Dry Eye Disease: Perspectives of a Patient and Both US and UK Physicians.

Dry eye disease (DED) is a multifactorial disorder of the ocular surface characterized by tear film instability and inflammation. Evaporative dry eye driven by meibomian gland dysfunction (MGD) accounts for most DED cases and can cause a substantial burden on a patient's quality of life. Current treatment algorithms include lipid-containing drops and in-clinic procedures, but the reliance on trial-and-error management can result in delayed symptom relief for patients. To better illustrate the patient's lived experience of DED and the challenges of treatment options, a female patient (E.C.) in her mid-30s living with MGD-related DED collaborated with physician authors to develop this patient-led manuscript. We integrate E.C.'s narrative with a literature review and discussion of current guidelines in both the UK and the USA to examine how trial-and-error treatment approaches and limited access to advanced testing and procedures can affect patient outcomes. E.C.'s experience within the UK healthcare system illustrates how time constraints and financial barriers can delay effective treatment and contribute to patient frustration. E.C. reported fluctuating DED symptoms and poor correlation between clinical signs and symptom severity. Coupled with the feeling of being dismissed and mismanaged, E.C. felt that she needed to rely on online communities for novel therapy ideas and support to gain a better understanding of her disease. These perspectives will allow patients and clinicians to better understand the challenges of DED management and guide the development of more effective, patient-focused care pathways.