15. DED Management & Therapy I Flashcards
What is the primary goal of dry eye management and why is it complicated?
Primary goal is to restore homeostasis to the ocular surface.
Can be complicated due to the multifactorial aetiology. We have to identify the degree of evaporative and aqueous-deficiency as they are a range as opposed to black/white diagnoses.
What are step one treatments for dry eye treatment?
General:
* ... which includes ...
* ... modifications
* Elimination of ...
Aqueous
* ...
Evaporative
* ...
* ... eye sprays
* ...
* ...
What are step one treatments for dry eye treatment?
General:
* education which includes dietary modification
* environmental modifications
* Elimination of offending systemic medications
Aqueous
* aqueous-based lubricant drops
Evaporative
* lipid-based lubricant drops
* liposomal eye sprays
* eyelid hygiene
* Meibomian gland warm compresses
Essential fatty acids (EFAs)
Can only be obtained from ... and/or ....
Omega-3 short chain (ALA) from: ..., ..., ..., ..., and .... Omega-3 long chain (EPA and DHA) from: ... and ....
Omega-6 (LA) from ..., ... and ... and (AA) from ..., ..., and ....
Essential fatty acids (EFAs)
Can only be obtained from diet and/or supplementation.
Omega-3 short chain (ALA) from: flaxseed, canola oil, soybean oil, chia seeds, and walnuts. Omega-3 long chain (EPA and DHA) from: oily fish and shellfish.
Omega-6 (LA) from soybean oil, safflower oil and corn oil and (AA) from meat, poultry, and eggs.
What are the biological effects of omega-3 fatty acids?
ALA is converted to EPA which is converted to eicosanoids or resolvins which have anti-inflammatory effects.
EPA is converted to DHA which is converted to protectins which have neuroprotective effects.
Omega-3 fatty acids and health
Ratio of consumed ...:... influences .... Ideally, this is <=... but most western diets have a >... ratio.
Diets rich in omega-3: have decreased risk of ..., ..., ..., and ....
In terms of dry eye disease, diets low in ... or with high ... ratio have increased risk. Can reduce risk by ...% with each additional ... of ....
Omega-3 fatty acids and health
Ratio of consumed omega-6:omega-3 influences systemic inflammatory status. Ideally, this is <=4:1 but most western diets have a >15:1 ratio.
Diets rich in omega-3: have decreased risk of coronary heart disease, stroke, late-stage AMD, and mortality.
In terms of dry eye disease, diets low in omega-3 or with high omega-6:omega-3 ratio have increased risk. Can reduce risk by 30% with each additional gram/day of omega-3.
What do patients think about optometrists providing advice about diet?
Most think optometrists don’t ask about diet but even more are comfortable with the idea.
How much omega-3 is needed?
At least ...mg/day of ... which is approximately ... servings at ...g/serving of oily fish per week.
...% of Australians don’t meet this recommendation.
Upper safety limit is ...mg/day between food and supplements.
How much omega-3 is needed?
At least 500mg/day of preferably long-chain omega-3s which is approximately 2 servings at 100g/serving of oily fish per week.
80% of Australians don’t meet this recommendation.
Upper safety limit is 3000mg/day between food and supplements.
When choosing an omega-3 supplement, what is important out of the following?
Long-chain vs short-chain: ... is preferable
Ethyl ester vs re-esterified TG forms formulation: ...
Dose: ... + ..., but how many capsules per day?
Duration: takes ... for ... and has to be taken ... to improve ...
Storage: temperature <...degC
When choosing an omega-3 supplement, what is important out of the following?
Long-chain vs short-chain: long chain is preferable
Ethyl ester vs re-esterified TG forms formulation: TG form, found in fish, is more easily absorbed
Dose: 1000mg EPA + 500mg DHA, but how many capsules per day?
Duration: takes 3 months for ocular effects and has to be taken everyday to improve meibum secretion
Storage: temperature <25degC
Environmental modifications
Minimise ... to ....
Can use a ....
Might have to .../.../... contact lens wear.
Environmental modifications
Minimise exposure to exacerbating factors.
Can use a humidifying device.
Might have to modify/reduce/eliminate contact lens wear.
Which medications can result in dry eye and what are the clinical considerations?
Clinical considerations: aim to ...
Systemic medications:..., ..., ..., ..., ..., ..., ..., and ....
Topical medications:..., ..., ...
Which medications can result in dry eye and what are the clinical considerations?
Clinical considerations: aim to reduce/eliminate side effects
Systemic medications:anti-histamines, beta-blockers, anti-depressants/anxiolytics, diuretics, anti-psychotics, isotretonin, hormone therapies, and systemic chemotherapy.
Topical medications:Preservatives in meds, BAK/benzalkonium chloride, glaucoma meds
Ocular lubricants
It’s a mainstay of dry eye therapy for ... severities and ... subtypes. Typically, they are ... therapy and remain an element of ....
They aim to ... the ocular surface, ... dehydration, and ... eyelid friction. Dosage is at least .... Major problems are that they are not ... or the ....
Ocular lubricants
It’s a mainstay of dry eye therapy for all severities and all subtypes. Typically, they are first-line therapy and remain an element of all therapy levels.
They aim to hydrate the ocular surface, counteract dehydration, and reduce eyelid friction. Dosage is at least qid. Major problems are that they are not instilled frequently enough or the necessity of long term use is not understood by the patient.
What are some examples of liquid ocular lubricants?
Muco-mimetic:.../...
Aqueous replacement:..., ..., ...
Lipid replacement:..., ...
What are some examples of liquid ocular lubricants?
Muco-mimetic:hydroxypropyl-guar/HP-guar
Aqueous replacement:Bion tears, Thera tears, Refresh
Lipid replacement:Systane Balance, Tears again liposomal spray
What are some examples of gel ocular lubricants?
Muco-mimetic:...
Aqueous replacement:..., ...
Lipid replacement:...
What are some examples of gel ocular lubricants?
Muco-mimetic:None
Aqueous replacement:Genteal gel, Celluvisc
Lipid replacement:Artelac
What are some clinical considerations for ocular lubricants?
Multi-use bottles vs unit dose/minims
Preserved products should be .... Use of more than ...
drops/day of preserved eyedrops might result in ... and may .... ... is most toxic to ocular surface. Preserved products are ... than minims.
What are some clinical considerations for ocular lubricants?
Multi-use bottles vs unit dose/minims
Preserved products should be discarded 4 weeks after opening. Use of more than 8 drops/day of preserved eyedrops might result in epithelial disruption and may cause irritation dry eye symptoms. BAK is most toxic to ocular surface. Preserved products are more costly than minims.
