AED - Dry Eye Management - Week 4

Question 1

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

Answer 1

NI TBUT

Osmolarity

Question 2

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

Answer 2

Score of 6

Question 3

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

Answer 3

Lubrication
Contact lenses
Surgery

Question 4

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

Answer 4

Lubrication
Steroids
Surgery

Question 5

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

Answer 5

Lubrication
Contact lenses
Surgery

Question 6

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

Answer 6

Lubrication
Steroids
Surgery

Question 7

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

Answer 7

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

Question 8

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

Answer 8

Without - unpreserved tears, gels, oinments

With - steroids, cyclosporine, nutritional supplements, secretagogues

Question 9

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

Answer 9

Tetracyclines
Autologous serum
Punctal plugs

Question 10

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

Answer 10

Topical vitamin A
Contact lenses
Acetylcysteine
Moisture goggles
Surgery

Question 11

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

Answer 11

Tear flim signs
Mild PEE
Conjunctival staining
Visual signs

Question 12

What are 5 signs that might indicate severe dry eye?

Answer 12

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

Question 13

List three palliative/protective treatment options for dry eye.

Answer 13

Supplements
Sodium hyaluronate
Autologous serum eye drops

Question 14

Are autologous serum eye drops anti-inflammatory?

Answer 14

Yesd

Question 15

List 4 anti-inflammatory treatment options for dry eye.

Answer 15

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

Question 16

What form of tear supplements need and dont need preservatives?

Answer 16

Multi-use bottles need them

Unit doses do not

Question 17

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?

Answer 17

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

Question 18

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

Answer 18

Benzalkonium chloride

Question 19

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

Answer 19

More expensive

Question 20

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

Answer 20

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

Question 21

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

Answer 21

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

Question 22

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

Answer 22

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

Question 23

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

Answer 23

No

Question 24

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

Answer 24

Must be tapered slowly

Question 25

Should steroid drops be prescribed on repeat?

Answer 25

No, prescribe on review

Question 26

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?

Answer 26

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

Question 27

In what 3 conditions can omega supplements be contraindicated?

Answer 27

Liver disease Arterial fibrillation Bleeding disorders

Question 28

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

Answer 28

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

Question 29

What is cyclosporine A?

Answer 29

An immunomodulatory drug that has anti-inflammatory properties

Question 30

Can cyclosporine be used with corneal surgery and contact lenses?

Answer 30

Not effective

Question 31

Is cyclosporine commercially available in Australia?

Answer 31

No

Question 32

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

Answer 32

It is effective

Question 33

What is meant by autologous serum eye drops?

Answer 33

Formulating the patient's own blood into eye drops

Question 34

List 4 disadvantages of autologous serum eye drops.

Answer 34

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

Question 35

List 6 advantages of autologous serum eye drops.

Answer 35

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

Question 36

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

Answer 36

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

Question 37

How long do collagen plugs last for?

Answer 37

7-10 days

Question 38

Are collagen plugs diagnostic or therapeutic?

Answer 38

Diagnostic

Question 39

What happens what a patient is given collagen punctal plugs?

Answer 39

Report improvement, then worstening of symptoms

Question 40

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

Answer 40

Collagen - not needed | Silicon - useful

Question 41

List 8 possible complications of punctal plugs.

Answer 41

``` 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 ```

Question 42

When is the use of punctal plugs most useful?

Answer 42

When combined with other DED treatments

Question 43

What is the consensus on using punctal plugs?

Answer 43

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

Question 44

What does acetylcysteine do?

Answer 44

Reduces tear viscosity in patients where mucus prevents tear distribution

Question 45

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

Answer 45

Goblet cell loss | Primary vitamin A deficiency

Question 46

What is the function of tetracyclines in dry eye?

Answer 46

Promotes posterior lid function and inflammation control