I sat in on a panel discussion for media during Vision Expo West 2025 about interventional dry eye hosted by Lumenis. I took notes, transcribed the conversation, and edited it for better reading.
Because the overall piece itself is long, I'll share it in chunks.
Experts weigh in on dry eye management
Three dry eye-focused practitioners held a panel discussion during Vision Expo West in Las Vegas in September 2025 to share perspectives and offer advice to their colleagues.
Participants:
• Moderator: @Cory J. Lappin , OD, MS, FAAO; Montgomery, OH
• Celesta Ferreira, OD; Cypress, TX
• Periman, MD; Seattle, WA
Dr. Lappin: Where do we start with diagnosis with so much overlap between the symptoms and signs of multiple ocular surface conditions?
Dr. Periman: I have always subscribed to the belief that if you listen to the patient, they will tell you what is wrong. A careful history often points me in the right direction of underlying drivers. It is a critical part for me in my assessment diagnosis and treatment plan.
Dr. Ferreira: I'm looking at every single patient. We used to do only age 30 and up; now I'm doing age 8 and up. If they can fit their face in my meibiographer, we take a scan. We have to screen everybody and not be afraid of the screening. Take the time to do it.
Dr. Periman: Imagine if that was a primary care clinic where you fail to check blood pressure on everyone. You are going to miss dangerous, silent things that have a major health impact down the road.
Dr. Lappin: How do you determine what to use once you have diagnosed dry eye? Where do you start?
Dr. Periman: When I do that exam, I have already checked meibography, corneal staining, osmolarity, MMP-9—not necessarily in that order. That guides me. Often, you can see demodex collarettes on meibography. That is a big clue, and you see the altered meibomian gland structure and appearance in that context. My game plan is to identify all the mischief makers in the room and pick them off one by one.
Dr. Ferreira: Some doctors don’t know how to implement a protocol for dry eye diagnostics. They get bogged down on not knowing what to look for. I'm looking for demodex, rosacea, turbid glands, how the lid pulls down, the snap-back test. I like storytelling with visuals for patients. After I have captured my data, I show them every image. This is demodex. This is how we are going to treat it. This is rosacea. This is how we are going to treat it. You have to tie it back for patients to understand—if we simply tell them, “You have blepharitis and rosacea, you need to buy this treatment,” they get lost in the weeds. If they physically see it, it’s a complete game changer.
Dr. Lappin: They start to own their own condition when you present it to them that way.
Dr. Lappin: We have seen a lot of innovation in the past five years. I guarantee that we do not treat patients the same way five years ago that we do today. What motivated you invest in new technology? What pushed you from traditional, over-the-counter treatments to interventional dry eye?
Dr. Periman: It is the patient with the unmet need. In 2017, I had a wonderful plastic surgeon patient with impressive rosacea. I had just read studies saying that IPL could help with MGD and dry eyes. I suggest IPL to him, and his assistants in his office do it because he had a machine—I didn’t have one yet. He came back looking like a candy cane with a red forehead. I had a realization that rosacea is a local regional disease, and that drove me to to purchase a unit. Plus, I was tired of sending patients to my dermatologist, only to say they don’t have rosacea while it is staring me in the face. That unmet need pushed me to do it along with the drive to do everything I can to help the patient.
Dr. Ferreira: For me, it was myself. I have always been a dry sufferer. I have had chalazion surgery. I have had injections. I have done all the meds, all the drops, and still suffered wildly. Being able to step into the realm of treating myself and having full confidence in the advanced technologies I am bringing in was the game changer. I thought to myself, “If I can bring something in, I don’t have to get another surgery. I don’t have to get another injectable. I don’t have to use drops every single day. Why would I not do it?” So I brought in IPL and was blown away by my own recovery that I was like, “I’m going to keep going until I feel better. I’m going to keep buying toys because I know they work.” I have photos of myself with my chalazion surgery that I show patients. They look at it and they’re like, “I am my patient.” Trust that I would not put this device or this treatment on myself if I didn't believe in it.
Because the overall piece itself is long, I'll share it in chunks.
Experts weigh in on dry eye management
Three dry eye-focused practitioners held a panel discussion during Vision Expo West in Las Vegas in September 2025 to share perspectives and offer advice to their colleagues.
Participants:
• Moderator: @Cory J. Lappin , OD, MS, FAAO; Montgomery, OH
• Celesta Ferreira, OD; Cypress, TX
• Periman, MD; Seattle, WA
Dr. Lappin: Where do we start with diagnosis with so much overlap between the symptoms and signs of multiple ocular surface conditions?
Dr. Periman: I have always subscribed to the belief that if you listen to the patient, they will tell you what is wrong. A careful history often points me in the right direction of underlying drivers. It is a critical part for me in my assessment diagnosis and treatment plan.
Dr. Ferreira: I'm looking at every single patient. We used to do only age 30 and up; now I'm doing age 8 and up. If they can fit their face in my meibiographer, we take a scan. We have to screen everybody and not be afraid of the screening. Take the time to do it.
Dr. Periman: Imagine if that was a primary care clinic where you fail to check blood pressure on everyone. You are going to miss dangerous, silent things that have a major health impact down the road.
Dr. Lappin: How do you determine what to use once you have diagnosed dry eye? Where do you start?
Dr. Periman: When I do that exam, I have already checked meibography, corneal staining, osmolarity, MMP-9—not necessarily in that order. That guides me. Often, you can see demodex collarettes on meibography. That is a big clue, and you see the altered meibomian gland structure and appearance in that context. My game plan is to identify all the mischief makers in the room and pick them off one by one.
Dr. Ferreira: Some doctors don’t know how to implement a protocol for dry eye diagnostics. They get bogged down on not knowing what to look for. I'm looking for demodex, rosacea, turbid glands, how the lid pulls down, the snap-back test. I like storytelling with visuals for patients. After I have captured my data, I show them every image. This is demodex. This is how we are going to treat it. This is rosacea. This is how we are going to treat it. You have to tie it back for patients to understand—if we simply tell them, “You have blepharitis and rosacea, you need to buy this treatment,” they get lost in the weeds. If they physically see it, it’s a complete game changer.
Dr. Lappin: They start to own their own condition when you present it to them that way.
Dr. Lappin: We have seen a lot of innovation in the past five years. I guarantee that we do not treat patients the same way five years ago that we do today. What motivated you invest in new technology? What pushed you from traditional, over-the-counter treatments to interventional dry eye?
Dr. Periman: It is the patient with the unmet need. In 2017, I had a wonderful plastic surgeon patient with impressive rosacea. I had just read studies saying that IPL could help with MGD and dry eyes. I suggest IPL to him, and his assistants in his office do it because he had a machine—I didn’t have one yet. He came back looking like a candy cane with a red forehead. I had a realization that rosacea is a local regional disease, and that drove me to to purchase a unit. Plus, I was tired of sending patients to my dermatologist, only to say they don’t have rosacea while it is staring me in the face. That unmet need pushed me to do it along with the drive to do everything I can to help the patient.
Dr. Ferreira: For me, it was myself. I have always been a dry sufferer. I have had chalazion surgery. I have had injections. I have done all the meds, all the drops, and still suffered wildly. Being able to step into the realm of treating myself and having full confidence in the advanced technologies I am bringing in was the game changer. I thought to myself, “If I can bring something in, I don’t have to get another surgery. I don’t have to get another injectable. I don’t have to use drops every single day. Why would I not do it?” So I brought in IPL and was blown away by my own recovery that I was like, “I’m going to keep going until I feel better. I’m going to keep buying toys because I know they work.” I have photos of myself with my chalazion surgery that I show patients. They look at it and they’re like, “I am my patient.” Trust that I would not put this device or this treatment on myself if I didn't believe in it.
