Beyond "Just Dry": How to Reframe Chronic Dry Eye (CDE) as a Chronic Condition

Key Takeaways:

• Shift patient expectations from finding a "cure" to lifelong management, emphasizing that Chronic Dry Eye (CDE) is a complex inflammatory disease requiring ongoing care.
• Educate patients on the importance of consistent dosing to control inflammation and stabilize the tear film, rather than using drops only when symptoms flare.
• Frame the recommendation for preservative-free drops as a critical clinical decision to protect the ocular surface from long-term toxicity, rather than just a product preference.

Chronic dry eye (CDE) is one of the most frequent complaints eye care specialists hear and is a primary reason for eye clinic visits. However, the trivialization of the condition as "just dry eye" can create a deep divide between patient expectations and clinical reality. This disconnect directly impacts satisfaction and outcomes.^1,2

Data from the 2023 Chronic Dry Eye In America survey highlights this gap. Less than half of patients report being very satisfied with their healthcare provider (HCP). In fact, only 4 in 10 (42 percent) are "extremely satisfied" with their HCP. This dissatisfaction is often linked to a lack of control. Only 1 in 4 patients feels their CDE is "very well-controlled" with their current treatment plan.²

This feeling of poor control means patients are not passive. They are actively seeking solutions and plan to ask for new options. Reframing CDE as the complex, chronic inflammatory condition it is, rather than a simple nuisance, is essential.

The disconnect: Patient frustration and the search for control

The low rates of satisfaction and perceived control are driving patient behavior. Survey data shows 1 in 3 (34 percent) plan to speak to their HCP about changing treatment in the next 6 months.²

Patients are frustrated by a perceived lack of proactive planning. As one patient stated, “I don't need to be told how bad my eyes are, I need to be told what we can do to make them better and get to work on that.” This reveals a desire for an actionable plan, not just a diagnosis.²

When they do not get this plan, patients search for it themselves. Between 88 and 90 percent use online resources to gather information about CDE. Their primary topic of interest, by far, is treatment options. Furthermore, 36 percent actively seek information about the latest treatments.²

This data presents an opportunity. Patients are highly engaged and looking for a clear strategy. Clinicians can meet this need by reframing the initial consultation.

Setting expectations for chronic management

An effective strategy is to define CDE as a chronic disease, similar to arthritis, asthma, or diabetes. This conversation must shift expectations from a one-time "cure" to long-term "management."

This framework helps patients understand several key concepts:^2,3

• It is a lifelong condition – There is no single fix.
• Management is the goal – The objective is to control inflammation, maintain the tear film, and improve quality of life.
• Flares will happen – There will be good days and bad days. A flare-up does not mean the treatment plan has failed. It means it needs adjustment or short-term intervention.

This conversation also builds trust by acknowledging the patient's frustration. The survey data show patients wish their doctors understood the total burden of the disease. This includes the financial hardship of treatment. One patient wished their doctor understood "that the cost of the current treatment is a hardship sometimes.” Acknowledging these realities shows empathy and validates their experience, strengthening the provider-patient alliance.²

The "why" behind consistent treatment

A key part of the management plan is explaining the "why" behind consistent treatment. Patients often use lubricating drops reactively, only using them when symptoms flare up.

This approach only chases symptoms. Clinicians must explain that CDE is a cyclical inflammatory disease. Symptoms like grittiness and burning are the end result of underlying tear film instability and inflammation.³

Consistent, proactive use of high-quality lubricating drops (such as over-the-counter Refresh® eye drops) is designed to maintain the tear film. This proactive maintenance helps stabilize the ocular surface and reduce the baseline inflammation that leads to symptomatic flares. This is not just masking a symptom. It is actively managing the health of the ocular surface to prevent future damage and discomfort.³

The "why" behind preservative-free recommendations

Explaining the "why" is also critical when recommending preservative-free (PF) drops. To the patient, a drop is just a drop, and they may not understand the price difference between options.³

Clinicians must explain the recommendation as a clinical decision, not an upsell. For a chronic condition like CDE, patients will be using drops frequently and long-term. Preservatives, especially benzalkonium chloride (BAK), can be cytotoxic to the corneal epithelium and goblet cells. In a patient already struggling with ocular surface health, long-term preservative use can paradoxically worsen the condition.⁴

Recommending a preservative-free option is a clinical strategy to protect the long-term health of the ocular surface. This explanation empowers the patient to make an informed choice and improves adherence to the specific recommendation.³

Bridging the gap with proactive communication

Reframing chronic dry eye as a complex disease, not a simple complaint, is essential for modern practice. The data reveal a clear patient need. There is low satisfaction and low perceived control. Patients are actively seeking solutions and are seeking clearer treatment communication.²

By setting realistic expectations (management, not cure) and clearly explaining the "why" behind a consistent, PF treatment plan, clinicians can bridge this communication gap. This proactive approach validates the patient's experience, improves treatment adherence, and ultimately leads to better long-term ocular health.