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Flashcards in Dry Eye (Yumori) Deck (28):
1

Dry Eye disease

multifactorial disease that results in symptons of discomfort, visual disturbance, tear film instability. With potential damage to ocular surface. Increased osmolarity of tear film and inflammation

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two main types of dry eye

evaporative or aqueous deficient

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evaporative dry eye

intrinsic and extrinsic

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intrinsic dry eye causes

meibomian oil deficiency, disorders of lid aperture, low blink ratio, drug action accutane

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extrinsic dry eye causes

Vitamin A deficiency, topical drugs preservatives, CL wear, ocular surface disease (allergy)

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aqueous defficient dry eye

sjogren syndrome and non-sjogren dry eye

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sjogren's syndrome

chronic inflammatory disorder which affects lacrimal and salivary gland

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major long-term concern for sjogren's syndrome

lymphoma can develop which is threatening. 5% lifetime risk

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ACR criteria for sjogren's syndrome

two or more of following features: 1. positive serum anti-SSA/Ro and or anti-SSB/La 2. labial salivary gland biopsy 3. keratoconjunctivitis sicca with ocular staining score 3

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probe for systemic inflammatory symptoms which include

morning stiffness and dry mouth

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DED Tests

symptoms survey, tear osmolarity, external exam (lids, meibomian gland), TBUT, staining (cornea with fluorescein and conj with lissamine), tear meniscus height, schirmer w/out anesthetic

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DED symptoms

burning, foreign body sensations, decreased vision, excess tearing, exacerbated by smoke, wind, heat, humidity, worse later in day, bilateral and chronic

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which symptom survey do we use?

ocular surface disease index (OSDI)

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NORM for OSDI

less than 13

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tearlab norm

308 mOsm/L or less
inter-eye less than 8 mOsm/L

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external exam norm

negative

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TBUT norm

greater or equal to 10 sec

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staining norm

less than or equal to grade 2

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TMH

greater or equal to 0.10mm, convex

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Schirmier without anesthetic norm (5 min)

>5mm

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environmental modifications

minimize desiccating enviornmental stresses. Add humidifier, avoid air conditioning drafts. add periodic breaks with eye closure when reading or working on comp

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anti-inflammatories

topical steroids not for topical use because increases IOP and cataract formation. Omega 3, oral tetracycline (doxycycline

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if Pt responds to steroids we perscribe

Restasis BID OU

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can't perscribe doxycycline to

pregnant/nursing women and children

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level one treatment

education and environmental modifications, elimination of offending systemic meds, artificial tear subs, eye lid therapy

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level two treatment

add anti-inflammatories, tetracyclins for meibomitis, punctal plugs, secretogogues, moisture chamber spectacles

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level 3

add serum, contact lenses, permanent punctal occlusion

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level 4

add systemic anti-inflammatory agents, surgery