Introduction
In Episode 17 of the Eye-Q Podcast, host Dr. Rudrani Banik delves into one of the most pervasive—and often under recognized, ocular surface challenges: dry eye. Joining the conversation is Dr. Masako Chen, board-certified cornea surgeon at the New York Eye and Ear Infirmary of Mount Sinai and Associate Residency Program Director, whose expertise spans cataract and corneal transplant surgery as well as advanced dry eye management. Together, they unpack the complex anatomy of the tear film, explore the latest diagnostic tools (including point-of-care inflammation testing and emerging tear film imaging), and share practical strategies from eyelid hygiene to nutritional and environmental interventions that you can integrate into your practice. Whether you’re seeking to refine your approach to meibomian gland dysfunction or curious about personalized, layer-by-layer dry eye treatment, this episode delivers actionable insights to elevate patient care.

When the lipid layer is compromised—often due to meibomian gland dysfunction—tears evaporate rapidly. Digital device users frequently report blur after prolonged screen time. On examination, expressibility of meibomian glands and gland dropout on meibography confirm evaporative dry eye.

Insufficient tear production, linked to lacrimal gland hypofunction, autoimmune disease, or age, leads to persistent dryness and ocular staining. Schirmer testing quantifies tear volume, guiding therapies that boost aqueous secretion.

Inflammation underlies many dry eye cases. Dr. Chen highlights point-of-care MMP-9 testing: “A tear test can reveal inflammatory markers guiding targeted anti-inflammatory therapy.” Positive results prompt initiation of cyclosporine A or lifitegrast to quell surface inflammation.

Dr. Chen emphasizes nightly lid cleansing to maintain meibomian gland health. Warm compresses or in-office thermal pulsation (e.g., LipiFlow) liquefy inspissated secretions. Tea-tree oil–based cleansers reduce Demodex mite load—common inflammatory contributors.

Anti-Inflammatory Drops

Tear Supplements & Devices

In-Office Procedures

Contact lens wear often exacerbates evaporative dry eye. Dr. Chen advises:

Dr. Chen observes that postmenopausal women constitute the largest dry eye demographic, but she also treats younger patients with evaporative dry eye linked to extensive screen time. Glaucoma patients on multiple preserved eyedrops often present with diffuse ocular surface inflammation; switching to preservative-free formulations or considering MIGS (minimally invasive glaucoma surgery) at the time of cataract extraction can reduce drop burden and alleviate dry eye symptoms.

Conclusion
Dry eye is a complex, heterogeneous disease requiring a precise, etiology-driven approach. By leveraging point-of-care inflammation assays, advanced tear film imaging, and a spectrum of pharmacologic, procedural, and lifestyle therapies, eye care professionals can deliver personalized, effective relief. Implement this multilayered protocol in practice and stay tuned for future advances in ocular surface care.