Physician, comanagement with

Herpes simplex infection in the immunocompromised host, especially the patient infected with the human immunodeficiency virus (HIV), requires careful comanagement with the patients physician. 

Before directly treating dry eye, any comorbid conditions should be treated to the best extent possible. As previously mentioned, any associated ocular disease, such as blepharitis, MGD, ocular allergy, infections, and contact lens-related problems, should be appropriately addressed. Local or systemic disease, such as thyroid orbitopathy and orbital inflammatory pseudotumor, can cause exophthalmos and proptosis and should be comanaged with the patient s primary care physician or appropriate specialist. Neuroimaging is often required to exclude orbital tumors in these cases. 

Although most eye care practitioners are capable of ordering laboratory tests directly, it is often more prodne-tive to commnnicate with the patient s primary care physician before proceeding, snch that all aspects of the systemic history may be taken into account. Shonld the patient be diagnosed with a contribntory systemic disease, comanagement with the primary care physician becomes paramonnt. 

Therapy depends on etiology. In individuals who are suspected of having tuberculosis, diagnosis should make use of a purified protein derivative skin test, chest radiograph, and sputum cultures if necessary. These individuals should be referred for comanagement to their primary physician or to an infectious disease specialist. Though antituberculin agents are systemically administered, the ocular lesions are appropriately treated with topical steroids. In most instances, patients respond to 1% prednisolone acetate every 3 to 4 hours for the first day, subsequently tapered rapidly on the basis of the clinical response. 

If exposure keratopathy is the result of an ocular or systemic abnormaUty, the underlying condition should be addressed. Patients with exposure keratopathy resulting from Bell s palsy or Graves disease often are comanaged by a physician caring for the systemic problem together with the eye care practitioner attending to the ocular complications. 

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