Managing ocular surface disease: a common-sense approach

Many diseases can cause ocular surface disorders. The poster on pages 50–51 provides an overview of the most common diseases, and other articles in this issue focus on the management of individual diseases. In this article, the authors offer a systematic strategy for the overall management of ocular surface diseases. When managing patients with an ocular surface condition, identifying the underlying disease is valuable (see pages 41–43 for guidance on assessment and diagnosis). However, diagnosis can sometimes be difficult or even impossible, as complex interactions exist between the different components of the ocular surface. A wide range of conditions can therefore result in similar functional effects at the ocular surface. These functional effects manifest as clinical signs common to several diseases, and include chronic punctate keratopathy, filamentary keratopathy, recurrent corneal erosion, bacterial conjunctivitis, culturenegative conjunctivitis, cicatrising (scarring) conjunctivitis, persistent epithelial defect, infectious keratitis, corneal melt and ocular surface failure (Figures 1A–G). Fortunately, in the absence of a definite diagnosis, ocular surface diseases can usually still be managed effectively, provided the choice of approach and therapy is based on the functional effects observed and their severity. It is therefore important to have a systematic approach to the identification of functional effects and their severity (see Figure 2). Many of these functional effects are susceptible to a range of therapies, as discussed below.