If you’ve ever had a patient tell you their eyes feel like they’re on fire, but their ocular surface looks completely clear, you know dry eye care is rarely straightforward.

Ahead of her talk at the upcoming Dry Eye Summit, Dr. Mahnia Madan, Vancouver Eye Doctor, shares how she navigates those tricky, mismatched cases, and why the most powerful tool in your clinic isn't necessarily the most expensive piece of equipment.

Defining the ‘Complex’ Dry Eye Case

When you hear "complex dry eye," it’s easy to picture a severe, advanced case.

But according to Dr. Madan, the hardest cases aren't always the ones with the most damage.

“For me, complex isn't just a patient that has advanced dry eye disease, and typically that's what we kind of think of as complex, that this person has very advanced dry eye, you know, this is going to be a complex case,” Madan says.

“But I think what I find more challenging than just an advanced dry eye case is a patient who has signs, but their symptoms don't match.”

When there’s misalignment between what the patient feels and what shows up on the ocular surface, you must put on your detective hat. Success comes down to digging beneath the surface to uncover the hidden drivers at play before you can offer real relief.

Layering Treatments: It’s About the Combination

Dry eye is a multifactorial condition, which means no single drop or procedure is going to be a magic bullet.

"There isn't one treatment that solves the whole problem," notes Dr. Madan. " It's like when I go to a drugstore, and I want a lotion, and they'll ask me, ‘What do you want this lotion to do?’ Well, I want it to be anti-aging, I want it to be lifting, I want it to be clarifying, and they're like, there's five different things here."

No Expensive Tech? No Problem

If you're an optometrist just getting started in ocular surface disease, building out a specialty clinic can feel intimidating—especially if you don't have a room full of expensive diagnostic devices.

Dr. Madan has a reassuring message: you don't need high-tech equipment to make a difference.

“We don't need expensive stuff to start. What we really need is a very curious clinician, somebody who asks questions, somebody who asks the right questions, somebody who wants to learn and really dive down and look for those root drivers that are causing dry eye disease.”

Working with your colleagues and referring out when you need to are great options to help position yourself as a dry eye specialist, even without the high-tech equipment. Connection and networking are additional reasons why conferences like the Dry Eye Summit are so valuable, says Dr. Madan.

• Start with curious inquiry: Ask targeted lifestyle and environmental questions.

• Observe visual cues: Check blink dynamics, lid margin health, and facial anatomy.

• Uncover root drivers: Identify what is causing the ocular surface disruption.

Deliver practical guidance: Educate the patient and offer achievable first-line changes.

Most dry eye cases walking through the door aren't high-level mysteries; they just need a starting point. Helping a patient understand how contact lens wear or lifestyle habits impact their eyes builds the trust needed for long-term management.

Looking to the Future of Dry Eye Care

Looking ahead over the next three to five years, Dr. Madan is particularly excited about innovative research.

"What I'm really excited to see are more therapies geared towards neurosensory abnormalities," shares Dr. Madan. "The cornea has more nerve endings than anywhere else in the body. Once those nerves become dysregulated, it can completely consume a patient's life. Moving toward regenerative medicine allows us to get to the root neuroscience rather than just chasing symptoms."

Why You Shouldn't Miss the Dry Eye Summit

Whether you’re looking to refine advanced clinical protocols or simply want to start asking better questions in the exam room, dedicated education is where real practice growth happens.

"Register for the conference," Dr. Madan encourages. "It's one of my favourite conferences to go to. Like I said earlier, I always pick up a tidbit, even though I've been doing dry eye for so long. I always come back with a pearl that I can implement Monday morning, and that's really powerful.”