Dry Eye Flashcards

1
Q

what is dry eye disease?

A

a multifactorial disease that results in symptoms of discomfort, visual disturbances, tear film instability

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2
Q

what are some subjective (symptoms)?

A

dryness, red eyes, general irritation, gritty sensation, burning, FB sensation, excessive tearing, light sensitivity and blurred vision

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3
Q

what is a subjective test that you can give patients and what is a normal score?

A

Ocular surface disease index survey (OSDI) = normal is less than 13 points

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4
Q

what is the TearLab test?

A

an objective test = measures osmolarity or saltiness of tears

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5
Q

what is a normal result for the TearLab test?

A

308mOsm/L or less

inter-eye difference of less than 8mOsm/L

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6
Q

what are some external observations that can be associated with dry eyes?

A

objective - lagophthalmos, ectropion, pterygium, blepharitis, meibomitis

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7
Q

what are some signs of anterior blepharitis?

A

collarettes, increased vascularization, trichiasis, irregular lid margin

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8
Q

how do you grade meibomitis (posterior blepharitis)?

A

based on expressibility = percentage of glands secreting and secretion quality (clear vs. white/thick)

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9
Q

what is a normal result for TBUT?

A

objective test - 10 seconds or longer

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10
Q

what is a normal tear meniscus height?

A

0.2mm and convex shape (concave is abnormal)

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11
Q

what is a normal schirmer I result?

A

objective - more than 15mm in 5 minutes

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12
Q

what are 3 non-specific tests used in assessment of dry eye?

A

OSDI, TearLab, and external exam

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13
Q

what are 2 tests used for aqueous deficient dry eye?

A

schirmer and TMH

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14
Q

what are the 2 layers affected in aqueous deficient dry eye?

A

aqueous and mucin

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15
Q

what are the 2 categories within aqueous deficient dry eye?

A

sjogren syndrome dry eye and non-sjogren dry eye

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16
Q

what are some causes of non-sjogren dry eye?

A

lacrimal deficiency, lacrimal gland duct obstruction, reflex block or due to systemic drugs (antihistamines, beta-blockers, diuretics, antidepressants)

17
Q

what is the test used to test for evaporative dry eye and which layer is affected?

A

TBUT and lipid layer

18
Q

what are some intrinsic causes of evaporative dry eye?

A

meibomian oil deficiency, disorders of lid aperture, low blink rate, Accutane

19
Q

what are some extrinsic causes of evaporative dry eye?

A

vitamin A deficiency, topical drug preservatives, CL’s, ocular surface disease (allergy)

20
Q

what is sjogren’s syndrome?

A

a chronic inflammatory disorder where the lacrimal and salivary glands are involved

21
Q

what is a major long-term concern in sjogren’s syndrome?

A

lymphoma - NHL risk is 5% (16-44 times higher than normal population)

22
Q

what ocular feature is needed to make a sjogren’s diagnosis?

A

keratoconjunctivitis sicca with ocular staining score 3 (fluorescein and lissamine green)

23
Q

what is the level 1 plan for dry eye treatment?

A

education, environmental/dietary modifications, elimination of systemic medications, artificial tears, gels/ointments, and eyelid therapy

24
Q

what are some environmental modifications?

A

minimize stressors, add humidifier, avoid air conditioning/fans, lower monitors below eye level, add periodic breaks while reading

25
Q

what are some dietary modifications?

A

decrease omega-6 and increase omega-3

26
Q

what is the level 2 plan for dry eye treatment?

A

anti-inflammatories, tetracyclines (meibomianitis, rosacea), punctal plugs, scretogogues, and moisture chamber specs

27
Q

what is the level 3 plan for dry eye treatment?

A

serum, CL, permanent punctal occlusion

28
Q

what is the level 4 plan for dry eye treatment?

A

systemic anti-inflammatories, surgery (lid surgery, tarsorrhaphy, mucus membrane, salivary gland, amniotic membrane transplants)

29
Q

according to the treatment flowchart - what are you supposed to start with when treating dry eye?

A

CMC (Refresh optive, Liquigel), HPMC (GenTeal), Hyaluronic acid (Blink)

30
Q

what do you use when the patient is resistant to CMC, HPMC, and Hyaluronic acid?

A

need stronger active ingredients = PEG 400 or PG/Glycerin

31
Q

if symptoms persist after using PEG 400 or PG/Gylcerin what do you turn to?

A

gel/lipid formulations and increase the frequency and length of therapy (at least 60 days)

32
Q

what are some ancillary options when gel/lipid formulations do not seem to work for dry eye?

A

prescription medications, ointments, liposomal sprays, prescription inserts

33
Q

what type of eyelid therapy do you use for anterior blepharitis?

A

topical antibiotic ointment - erythromycin or bacitracin QHS OU

34
Q

what type of eyelid therapy do you use for posterior blepharitis?

A

(Meibomitis) = warm compress and lid massage

35
Q

what are 3 treatment options for evaporative dry eye?

A

eyelid therapy, anti-inflammatories, oral tetracyclines

36
Q

what do oral tetracyclines treat when prescribed for evaporative dry eye?

A

treats meibomitis, reduces lid and conjunctival bacteria, decreases keratinization and bacterial lipase production, reduces matrix metalloproteinase activity

37
Q

what are 2 treatment options for aqueous deficient dry eye?

A

anti-inflammatories and punctal plugs