Collaboration in ocular surface diseases: Bridging specialties for better care

Ocular surface diseases are a group of complex conditions that often arise from multifactorial etiologies, involving various pathophysiological mechanisms that may overlap with systemic diseases.[1] The intricacies of these diseases frequently require a multidisciplinary approach to diagnosis and treatment, as conditions that affect the ocular surface often have systemic implications. Consequently, collaboration among specialists from diverse fields—such as ophthalmology, immunology, rheumatology, dermatology, and allergy—is not just beneficial but essential. Conditions like dry eye disease and ocular allergies often involve overlapping pathophysiological mechanisms that can benefit from expertise in both ophthalmology and immunology. In dry eye disease, the tear film and ocular surface are compromised, leading to inflammation and discomfort. Ophthalmologists employ specialized tests such as tear break-up time, Schirmer’s test, ocular staining, and a detailed slit lamp evaluation to assess the severity of the disease along with identifying the cause based on the ocular telltale signs.[2] However, the presence of systemic conditions such as Sjögren’s syndrome, rheumatoid arthritis, or lupus may exacerbate the disease, necessitating input from rheumatologists to rule out underlying autoimmune disorders and initiate appropriate systemic treatment.[2] Similarly, acne rosacea and psoriasis are often associated with severe meibomian gland dysfunction and cause recurrent marginal keratitis, requiring a collaborative effort from ophthalmologists and dermatologists to treat appropriately.[3] Referral to an allergist, once the symptoms of vernal keratoconjunctivitis become moderate to persistent, is now recommended in the new universal grading of VKC.[4] Timely diagnosis of allergens and avoidance of aggravating factors will further aid in controlling the frequency and severity of disease activity. In more severe cases, allergist-led interventions such as allergen immunotherapy, systemic immunosuppressives, or biologics can play a pivotal role in preventing complications and improving the quality of life.[5] Atopic keratoconjunctivitis is closely associated with atopic dermatitis, and unless the dermatitis is appropriately managed by a dermatologist, ocular flare-ups continue. Similarly, in the management of peripheral ulcerative keratitis (PUK), which is often linked to autoimmune diseases like rheumatoid arthritis or lupus, coordination between ophthalmologists and rheumatologists is key. Managing localized ocular inflammation and providing tectonic support form only part of the treatment and require a complete evaluation by the rheumatologist to rule out underlying autoimmune connective tissue disorders, along with initiating and adjusting immunosuppressive therapies.[6] While ophthalmologists are experts in managing the ocular manifestations of cicatricial pemphigoid, they may not have the expertise to handle systemic complications or monitor the side effects of immunosuppressive drugs. These drugs, such as cyclophosphamide or methotrexate, carry significant risks, including organ toxicity, infections, and hematologic issues, which require specialized knowledge in immunology.[7] Therefore, an immunologist is crucial in managing these systemic risks, adjusting treatment plans, and ensuring that the patient’s overall health is protected during therapy. While interdisciplinary collaboration offers numerous benefits, challenges remain, such as standardizing collaborative models and improving communication between healthcare providers. Future efforts should focus on developing educational programs that emphasize interdisciplinary collaboration, leveraging technology such as telemedicine and digital health platforms to facilitate better communication, and encouraging policy changes that support interdisciplinary collaboration to help overcome systemic barriers. In conclusion, the management of ocular surface diseases requires a collaborative, multidisciplinary approach that bridges specialties to provide patients with the most comprehensive care possible. By working together, healthcare professionals can enhance diagnostic accuracy, tailor treatment plans to individual needs, and monitor both ocular and systemic health. As the field of ocular surface diseases continues to evolve, fostering collaboration among specialists will remain essential to advancing patient care and improving quality of life.