The Wet Eye

Question 1

What are the three layers of tears?

Answer 1

Lipid layer
Aqueous layer
Mucin layer

Question 2

What is the function of the lipid layer? What produces it?

Answer 2

Reduces evapouration of tears and is made and secreted by the meibomian glands found along the edge of the eyelid

Question 3

What is the function of the aqueous layer and what produces it?

Answer 3

Nourishes the ocular surface and is made a secreted by the lacrimal gland and the accessory lacrimal gland

Question 4

What is the function of the mucin layer and what is it produced by?

Answer 4

Produced by goblet cells in the conjunctival epithelium and helps the aqueous layer adhere to the corneal surface

Question 5

What is the path of tear flow?

Answer 5

Glands across the corneal surface to the upper/lower lacrimal puncta through canaliculi into the lacrimal sac which connects to the nasolacrimal duct that has an intraosseous part and exits at the nasal planum

Question 6

What nerve requires innervation to cause increased tear production?

Answer 6

Trigeminal nerve

Question 7

What are the methods of irritating cornea?

Answer 7

Distichiasis, trichiasis, extopic cilium, foreign body, corneal ulceration, prolapse of the 3rd eyelid lacrimal gland, lymphoplasmacitic infiltrate of cornea, lymphoplasmacitic infiltrate of third eyelid, eyelid mass, entropion, blepharospasm

Question 8

What does a lymphoplasmacitic infiltrate of the cornea look like?

Answer 8

Red, dotty appearance, blood vessels, immune mediated

Question 9

What does a lymphoplasmacytic infiltrate of third eyelid look like?

Answer 9

Pigmented or not

Question 10

How do you remove an eyelid mass?

Answer 10

Wedge/inverted horse resection if covering 25% refer, close with a figure of 8 stitch

Question 11

How do acquired and congenital entropion treatments differ?

Answer 11

If young = tacking sutures

If acquired = surgical correction

Question 12

What are the causes of tear drainage problems?

Answer 12

Eyelid abnormalities (euryblepharon, entropion, ectropion, diamond eye, eyelid coloboma/agenesis)
Nasolacrimal blockage
Retrobulbar or nasal disease
Third eyelid gland prolapse

Question 13

How would you identify nasolacrimal blockage?

Answer 13

Unilateral chronic discharge
Dacryocystits (generally FB sometimes idiopathic)
Jones test identifies