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OD2 (S1&2) > AED - Dry Eye Management - Week 4 > Flashcards

AED - Dry Eye Management - Week 4 Flashcards

1
Q

What are the two most useful tests to do for assessing dry eye?

A

NI TBUT
Osmolarity

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2
Q

What is a positive result for the DEQ-5 test?

A

Score of 6

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3
Q

What is the general treatment option for reduced/incomplete blinking (3)?

A

Lubrication
Contact lenses
Surgery

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4
Q

What is the general treatment option for elevated surface lesions (3)?

A

Lubrication
Steroids
Surgery

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5
Q

What is the general treatment option for reduced/lid/lash malposition (3)?

A

Lubrication
Contact lenses
Surgery

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6
Q

What is the general treatment option for reduced/conjunctivochalasis (3)?

A

Lubrication
Steroids
Surgery

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7
Q

What is the treatment options for level 1 dry eye disease (5)?

A

Patient education
Environmental modifications
Control of systemic medications
Preserved tears
Allergy control

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8
Q

What is the treatment options for level 2 dry eye disease, with (3) and without (4) inflammation?

A

Without - unpreserved tears, gels, oinments
With - steroids, cyclosporine, nutritional supplements, secretagogues

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9
Q

What is the treatment options for level 3 dry eye disease (3)?

A

Tetracyclines
Autologous serum
Punctal plugs

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10
Q

What is the treatment options for level 4 dry eye disease (5)?

A

Topical vitamin A
Contact lenses
Acetylcysteine
Moisture goggles
Surgery

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11
Q

What are 4 signs that might indicate moderate/severe dry eye?

A

Tear flim signs
Mild PEE
Conjunctival staining
Visual signs

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12
Q

What are 5 signs that might indicate severe dry eye?

A

Marked SPK
Central corneal stain
Filamentary keratitis
Severe corneal staining/erosion
Conjunctival scarring

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13
Q

List three palliative/protective treatment options for dry eye.

A

Supplements
Sodium hyaluronate
Autologous serum eye drops

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14
Q

Are autologous serum eye drops anti-inflammatory?

A

Yesd

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15
Q

List 4 anti-inflammatory treatment options for dry eye.

A

Flaxseed/fish oil (weak evidence)
Topical corticosteroids
Oral tetracycline
Autologous serum eye drops

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16
Q

What form of tear supplements need and dont need preservatives?

A

Multi-use bottles need them
Unit doses do not

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17
Q

If a tear supplement is preserved, what does this mean for the number of drops that can be used per day, and the effect of that on the eye?

A

More than ~8 drops per day may disrupt the epithelium and cause irritation

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18
Q

What preservative is the most toxic preservative that may be used in tear supplements?

A

Benzalkonium chloride

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19
Q

Are unit doses more or less expensive than multi-use bottles?

A

More expensive

20
Q

What is the general consensus on the effectiveness of artificial tears on treating dry eye? What about individual formulations for OTC products?

A

While artificial tears are effective in treating dry eye, more evidence is needed to establish the effectiveness of individual formulations

21
Q

What is the general consensus on the use of high- and low-viscosity eye drops?

A

High-viscosity eye drops can increase retention times, but result in crusting, visual disturbances, and unwanted debris, leading to poor compliance and tolerance
It is recommended that high-viscosity products are used overnight and low-viscosity products during the day

22
Q

What is the general consensus on the use of benzalkonium chloride by individuals with dry eye?

A

Those who require frequent dosing, or who use lubrication in conjunction with other chronic topical therapies should avoid the use of lubricants with BAK
Preservative-free drops may be a better choice for patients who have pre-existing ocular surface conditions

23
Q

Is there a consensus on a steroid regimen for dry eye treatment?

24
Q

What must be done with steroid use for dry eye treatment?

A

Must be tapered slowly

25
Q

Should steroid drops be prescribed on repeat?

A

No, prescribe on review

26
Q

What are the sources of omega 3 and omega 6? What is the ideal ratio between the two and what is the ratio in a typical western diet?

A

Omega 3 - oily fish
Omega 6 - vegetable oils
Ideal ratio is 15:1
Western diet is on average 4:1

27
Q

In what 3 conditions can omega supplements be contraindicated?

A

Liver disease
Arterial fibrillation
Bleeding disorders

28
Q

What is the general consensus on the use of omega supplements for the treatment of dry eye?

A

There are few high quality studies investigating its role and so there is a lack of consensus.

29
Q

What is cyclosporine A?

A

An immunomodulatory drug that has anti-inflammatory properties

30
Q

Can cyclosporine be used with corneal surgery and contact lenses?

A

Not effective

31
Q

Is cyclosporine commercially available in Australia?

32
Q

What is the consensus on the use of cyclosporine for the treatment of dry eye?

A

It is effective

33
Q

What is meant by autologous serum eye drops?

A

Formulating the patient’s own blood into eye drops

34
Q

List 4 disadvantages of autologous serum eye drops.

A

Cost
Useful for severe dry eye only
Shelf life
Variability in manufacture

35
Q

List 6 advantages of autologous serum eye drops.

A

Favourable biochemical factors
Contains:
-epithelial growth factor
-vitamin A
-fibronectin
-IgG
-lysozymes

36
Q

What do autologous serum eye drops directly and indirectly support (2)?

A

The proliferation and migration of epithelial cells or indirectly enhances epithelial viability by binding and neutralizing inflammatory cytokines

37
Q

How long do collagen plugs last for?

38
Q

Are collagen plugs diagnostic or therapeutic?

A

Diagnostic

39
Q

What happens what a patient is given collagen punctal plugs?

A

Report improvement, then worstening of symptoms

40
Q

Is the dilation measurement of punctal essential for collagen and silicon plugs?

A

Collagen - not needed
Silicon - useful

41
Q

List 8 possible complications of punctal plugs.

A

Rupture of the punctum
Canthal discomfort
Abrasion of the conjunctiva/cornea
Epiphora
Loss of the silicon plug
Breakage during insertion/removal
Distal migration of the plug requiring surgical removal
Canaliculitis/dacryoadenitis

42
Q

When is the use of punctal plugs most useful?

A

When combined with other DED treatments

43
Q

What is the consensus on using punctal plugs?

A

There are no large scale, Level 1 studies to support the contention that punctal occlusion of any form is effective in the management of DED

44
Q

What does acetylcysteine do?

A

Reduces tear viscosity in patients where mucus prevents tear distribution

45
Q

In what two cases are vitamin A supplements used for dry eye?

A

Goblet cell loss
Primary vitamin A deficiency

46
Q

What is the function of tetracyclines in dry eye?

A

Promotes posterior lid function and inflammation control

OD2 (S1&2) (174 decks)

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