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. 2023 Apr;71(4):1546-1550.
doi: 10.4103/IJO.IJO_3364_22.

Nexus of ocular motility and dry eye

Bhavya Gorimanipalli  1 , Sumitha Muthu  2 , Rohit Shetty  1 , Reshma Raghunath Ranade  3 , Pooja Khamar  3
Affiliations

Nexus of ocular motility and dry eye

Bhavya Gorimanipalli et al. Indian J Ophthalmol. 2023 Apr.

Abstract

Purpose: To evaluate the effectiveness of vision therapy (VT) in patients with chronic presumed refractory dry eye disease (DED) and concurrent nonstrabismic binocular vision anomalies (NSBVAs). To propose an algorithmic approach to manage patients with refractory DED.

Methods: Thirty-two patients with chronic (>1 year) presumed refractory DED and NSBVA were prospectively evaluated. The baseline dry eye evaluation and comprehensive orthoptic evaluation were done. VT was administered by a trained orthoptist for 2 weeks. The binocular vision (BV) parameters and percentage subjective improvement were assessed after the VT.

Results: On evaluation, 12 patients (37.5%) had both DED and NSBVA, and 20 patients (62.5%) had only NSBVA. Twenty-nine patients (90.62%) showed significant improvement in BV parameters following VT. Binocular near point of accommodation (median, range) improved from 17 (8-40) to 12 (5-26) mm (P value < 0.0001), and near point of convergence (median, range) improved from 6 (3-33) to 6 (5-14) (P value 0.004) with VT. Thirty-one patients (96.87%) reported symptomatic improvement after VT, and 62.5% of these showed more than 50% improvement in symptoms.

Conclusion: The present study confirms the beneficial role of VT in the treatment of patients with DED with concurrent NSBVA. It is essential to diagnose and treat NSBVA in patients with DED to ensure complete relief of symptoms and patient satisfaction. As there is a significant overlap between symptoms of dry eye disease and that of NSBVA, a complete orthoptic evaluation is recommended in all patients presenting with refractory dry eye disease related symptoms.

Keywords: Binocular vision anomalies; dry eye disease; refractory dry eye; vision therapy.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
(a) Diagnosis of DED and NSBVA among study subjects. Pie chart showing the proportion of patients with DED and NSBVA, and those with only NSBVA. (b) Classification of NSBVA. Pie chart showing the proportion of different diagnoses of NSBVA
Figure 2
Figure 2
Algorithmic approach to the management of patients with DED. Patients with DED symptoms should be assessed with standard dry eye evaluation. Those with refractory symptoms or who show discordance between clinical signs and symptoms should undergo orthoptic evaluation and to be treated accordingly. Patients with NSBVA alone are to be given VT; those with NSBVA and DED are to be given DED therapy and VT; and those with few signs of DED are to be investigated with IVCM (for nerve-related changes) and for vitamin D and B12 deficiency and treated accordingly. NSBVA – nonstrabismic binocular vision anomalies; DED – dry eye disease; IVCM – in vivo confocal microscopy
See this image and copyright information in PMC

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