2: Dry Eye Flashcards
1
Q
dry eye: dry eye disease (DED), dry eye syndrome (DES)
A
a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by variable ocular symptoms
2
Q
DED etiology
A
tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities
3
Q
DED demographics
A
- more common with age
- women > men
4
Q
DED laterality
A
bilateral > unilateral, can be asymmetric
5
Q
DED: aqeuous deficient dry eye
A
- Sjogren’s syndrome (can also cause MGD)
- age-related changes of the lacrimal gland
- cicatricial obstruction of the lacrimal gland (e.g., trachoma, SJS, OCP, chemical injury)
- inflammation and infiltration of the lacrimal gland (e.g., sarcoidosis, lymphoma, viral infection, radiation injury)
- hyposecretory states: CN V damage, parasympathetic pathway damage, medications, familial dysautonomia
- lacrimal gland ablation
- congenital alacrima (aplasia or hypoplasia of lacrimal glnads)
6
Q
DED: evaporative dry eye
A
- primary MGD
- secondary MGD (e.g., blepharitis, rosacea, atopic dermatitis, antiandrogens)
- distichiasis (congenital condition in which a row of aberrant lashes grows from meibomian gland orifices)
- disorders of lid aperture, congruity, and dynamics (e.g., lagophthalmos, ectropion, blink-related, blepharospasm)
- ocular-surface related (e.g., allergic eye diesease, vitamin A deficiency, CL-related)
7
Q
DED symptoms
A
- red eye
- ocular irritation: burning, FBS, pain; “sandy, gritty, trash in eye”
- ocular itching
- tearing
- intermittent blurred vision
- discomfort with CL wear
8
Q
DED signs
A
- conjunctival injection (bulbar and palpebral)
- conjunctival staining with lissamine green and rose bengal (typically in the inferior 1/3 or in the interpalpebral region)
- superficial punctate keratitis (SPK) (typically in the inferior 1/3 or as a horizontal band in the interpalpebral region; inferior 1/3 may symbolize MGD, lagophthalmos)
- lid wiper epitheliopathy (damage of lid wiper region)- stains with fluorescein, lissamine green, and rose bengal
- decreased TBUT
- decreased tear prism (normal is 0.2-0.4 mm)
- increased tear osmolarity (can use TearLab)
- positive InflammaDry
9
Q
diffuse SPK causes
A
- viral conjunctivitis
- trauma
- toxicity
10
Q
inferior SPK causes
A
- blepharoconjunctivitis
- lagophthalmos
- trichiasis
11
Q
interpalpebral SPK causes
A
- dry eye disease
- exposure
- neurotrophic keratopathy
12
Q
superior SPK causes
A
- superior limbic keratoconjunctivitis
- foreign body under eyelid
- trichiasis
13
Q
3 and 9 o’clock SPK causes
A
contact lens
14
Q
lower conjunctivitis SPK causes
A
- mechanical
- meibomian gland dysfunction
15
Q
dry eye screening tests (surveys)
A
- SPEED
- OSDI
- DEQ-5
16
Q
severe dry eye signs
A
- pannus
- corneal epithelial breakdown
- corneal ulceration
- corneal scarring
- bitot spot (keratinization of the conjunctiva; typically seen with vitamin A deficiency)
- filamentary keratitis (filaments attached to the corneal epithelium; move with each blink, stain well with dye)
- signs of lacrimal gland, meibomian gland, and/or goblet cell/ocular surface damage
- signs of CN V and parasympathetic (CN VIII) pathway damage
- signs of increased eyelid aperture, poor eyelid congruity and dynamics
17
Q
DED complications
A
- microbial keratitis
- corneal ulcer
- corneal perforation
18
Q
DED treatment and management
A
- determine and treat the underlying cause
- modification of local environment
- blinking exercises
- warm compress to liquify the meibum
- eyelid cleanser qday-bid
- hypochlorous acid eyelid spray (neutralizes bacteria, toxins, and inflammatory mediators)
- topical lubrication
- omega-3 fatty acid supplement (fish oil)- improves meibum production
- punctal occlusion/plugs
- moisture chamber goggles qhs
- topical steroid or antibiotic/steroid combo bid-qid for 2-4 weeks
- Restasis or Xiidra bid
- acetylcysteine for dissolving mucous filaments
- oral doxycycline
- BlephEx with eyelid cleanser in office (scrubs lids/lashes clean; Rx antibiotic/steroid ung following Tx)
- meibomian gland expression in office
- meibomian gland probing in office
- LipiFlow in office
- iLux in office
- intense pulse light (IPL) therapy in office
- autologous serum eye drops
- BCL or scleral lens
- amniotic membrane
- if significant stromal thinning occurs, limit the risk of corneal perforation by treating with ascorbic acid and citric acid or a tetracycline
- if medical therapy fails, refer for surgery (surgical punctal occlusion, tarsorrhaphy)
19
Q
DED clinical pearls:
- low degree of (+) staining is _____ on the normal conj and cornea
- 85% of dry eye cases have _____ as primary cause or contributory
A
a regular finding;
MGD
