AED - Dry Eye Assessment - Week 4 Flashcards

1
Q

Describe the thickness and origin of each of the three layers of the tear flim.

A

Lipid phase - meibomian gland - 0.1μm
Aqueous phase - lacrimal gland and conjunctiva - 7μm
Mucoid phase - goblet cells - 0.05μm

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2
Q

Describe the two kinds of dry eye disease and list the subclassifications for each (7).

A

Tear-deficient
-sjogren’s syndrome
-non-sjogren tear deficient

Evaporative
-oil deficient
-aqueous deficient
-lid related
-contact lens
-surface change

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3
Q

List three possible causes of aqueous deficient dry eye.

A

Tear hyperosmolarity
Tear film instability
Reflex block

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4
Q

List three possible causes of reflex block.

A

Refractive surgery
CL wear
Topical anaesthesia

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5
Q

List four possible causes of tear film instability.

A

Xerophthalmia
Ocular allergy
Preservatives
CL wear

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6
Q

List four possible causes of evaporative dry eye.

A

Environment
Deficient or unstable tear flim lipid layer
Blepharitis
Lid flora

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7
Q

List the two broad classifications for evaporative dry eye. For each, list four subclassifications and an example if applicable.

A

Intrinsic
-meibomian oil deficiency
-lid aperture disorder
-low blink rate
-drug action (accutane)

Extrinsic
-vitamin A deficiency
-topical drugs (preservatives)
-contact lens wear
-ocular surface disease (allergy)

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8
Q

Can dry eye be asymptomatic? Explain.

A

Yes, it can be due to neurotrophic conditions or a predisposition to dry eye
Preventative management is needed

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9
Q

What if a patient presents complaining of dry eye, but there are no signs of dry eye upon assessment (2)?

A

It could be a preclinical state, in which case you offer preventative therapy
It could be neuropathic pain, in which case you would refer for pain management

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10
Q

What are the four main causes of dry eye? What may occur secondary to these causes and what is a consequence of this?

A

Reduced aqueous production
Mucin deficiency
Lipid deficiency
Lid/ocular surface abnormality
Inflammation can occur secondary to these, and perpetuate the disease

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11
Q

What can cause mucin deficiency?

A

Goblet cell destruction

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12
Q

List a primary and secondary cause of reduced aqueous production.

A

Primary - gland dysfunction/blockage
Secondary - abnormal neural reflex/control

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13
Q

Is primary inflammation a possible cause of dry eye disease or only secondary?

A

Primary can also be a precipitating factor

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14
Q

Can reduced aqueous production occur in sjogren’s syndrome?

A

Yes

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15
Q

Can systemic or topical drugs cause reduced aqueous production?

A

Yes

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16
Q

Aside from goblet cell dysfunction, list three possible causes of mucin deficiency.

A

Vitamin A deficiency
Systemic or topical drugs
Severe ocular surface inflammation/trauma

17
Q

List four possible causes of lipid deficiency.

A

Lid disease
Meibomian gland dysfunction
Systemic/topical drugs
Lid inflammation/trauma

18
Q

List 6 conditions that can result in blink abnormalities.

A

Desensitised cornea
Bell’s palsy
Concentrated use of eyes (TV/PC etc)
Coma
Parkinsons disease
Systemic/topical drugs

19
Q

List 5 conditions that can result in eyelid malposition.

A

Exophthalmos
Ectropion
Entropion
Lagophthalmos
Bell’s palsy

20
Q

List 6 conditions that can cause surface disruption leading to dry eye.

A

Contact lenses
Flitering bleb
Pterygia/pingueculae
Tumours
Trachoma/scarring
Inflammation

21
Q

Is smoking a risk factor for, or protective against dry eye?

A

Risk factor

22
Q

Is ocular surface staining sensitive to severity?

A

No

23
Q

hat is the osmolarity cutoff for dry eye?

A

> 308mOsm/L

24
Q

What is the cutoff for Shirmer’s test?

A

<5mm

25
Q

List four symptoms of dry eye.

A

Scratchy eyes
Burning
Gritty feeling
Foreign body sensation

26
Q

What 7 factors can worsen dry eye?

A

Worse on waking
Hot dry locations
Air conditioning
Smoky areas
Wind
Low humidity
Computer use

27
Q

Can excessive tearing occur with dry eye?

A

Yesd

28
Q

Can vision loss occur with dry eye?

A

Yes, mild to moderate

29
Q

List 7 signs of dry eye.

A

Excess mucus/debris/foam/oil in tear film
Reduced or absent tear prism/meniscus (1mm)
Conjunctival hyperaemia
Wrinkles/scarring
Corneal erosion/ulceration/vascularisation/scarring
Blurred/fluctuating vision
Lid disease

30
Q

What is the response of dry eye to phenol red thread?

A

Reduced

31
Q

What kind of appearance do dry eyes have under staining (2)?

A

SPK and conjunctival staining

32
Q

Explain the workup for a patient with dry eye (8).

A

History
Symptomatology
Vision
Slit lamp (lid health, tear prism, breakup time etc)
Fluorescein staining
Cotton/Schirmer’s test
Rose bengal/lissamine green or equivalent
Tear osmolarity