This educational supplement is sponsored by Allergan Global Medical Affairs.

Often, we view the failure of a therapeutic to induce the intended outcome as a failure of the drug, but many times we are not treating the right disease. If the primary disease is not dry eye disease, do not expect the patient to respond to Restasis (cyclosporine A 0.05% ophthalmic emulsion; Allergan) or Xiidra (lifitegrast; Shire Pharmaceuticals). Often, patients come in and say they tried Restasis previously, and it did not work for them. Upon examination, it turns out the patient has entropion, ectropion, conjunctival chalasis, floppy eyelid syndrome, or mucus fishing syndrome (Figure). The reason the therapeutic did not work is that we were not treating the primary disease. Even with meibomian gland disease, Restasis is good ancillary therapy, but it should not be primary therapy.

(Courtesy of Chris Starr, MD)

Figure. Final diagnoses of patients who complained of dry eye disease symptoms but had normal tear osmolarity.