitropoulos AT, Daya SM, Matossian C, et al. OC-01 (Varenicline Solution) Nasal Spray Demonstrates Consistency of Effect Regardless of Age, Race, Ethnicity, and Artificial Tear Use. Clin Ophthalmol. 2022;16:3405-3413. Published 2022 Oct 13. doi:10.2147/OPTH.S383091
  93. Frampton JE. Varenicline Solution Nasal Spray: A Review in Dry Eye Disease. Drugs. 2022;82(14):1481-1488. doi:10.1007/s40265-022-01782-4
  94. Black RL, Oglesby RB, Von Sallmann L, et al. Posterior subcapsular cataracts induced by corticosteroids in patients with rheumatoid arthritis. JAMA. 1960;174:166-171. doi:10.1001/jama.1960.63030020005014
  95. Urban RC Jr, Cotlier E. Corticosteroid-induced cataracts. Surv Ophthalmol. 1986;31(2):102-110. doi:10.1016/0039-6257(86)90077-9
  96. Costagliola C, Cati-Giovannelli B, Piccirillo A, et al. Cataracts associated with long-term topical steroids. Br J Dermatol. 1989;120(3):472-473. doi:10.1111/j.1365-2133.1989.tb04181.x
  97. Renfro L, Snow JS. Ocular effects of topical and systemic steroids. Dermatol Clin. 1992;10(3):505-512.
  98. Veenstra DL, Best JH, Hornberger J, et al. Incidence and long-term cost of steroid-related side effects after renal transplantation. Am J Kidney Dis. 1999;33(5):829-839. doi:10.1016/s0272-6386(99)70414-2
  99. Carnahan MC, Goldstein DA. Ocular complications of topical, peri-ocular, and systemic corticosteroids. Curr Opin Ophthalmol. 2000;11(6):478-483. doi:10.1097/00055735-200012000-00016
  100. Tripathi RC, Parapuram SK, Tripathi BJ, et al. Corticosteroids and glaucoma risk. Drugs Aging. 1999;15(6):439-450. doi:10.2165/00002512-199915060-00004
  101. Paton DM. Loteprednol etabonate: a formulation for short-term use in inflammatory flares in dry eye disease. Drugs Today (Barc). 2022;58(2):77-84. doi:10.1358/dot.2022.58.2.3367993
  102. Geerling G, Maclennan S, Hartwig D. Autologous serum eye drops for ocular surface disorders. Br J Ophthalmol. 2004;88(11):1467-74. doi: 10.1136/bjo.2004.044347. PMID: 15489495; PMCID: PMC1772389.
  103. Pflugfelder SC. Anti-inflammatory therapy of dry eye. Ocul Surf. 2003;1(1):31-36. doi:10.1016/s1542-0124(12)70005-8
  104. Zhou L, Zhao SZ, Koh SK, et al. In-depth analysis of the human tear proteome. J Proteom. 2012;75:3877–85. 10.1016/j.jprot.2012.04.053
  105. Ribeiro MV, Ribeiro EA, Ribeiro LF. The Use of Platelet-Rich Plasma in Dry Eye Disease. In: Tutar Y, and Tutar L, eds. Plasma Medicine - Concepts and Clinical Applications. 2018.
  106. Alio JL, Rodriguez AE, WróbelDudzińska D. Eye platelet-rich plasma in the treatment of ocular surface disorders. Curr Opin Ophthalmol. 2015;26(4):325-332. doi:10.1097/ICU.0000000000000169
  107. Alio JL, Rodriguez AE, Ferreira-Oliveira R, et al. Treatment of Dry Eye Disease with Autologous Platelet-Rich Plasma: A Prospective, Interventional, Non-Randomized Study. Ophthalmol Ther. 2017;6(2):285-293. doi:10.1007/s40123-017-0100-z
  108. Metheetrairut C, Ngowyutagon P, Tunganuntarat A, et al. Comparison of epitheliotrophic factors in platelet-rich plasma versus autologous serum and their treatment efficacy in dry eye disease. Sci Rep. 2022;12(1):8906. doi:10.1038/s41598-022-12879-x
  109. Cole BJ, Seroyer ST, Filardo G, et al. Platelet-rich plasma: where are we now and where are we going?. Sports Health. 2010;2(3):203-210. doi:10.1177/1941738110366385
  110. Ma IH, Chen LW, Tu WH, et al. Serum components and clinical efficacies of autologous serum eye drops in dry eye patients with active and inactive Sjogren syndrome. Taiwan J Ophthalmol. 2017;7(4):213-220. doi:10.4103/tjo.tjo_102_17
  111. Vaidyanathan S, Williamson P, Clearie K, et al. Fluticasone reverses oxymetazoline-induced tachyphylaxis of response and rebound congestion. Am J Respir Crit Care Med. 2010;182(1):19-24.
  112. Soparkar CN, Wilhelmus KR, Koch DD, et al. Acute and chronic conjunctivitis due to over-the-counter ophthalmic decongestants. Arch Ophthalmol. 1997;115(1):34-38.
  113. Torkildsen GL, Sanfilippo CM, DeCory HH, et al. Evaluation of efficacy and safety of brimonidine tartrate ophthalmic solution, 0. 025% for treatment of ocular redness. Curr Eye Res. 2018;43(1):43-51
  114. Cook EB, Stahl JL, Barney NP, Graziano FM. Mechanisms of antihistamines and mast cell stabilizers in ocular allergic inflammation. Curr Drug Targets Inflamm Allergy. 2002;1(2):167-180. doi:10.2174/1568010023344733
  115. Nankervis H, Thomas KS, Delamere FM, et al. Scoping systematic review of treatments for eczema. Southampton (UK): NIHR Journals Library; May 2016.
  116. Bilstein A, Heinrich A, Rybachuk A, et al. Ectoine in the Treatment of Irritations and Inflammations of the Eye Surface. Biomed Res Int. 2021;2021:8885032. doi:10.1155/2021/8885032
  117. Lentzen G, Schwarz T. Extremolytes: Natural compounds from extremophiles for versatile applications. Appl Microbiol Biotechnol. 2006;72(4):623-634. doi:10.1007/s00253-006-0553-9
  118. SCOPE. Allegro Eye Drops. Optase. Published May 16, 2023. Accessed September 16, 2023. https://optase.com/product/allegro-eye-drops/?v=7516fd43adaa.
Cory J. Lappin, OD, MS, FAAO
About Cory J. Lappin, OD, MS, FAAO

Dr. Cory J. Lappin is a native of New Philadelphia, Ohio and received his Bachelor of Science degree from Miami University, graduating Phi Beta Kappa with Honors with Distinction. He earned his Doctor of Optometry degree from The Ohio State University College of Optometry, where he concurrently completed his Master of Science degree in Vision Science. At the college he served as Class President and was a member of Beta Sigma Kappa Honor Society. Following graduation, Dr. Lappin continued his training by completing a residency in Ocular Disease at the renowned Cincinnati Eye Institute in Cincinnati, Ohio.

Dr. Lappin has been recognized for his clinical achievements, receiving the American Academy of Optometry Foundation Practice Excellence award. He has also been actively engaged in research, being selected to take part in the NIH/NEI T35 research training program and receiving the Vincent J. Ellerbrock Memorial Award in recognition of accomplishments in vision science research.

Dr. Lappin practices at Phoenix Eye Care and the Dry Eye Center of Arizona in Phoenix, Arizona, where he treats a wide variety of ocular diseases, with a particular interest in dry eye and ocular surface disease. He is a Fellow of the American Academy of Optometry, a member of the American Optometric Association, and serves on the Board of Directors for the Arizona Optometric Association. He is also a member of the Tear Film and Ocular Surface Society (TFOS) and volunteers with the Special Olympics Opening Eyes program.

More by Cory J. Lappin, OD, MS, FAAO
Cory J. Lappin, OD, MS, FAAO
Share
Copy Link

How would you rate the quality of this content?

Share
Copy Link
Eyes On Eyecare Site Sponsors
Astellas LogoOptilight by Lumenis Logo
Search
Jobs
Events