LACRIMAL SYSTEM EVAL

Question 1

what comprises the afferent lacrimal system

Answer 1

secretory lacrimal system

Question 2

basal tears are a part of which lacrimal system?

Answer 2

afferent / secretory

Question 3

the secretory lacrimal system is responsible for what

Answer 3

tear production

Question 4

the afferent lacrimal system has what two types of tears

Answer 4

basal tears and reflex trears

Question 5

what are reflex tears

Answer 5

produced in response to ocular surface irriation or emotions

Question 6

T/F there is 100x more basal tears than reflex tears

Answer 6

false

Question 7

what system is responsible for tear drainage

Answer 7

excretory efferent lacrimal system

Question 8

what is the efferent lacrimal system responsible for

Answer 8

tear drainage

Question 9

T/F 90% of tears are drained by the nasepharynx and 10% evaporate

Answer 9

true

Question 10

what percentage of tears evaporate?

Answer 10

10%

Question 11

what percent of tears are drained by the naseopharynx

Answer 11

90%

Question 12

what nerve innervates the lacrimal system?

Answer 12

lacrimal nerve, a branch of the opthalmic division of the trigeminal nerve (CN V)

Question 13

the lacrimal nerve is a branch of what nerve

Answer 13

ophthalmic division of the trigemnial nerve (CN V)

Question 14

T/F reflex tearing occurs with stimulation of branches of the opthalmic nerve or in response to external stimuli such as intense light

Answer 14

true

Question 15

what are functions of the tear film

Answer 15

surface moist
lubricant
trap debris
remove epithelial cells
oxygen source
smooth refractive surface
antimicrobial
corneal hydration
ocular surface wound healing

Question 16

what are the three layers of the tear film

Answer 16

lipid layer
aqueous layer
mucin layer

Question 17

what produces the lipid layer of the tear film

Answer 17

meibomian glands, zeiss and moll glands

Question 18

what is the function of the lipid layer

Answer 18

thicken, stabilize and decrease evaporation of the aqueous layer

Question 19

what is the outermost layer of the tear film

Answer 19

lipid layer

Question 20

in healthy eyes how thick should the lipid layer be

Answer 20

~0.10 um

Question 21

t/f blinking releases the lipid layer

Answer 21

true

Question 22

T/F forceful blinking releases more lipids

Answer 22

true

Question 23

what is the middle layer of the tear film

Answer 23

aqueous layer

Question 24

what produces the aqueous layer of the tear film

Answer 24

accessory exocrine glands of krause and wolfring

Question 25

what is the function of the aqeuous layer of the tear film

Answer 25

provides oxygen to the cornea, cushions the globe from the eyelids and contains antimicrobial proteins

Question 26

what are the antimicrobial proteins contained in the aqueous layer of the tear film

Answer 26

lactoferin and lysozymes

Question 27

T/F Aqeuous layer tear film production rate decreases with age

Answer 27

True

Question 28

What is the inner most layer of the tear film

Answer 28

Mucin layer

Question 29

what procudes the mucin layer of the tear film

Answer 29

goblet cells and tarsal crypts of Henle

Question 30

what is the function of the mucin layer of the tear film

Answer 30

lubrucate the lids and serves as the absorbing site for the aqueous layer, also performs waste management

Question 31

What layer of the tear film lubcircates the lids and performs waste management

Answer 31

Mucin Layer

Question 32

What will happen if the mucin layer of the tear film is disrupted or contaminated?

Answer 32

elicit tear break up

Question 33

What layer has these? Cholesteryl esters cholesterol triglyceride phospholipids

Answer 33

Oily layer (0.1um)

Question 34

What layer of the tear film has these 98-99% water approx 1% inorganic salts approx 0.2-0.6% proteins, globulins, and albumins approx 0.02-0.06% lysozyme rest: glucose, urea, neutral mucopolysaccharidse, and acidic mucopolysaccharides

Answer 34

Water Layer (8um)

Question 35

What Layer of the tear film has these? Conjunctival and goblet cells

Answer 35

Mucin Layer 0.8um

Question 36

what percentage of tears pass through the nasolcarimal drainage system?

Answer 36

75%

Question 37

What system is composed of the Puncta, canaliculi, lacrimal sac, nasolacrimal duct

Answer 37

nasolacrimal system

Question 38

What can we use to evaluate the quality of the tear film?

Answer 38

Fluorescin staining, tear break up time, rose bengal/lissamine green

Question 39

What can we use to evaluate the quantity of the tear film?

Answer 39

Schirmer test 1 and 2, red phenol thread

Question 40

What ophthalmic dye penetrates areas of corneal epithelium and conjunctival epithelium where intracellular junctions are disrupted?

Answer 40

Fluroescein

Question 41

What dye will be observed under direct diffuse cobalt blue at low mag

Answer 41

Fluroescein

Question 42

T/F the wratten filter can be used with diffuse cobalt blue and fluorescein to observe the cornea

Answer 42

True

Question 43

What dye is used to evaluate cornea and conjunctival epithelium disruptions

Answer 43

fluroescein

Question 44

what dye is used in tear break up time

Answer 44

flourescein

Question 45

What test quantifies the stability of the precorneal tear film

Answer 45

tear break up time

Question 46

what test must be performed prior to anesthesia and tonometry

Answer 46

tear break up time

Question 47

T/F TBUT must be performed before any other procedure that may mechanically or pharmacologically alter the ocular surface

Answer 47

True

Question 48

These are the steps to what procedure? 1. apply fluroescein using a wet NaFl strip 2. under low mag w cobalt blue illumination scan the cornea. ask the patient to blink several times and stare ahead without blinking 3. count the seconds it takes for the first tear film breaks to appear

Answer 48

tear break up time

Question 49

what is the name of this mechanism? who was it described by? in what year?

Answer 49

Holly and Lamps mechanism for tear film break up Desribed by Holly in 1973

Question 50

Values of less than 10s for TBUT

Answer 50

abnormal

Question 51

Values of 5-9s for TBUT?

Answer 51

borderline dry eye

Question 52

values of less than 5s for TBUT

Answer 52

indicates dry eye

Question 53

T/F perfroming TBUT after installing anesthesia may provide false positives

Answer 53

true

Question 54

What test is pictured?

Answer 54

TBUT w fluroscein dye

Question 55

toposcope is used for

Answer 55

non invasive tear break up time

Question 56

What dye is used in the picture?

Answer 56

Rose Bengal

Question 57

what dye is used in dectection of keratoconjunctivitis sicca and early detection of ocular surface disease

Answer 57

rose bengal

Question 58

T/F rose bengal is very painful and could be toxic

Answer 58

true

Question 59

T/F lissamine green is an alternative for rose bengal

Answer 59

true

Question 60

what dye is used in the picture

Answer 60

Lissamine green

Question 61

Lissamine green has an affinity for staining what?

Answer 61

dead and degenerated cells

Question 62

when evaluating with lissamine green, if illumination is too intense or bright what will happen to the contrast?

Answer 62

contrast will be diminished causing an underestimation of staining

Question 63

what is the following picture used to grade

Answer 63

staining

Question 64

What test measures primarily aqueous production due to the aqueous layer composing the largest part of the tear film and performed using Whatman no 41 filter paper?

Answer 64

Schimer Test I

Question 65

what filter paper does the Schimer test I use?

Answer 65

Whatman no 41 filter paper

Question 66

how much is the head of the whatman filter paper folded for the Schirmer test I?

Answer 66

5 mm

Question 67

What test has the procedure below - apply strip w folded end onto lower lid margin at lateral canthus after dryer the excess tears, ask patient to look nasal and insert temporal, instruct pt to keep eyes open and blink normally

Answer 67

Schimer test I

Question 68

T/F in the Schimer test I you want to make sure the Whatman no 41 filter paper is touching the cornea at all times

Answer 68

FALSE

Question 69

What test is depicted in the picture

Answer 69

Schirmer Test I