Dr. Vishal Arora | Dry Eye Clinic

Clinical Assessment

Patient Demographics

Date

Name

Age

Gender

Diagnostic Findings

OSDI-6 Score

Osmolarity

Staining

Risk Factors (Drivers)

Screen Use AC / Env Contact Lens Medications Autoimmune Sleep Apnea Cosmetics Rosacea Aqueous Def. Evaporative

Ocular Surface Assessment

Right Eye (OD)

NITBUT (sec)

LLT Grade

TMH (mm)

MG LOSS

Upper

Lower

Meiboscore: 0

Left Eye (OS)

NITBUT (sec)

LLT Grade

TMH (mm)

MG LOSS

Upper

Lower

Meiboscore: 0

Clinical Management Plan

Warm Compression Therapy

Ointments & Gels

Lipid Based Antibiotic Night Gel

Anti-Inflammatory

Steroids CsA Lifitegrast Tacrolimus Insulin Losartan Serum Tears

Lubricants

CMC 0.5% CMC 1.0% HA 0.1% HA 0.18% HA 0.3% PEG + PPG Trehalose Lipid Based Vit D

Supplements / Oral

Omega 3 Curcumin Maqui Berry Doxycycline Piperine Resveratrol

Disclaimer: Clinical record only. Follow prescribed advice.

Dr. Vishal Arora