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SCOT > Dry Eye > Flashcards

Dry Eye Flashcards

1
Q

Properties of the tear film

A
  • antibacterial
  • transports nutrients to cornea
  • optical performance
  • successful contact lens wear
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2
Q

Dry eye definition

A

Multifaceted condition characterised by a loss of homeostasis of the tear film, accompanied by ocular symptoms in which tear film instibility and hyperosmolarity, ocular surface inflammation and damage, and neurosensory conditions

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3
Q

Risk factors

A
  • female
  • age
  • smoking
  • caffeine
  • diabetes
  • topical medications
  • systemic meds
  • acne
  • history of arthritis
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4
Q

Types of dry eye

A
  • aqueous deficient
  • Evaporative
    • intrinsic
    • extrinsic
  • sjogrens
  • non sjogrens
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5
Q

What is aqueous deficient dry eye

A
  • failure in tear production
  • reduced tear volume
  • causes inflamed ocular surface
  • can be sjogrens or non-sjogrens
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6
Q

What is sjogrens dry eye , primary + secondary

A
  • autoimmune condition
  • damage to secretary glands throughout the body
  • primary SSDE occurs independently of other autoimmune condition
  • secondary SSDE occurs with autoimmune condition
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7
Q

What’s non-sjogrens dry eye

A
  • acinar atrophy and periductal fibrosis can cause an obstruction affecting tear production
  • secondary causes include obstruction of the lacrimal glands duct from chemical trauma or contact lens wear etc
  • secondary obstruction of the gland itself due to lymphoma or secoidosis
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8
Q

What causes intrinsic dry eye

A
  • MGD
  • proptosis
  • low blink rate
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9
Q

What’s extrinsic DED

A
  • contact lens wear
  • ocular surface disease
  • systemic drug use
  • Topical drug use
  • Vitimin A deficiency
  • environment
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10
Q

Differential diagnosis

A
  • Viral conjunctivitis
  • bacterial conjunctivitis
  • allergic conjunctivitis
  • eyelid abnormality
  • nocturnal lagophthalmos
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11
Q

Level 1 managment of dry eye

A

Education and environmental modifications
- chronic nature
- omega 3 - vegetables
- omega 6 - fish
- environmental modifications
- tear supplements

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12
Q

What is carbomer 980

A
  • tear supplement
  • increases tear film thickness
  • protects against desiccation
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13
Q

What’s hypromellose

A
  • lubricant for mild to moderte DED
  • used in combination with lots of other ingredients
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14
Q

Second line lubricant

A
  • carmellose sodium
  • sodium hyaluronate
  • Ointments
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15
Q

What is carmellose sodium

A
  • viscosity enhancing agent
  • can bind to corneal epithelial cells promoting epithelial cell healing
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16
Q

What is sodium hyaluronate

A
  • functions as tissue lubricant
  • increases viscosity
  • binds to epi cells and potential wound healing
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17
Q

Dosage of topical lubricants

A
  • standard 3-4 x a day
  • with preservative free then as much as necessary
  • if significant staining ask for every 1-2 hours
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18
Q

Other managment options

A
  • punctual plugs
  • moisture chamber specs
  • reduce CL wear time
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19
Q

When to refer

A
  • normally no referral
  • referral if adequate period of topical treatment or punctal plugs
  • secondary complications like vascularisation, corneal scaring or infection
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20
Q

Methods of eyelid therapy

A
  • lid hygiene for blepharitis
  • hot compress
  • lid massage
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21
Q

How to manage demodex

A
  • don’t respond to regular lid hygiene
  • tea tree oil has been shown to be mitacidal but toxic to the ocular surface
  • 50% tea tree oil mixed with macadamia nut oil
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22
Q

Level 2 topical anti-inflammatory meds

A
  • steroids
  • cyclosporin
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23
Q

Which steroids to use

A
  • loteprednol
  • dexamethasone
  • prednisolone
  • flouromethalone
24
Q

What steroid dosage would be employed

A
  • QID for 1 week
  • then taper
25
Q

Contraindications of steroid use

A
  • infection
  • CL wear
  • glaucoma
  • pregnancy and breast feeding
26
Q

What is cyclosporin

A

Immuno-modulator drug with anti inflammatory properties
- initiated by ophthalmologists

27
Q

When to use topical antibiotics

A
  • level 2
  • short term to reduce blepharitis in extreme cases
  • can be used pre surgery
28
Q

Which antibiotic drugs can be used

A
  • chloramphenicol
  • azithromycin
  • ## fuscidic acid
29
Q

What are systemic tetracyclines , and indications for use

A
  • anti infectives
  • anti inflammatory effects
  • for longstanding blepharitis
  • for chronic cases who haven’t responded to normal measures
30
Q

Which tetracyclines to use

A
  • doxycycline
  • minocycline
  • tetracycline
31
Q

Dosage

A
  • doxy - 100mg bds for 2 weeks then once daily for 2-3 months
  • minocycline once daily for 2 wks then ods for 10 wks
32
Q

Contraindications for tetracyclines

A
  • hypersensitivity
  • pregnancy or breast feeding
  • under 12
  • Renal impairment
33
Q

Side effects of tetracyclines

A
  • blurred vision/field loss
  • diplopia
  • GI disturbance
  • hypersensitivity
  • headaches
34
Q

When to use oral azythromycin, and dose

A
  • when tetracyclines are contraindicated
  • may improve unresponsive blepharitis
  • 500mg on day one, 250mg for 4 days
35
Q

When to refer blepharitis

A
  • if carcinoma is suspected
  • in patients that don’t respond to treatment
  • immune mediated diseases
36
Q

Symptoms of ADDE vs EDE

A

ADDE - burning gritty sensation
EDE - watery uncomfortable eyes

37
Q

Anterior eye assessment of DE px

A
  • tear meniscus height
  • LIPCOF
  • lid wiper epitheliopathy
  • TBUT
  • Lids/lashes
38
Q

What is LIPCOF

A
  • lid parallel conjunctival folds
  • 0.1mm in width
  • combine nasal and temporal for score
39
Q

Advice to give about chronic nature

A
  • no cure
  • explain condition on first visit
  • talk about management options
  • may be managing for life
  • why not to ignore
  • risk of blurred vision/infection/scarring
40
Q

What environmental modifications can be made

A
  • wrap around glasses
  • reduce temp of house
  • room humidifiers
  • lower VDU height
  • breaks from VDU
41
Q

What is HP-Guar

A
  • thickener
  • dispensed as a drop but thickens when in contact with the tear film
  • reduction in pH
42
Q

Indication and mechanism for lipid based treatment (second line)

A
  • primary evaporative
  • replace the lipid layer to try and prevent evaporation
43
Q

Examples of combination drops

A

Optive fusion - mixture of CMC, sodium hyaluronate (SH) and glycerine

Thealoz Duo - SH and trehalose

HyloCare - SH and dexpanthenol

44
Q

Why use hot compress

A

• To attempt to melt/soften the meibum to then manually express the glands
• Temperature recommended is 40°C (that is the temp of the palpebral conj/glands)
• The more severe the blockage, the higher the temperature required (45°C considered the maximum to avoid thermal damage)
• Research is divided on whether a wet or dry compress will heat more effectively (wet can help soften crusts in anterior bleph)

45
Q

Steroid side effects

A
  • raised iop
  • PSCC formation
  • headache
  • secondary infection
46
Q

Cyclosporin contraindications

A

Hypersensivity to the agent
• Active or suspected ocular infection
• Ocular or peri-ocular malignancies
• Pregnancy/breast feeding
• No trials have been done in children
• Glaucoma
• Ocular herpes
• Contact lenses

47
Q

Chloramphenicol forms and dose

A
  • 1% ointment
  • rub into lid margin BD for 1 week
  • continue with lid hygiene
  • entry level
48
Q

Azythromycin forms and dose

A
  • 1.5% azithromycin dehydrate
  • anti-inflammatory properties
  • BD for 3 days
49
Q

Fuscidic acid dose

A
  • BD for 1 week
50
Q

Advice to px about tetracyclines

A

Limit time in the sun and use high factor suncream
• No tanning equipment
• Alternative forms of contraception should be used during treatment
• To return if they experience any side effects

51
Q

Contraindications for oral azythromycin

A
  • pregnancy and breast feeding
  • hepatic and renal impairment
  • MG
52
Q

Oral azythromycin side effects

A
  • arthralgia - joint pain
53
Q

What are topical secretagogues

A
  • stimulate production of aqueous, lipid and mucin
54
Q

Topical secretagogues examples (level 3)

A
  • topical diquafosol
  • topical rebamipide Suspension
  • topical testosterone
55
Q

Example of systemic secretagogues and its effect

A
  • oral pilocarpine
  • improve signs and symptoms of DED, but with associated nausea and sweating
56
Q

What is an amniotic membrane (level 4)

A
  • promotes corneal healing in severe dry eye
  • derived from layer in amniotic sac
  • made from extra cellular matrix with anti-inflammatory, anti bacterial and anti-scarring properties
57
Q

Cyclosporin forms and dose

A
  • ikervis is 0.1%
  • once daily

SCOT (17 decks)

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