Dry Eyes

Question 1

Is photophobia always from uveitis

Answer 1

No, any ocualr surface problems can cause this

Question 2

What is considered chronic

Answer 2

3m

Question 3

Common ocular findings with SLE

Answer 3

Dry eyes

Disc edema

Question 4

MOA of plaquenil

Answer 4

Decrease PAL-2, increase heme

Question 5

Things that can cause chronic bilateral red eyes

Answer 5

Chlamydia
DED
Rosacea

Question 6

Tests for aqueous deficient dry eye

Answer 6

Schirmer

Question 7

Tests for evaporative DED

Answer 7

MG description

Meibomagraphy

Question 8

What are the main categories of DED

Answer 8

Aq deficient

Evaporative

Question 9

What are the types of aq deficient dry eye

Answer 9

Sjogrens

NonSjogrens

Question 10

Sjogrens aq deficient DED

Answer 10

Primary (without AI)

Secondary (with triad, AI)

Question 11

Primary non Sjogrens AQ def dry eye

Answer 11

Age atrophy of ducts

Question 12

Secondary non Sjogrens dry eye

Answer 12

Attacked ducts (sarcoidosis) 
Blocked ducts (trachoma, pemphigoid)
Cut signal (LASIK)

Question 13

Intrinsic evaporative dry eye

Answer 13

MGD

Question 14

Extrinsic evaporative dry eye

Answer 14

CL (friction)

Vit A deficiency

Question 15

Nonspecific dry eye tests

Answer 15

tear lab and TBUT

Question 16

Drugs that cause dry eye

Answer 16

Cholinergic antagonists

• STOPACH
• antidepressants
• antipsychotics
• antihistamines (1st gen)

Question 17

Dry eye definition

Answer 17

Multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbances, and tear film instability with potential damage to the ocular surface

Question 18

Vitamin A and DED

Answer 18

Vit A essential for goblet cells and glycocalyx development. Deficiency can cause aq def DED as as result of lacrimal gland acinar damage as well. It is associated with bitots spots on the conjunctiva

Question 19

Appx ___% of CL wearers have dry eye symptoms

Answer 19

50%

Question 20

Tear lab readings indicating dry eye

Answer 20

> 308 or >8 differnece

Question 21

What is the height of tear meniscus indicative of DED

Answer 21

0.3mm

Question 22

Schirmer 1

Answer 22

Without anesthetic
Measures basal and aq
Abnormal is <5mm wetting in 5m

Question 23

Schirmer 2

Answer 23

With anesthetic
Basal only
<5mm in 5m

Question 24

PRT findings and DED

Answer 24

<10mm in 15s

Question 25

DED Tx

Answer 25

``` Soft steroids with restasis Q12H (lotEmax) Fish oil 2000mg/day Doxy 50/100mg Azasite BID x 2 days then QD x 12 days Filaments-BCL or mucomyst ```

Question 26

AIC signs

Answer 26

Unilateral huge follicles with chronic red eye

Question 27

Treatment fo AIC

Answer 27

Doxy100mg BID x 10 days | Azithromycin 1000mg

Question 28

What drugs can you take on an empty stomach

Answer 28

PCN Azithrmycin Tetras (not doxy though)

Question 29

Premarin

Answer 29

Estrogen only HRT that can lead to severe aq def dry eye. Patients may be switched to a combo hormone replacement therapy by their PCP if warranted

Question 30

Rosacea keratitis

Answer 30

``` Sebaceous gland disease (zeiss, meibomian) Findings -hordeolum -phlyctenules -blepharitis -SPK -staph marginal keratitis ```

Question 31

Salzmanns nodular degeneration

Answer 31

Rare conditio nthat is most often associated with significant corneal inflammtory disease (eg. MGD, trachoma, phlyctenulosis, VKC, keratoconjunctivitis sicca, IK. Usually asymptomatic, hyperemia uncommon. Bowmans, blue, bad dry eye

Question 32

SLE

Answer 32

``` Type 2 HS (+) ANA DED Papilledema Episcleitis (30% of all cases come from RA, SLEm UCRAP, the rest idiopathic) ```

Question 33

Systemic symptoms of SLE

Answer 33

Butterfly rash, raynauds, discoid lupus, arthritis, renal disorders, neurological disorders, immunological disorders, and hemolytic anemia

Question 34

Ocular findings of SLE

Answer 34

DED, photosensitivity, peripheral keratitis, recurrent spiscleritis, photophobia, and neuro-ophthalmic complications (disc edema, papilledema)

Question 35

Treatment for DED

Answer 35

Avoidance of contributing environmental factors (ceiling fans, dry and dusty environments, wind, smoke, heat, AC, allergens) Counsel on activities that reduce blink rate (computers) AT q1-6h. If more than QID, use PFAT Thicker ointments at bedtime Topical restasis 0.05% Q12H Fish oil 2000mg/day punctal plugs (start inferior since 60% of drainage occurs here) Treatment of underlying disease Eval for underlying systemic disorders Treatment of corneal filaments Ruth acetylcysteine 10% Autologous serum QID Lateral tarsorrhaphy

Question 36

Lacrisert

Answer 36

Insert placed in the inferior conjunctival sac to treat DED in conjunction with or as an alternative to artificial tears

Question 37

Restasis

Answer 37

Q12H T cells decrease from being born Takes 3m to kick in, give steroid (lotemax or FML) with it until then For Aq def dry eye

Question 38

Treatment of MGD/bleph

Answer 38

- warm compresses with fingertip massage 5-10m QID - eyelid scrubs BID or TID until the condition stabilizes, then QD - topical ABX/steroid combo (tobradex) for short term care (avoid long term) - AzaSite BID x 2 days then QD x 12 days - oral doxy 100mf BID for 4 weeks, then 100mg QD for 3-6m, or 40-50mg QD for approximately 6-12m. Oral minocycline 50mgBID x 2m as alternative

Question 39

Oral tetracyclines for DED

Answer 39

Convert glandular neutral fats to physiological free FA, allowing for steady improvement of inspissated meibomian glands

Question 40

Treatment of AIC

Answer 40

Oral azith 1000mg and oral doxy 100mg BID x 10 days

Question 41

Treatment of salzmanns

Answer 41

Depends on severity Mild observed or AT or steroid Severe -SK or PTK

Question 42

Treatment of acne rosacea

Answer 42

- Oral doxy 100mg BID until symptoms are relieved (2-6weeks), followed by a taper of 100mg QD or 50mg QD for several weeks thereafter. Severe cases may rewuire long term treatment with periostat, a low dose (20mg) doxy tablet. Oral erythromycin is an alternative to doxy - metronidazole - fish oil and omega 3 FA - warm compresses, eyelid scrubs and DE therapy - topical ophthalmic Abx/steroid combo - telangiectasia can be treated with green tinted cosmetics or pulsed dye laser - rhinphyma can be treated with carbon dioxide laser, incisional surgery, or electrocautery

Question 43

Treatment of corneal filaments

Answer 43

Mucomyst of BCL - replace every week for 1-2 months - treat with doxy/fish oil/restasis while BCL

Question 44

Order of events when testing causes of papilledema

Answer 44

``` check BP first, if normal.. Then send for MRI Then send for lumbar puncture -look at cells for inflammation -check CSF pressure ```

Question 45

Papilledema

Answer 45

Bialteral disc edmea DUE TO INCREASED INTRACRANIAL PRESSURE. Use term bilateral disc edema until you know for sure it is form increased intracranial pressure