Dry Eye Disease Flashcards
(32 cards)
how many people in the US have been diagnosed w/ dry eye disease?
16.4 million ppl
what % of people ≥ 50 years old are affected by dry eye disease?
30%
which dry eye condition are these characteristics indicative of?
-lacrimal deficiency —
—primary (e.g. age-related)
—secondary (e.g AIDS, inflammatory & neoplastic lacrimal gland infiltration)
-lacrimal duct obstruction (e.g. trachoma, pemphigoid, SJS)
reflex hyposecretion —
—sensory block (e.g CL wear, DM, refractive surgery, neurotrophic keratitis)
—motor block (e.g. CN7 damage, systemic drugs)
aq. deficient— non-Sjogren’s keratoconjunctivitis sicca (KCS)
what are these characteristics indicative of?
- meibomian gland deficiency (eg, post bleph, rosacea)
- lid aperture disorders (eg, proptosis, CN7 palsy, lid retraction)
- low blink rate (eg, Parkinson’s, excessive computer use, reading)
- drug action (eg, antihistamines, beta-blockers, diuretics, antispasmodics)
evaporative — intrinsic
what are these characteristics indicative of?
- vitamin A deficiency (xerophthalmia)
- topical drugs including preservatives effect
- CL wear
- ocular surface disease (e.g. allergic conjunctivitis)
evaporative — extrinsic
list the tests of dry eye diseases
- symptoms survey: Ocular Surface -Disease Index (OSDI)
- non-invasive tear break-up time (NIBUT) — <10s
- tear osmolarity: Tearlab
-external exam — lids, meibomian glands
-tear break-up (TBUT)
ocular surface staining — cornea, conj. , lid margin.
- tear meniscus height
- Schirmer w/o anesthetic
what are signs of dry eye disease?
meibomitis, conjunctivitis, debris in tear film, SPK
what are these symptoms indicative of?
- morning stiffness
- dry mouth
- grittiness & burning that worsen over course of the day
- stringy discharge
- transient blurring of vision
- redness & crusting of lids
- usually bilateral & chronic
-symptoms are frequently exacerbated on exposure to conditions assoc. w/ increased tear evaporation (eg, air-conditioning, wind & central heating) or prolonged reading or video display unit use (when blink frequency is reduced)
dry eye disease
what are abnormal findings for OSDI, NIBUT, & Tear Lab?
OSDI — ≥ 13
NIBUT — < 15 sec
Tear Lab — ≥ 308 mOsm/L either eye/Inter-eye > 8 mOsm/L
what are abnormal findings for external exam, & TBUT?
external exam — positive
TBUT — < 10 sec
what are abnormal findings for corneal staining, conjunctival staining, & lid margin?
corneal staining — > 5 corneal spots
conjunctival staining — > 9 conjunctival spots
lid margin — ≥2 mm length & ≥25% width
what are abnormal findings for TMH & Schirmer w/o anesthetic (5 min)?
TMH — < 0.10 mm, concave
Schirmer w/o anesthetic (5 min) — <5 mm
what step of DED treatment is this?
- education on condition, management, treatment, prognosis
- environmental modification
- education regarding dietary modification — omega-3
- identification, modification of offending systemic & topical meds
- lid hygiene & warm compresses w/ lid massage
- ocular lubricants
step 1
what is the education regarding dietary modification — omega 3 in step 1 of DED treatment?
AHA —
—healthy folks: at least 2 portions of salmon/week
—coronary heart disease: 1g DHA + EPA combined
FDA — 3g/day DHA + EPA max
w/ PCP: omega-3 fatty acid index blood test for at-risk pts
what step of DED treatment is this?
- non-preserved ocular lubricants
- tea tree oil
- tear conservation
- overnight treatments
- in-office physical findings heating & expression of -meibomian glands
- in-office intense pulsed light therapy
- prescription drugs
step 2
what step of DED treatment is this?
oral secretagogues: nasal neurostimulation
therapeutic CL options — soft bandage lenses, rigid scleral lenses
autologous/allogeneic serum eye drops
step 3
what step of DED treatment is this?
topical corticosteroid for longer duration: NOT for chronic use
—increases IOP & facilitates cataract formation
—amniotic membrane
—surgical punctal occlusion
—other surgical approaches
step 4
Treatment options of DED
- FreshKote
- Lacrisert
- punctal plugs
- oral macrolide/tetracycline antibiotics
- cyclosporine BID
- Xiidra (lifitegrast BID)
- thermal pulsation therapy
- secretagogues (nasal neurostimulation)
treatment: punctal plugs (collagen vs silicone)
collagen: dissolvable
silicone: non-dissolvable
treatment: oral macrolide/tetracycline antibiotics
macrolides —
- controls bacterial flora, lid inflammation
- azithromycin 500mg qd x 3 days, 3 cycles w/ 7-day intervals
tetracyclines —
- decrease bacterial lipase production
- doxycycline 50
which dry eye treatment is this?
- shown to increase tear production
- restasis 0.05%
- single vials
- multi-dose
cyclosporine BID
what dry eye disease treatment is this?
- only artificial tears that requires Rx
- intended to stabilize the lipid layer
FreshKote
what dry eye disease treatment is this?
- slow release prescription lubricant
- preservative-free
- prolongs TBUT
Lacrisert
what is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, & accompanied by ocular symptoms, in which tear film instability & hyperosmolarity, ocular surface inflammation & damage, & neurosensory abnormalities play etiological roles?
dry eye
