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OD2 - Applied Clinical Training & Research Studies in Vision and Optometry > AED - Wet Eye - Week 2 > Flashcards

AED - Wet Eye - Week 2 Flashcards

1
Q

How thick is the tear flim? Describe each layer, where it comes from, and how thick they are.

A

Total thickness is ~7.15μm
Lipid phase - meibomian glands - ~0.1μm
Aqueous phase - lacrimal glands and conjunctiva - ~7μm
Mucoid phase - goblet cells - ~0.05μm

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2
Q

What does lid action do to the tear flim?

A

Pushes it to the drainage sites

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3
Q

What do meibomian secretions aid in, and what may it limit?

A

Aids in spreading and may limit overflow

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4
Q

What forms in the eye concerning the tear film?

A

A lacrimal lake at the margin of the bottom eyelid

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5
Q

Describe all the structures of the lacrimal drainage system (5).

A

At the nasal margin of the eyelids is found two puncta (one for each eyelid) which drains into a canaliculus. These two canaliculi merge nasally to form the common canaliculus.
This drains into the naso-lacrimal sac.
This drains into the naso-lacrimal duct.
At the bottom of this duct is the valve of hasner.

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6
Q

What two forces draw tears into the naso-lacrimal sac?

A

Lid and capillary action

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7
Q

Where does the nasolacrimal duct drain to?

A

The back of the nose

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8
Q

What does the valve of hasner prevent?

A

Backflow

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9
Q

Define epiphora.

A

Tear overflow from the ocular surface

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10
Q

List three possible mechanisms of epiphora.

A

Tear overproduction
Poor tear support / movement
Impaired tear drainage

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11
Q

List 3 symptoms of epiphora.

A

Watery eye
Slight discomfort
Blurred vision

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12
Q

What can be said of epiphora if it is worse in cold/windy conditions (2)?

A

Usually anatomical / obstructive

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13
Q

What can be said of epiphora if it is worse in hot/dry conditions (2)?

A

Usually overproduction / dry eye related

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14
Q

List 5 signs of epiphora.

A 
Increased marginal tear prism
Lid anomalies
Drainage blockage
Dry eye
Stenosed (narrowed) puncta
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15
Q

List 11 history questions you would ask for epiphora.

A 
Age?
True tear spillage or just poor vision?
When are symptoms worse?
Associated discomfort?
Previous therapy?
Previous CNVII related events, tearing while eating?
Medication?
Red eye/discharge/crusting/allergies?
Pain/swelling?
Surface trauma?
Lid or conj. trauma/surgery/scarring?
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16
Q

When doing a slit lamp examination for epiphora, list 5 things to look out for.

A 
Facial characteristics - entropion/ectropion
Normal lid movement
Lacrimal gland swelling
Punctal conformation/patency
Ocular surface condition
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17
Q

List 4 techniques (aside from slit lamp) that can be used to assess epiphora.

A

Lacrimal sac expression (pressure)
Lacrimal lavage (irrigation)
Fluorescein tests
Cotton thread/schirmers test

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18
Q

What is the normal range for schirmers test?

A

≥15 mm

19
Q

List 4 tertiary techniques that can be used to work up an epiphora presentation. Briefly describe the purpose of each test if applicable.

A

Intranasal examination
X-ray or CT scan - inspection of drainage anatomy
Dacryocystography - radio-opaque dye and x-ray
Dacryoscintigraphy - radiolabel and gamma camera

20
Q

List possible causes of tear overproduction.

A 
Foreign body
Corneal/conjunctival irritation (allergy/infection/dry eye)
Intraocular inflammation
Refractive error (asthenopia)
Nasal irritation/inflammation
Psychological/emotional/environmental
Drug-related
Neural dysfunction/tumour
21
Q

What does management of tear overproduction involve?

A

Managing the underlying condition

22
Q

List three possible causes of poor tear film support.

A

Poor apposition of punctae
Obstruction of tear movement (conj. scarring/irregularity)
Lid pumping deficiency
-neuromuscular/ectropion/entropion

23
Q

Define ectropion and entropion.

A

Ectropion - eversion of the eyelid, away from the eye

Entropion - inversion of the eyelid, towards the eye

24
Q

What is ectropion/entropion commonly due to?

A

Age-related CT degenerative changes

25
Q

List 4 signs and symptoms of ectropion (aside from lid alignment).

A

Hyperaemic palpebral conjunctiva
Watery/gritty eye
Droopy lower eyelid, exposing palpebral conjunctiva
Reduced TBUT

26
Q

List two treatment options for ectroption.

A

Protection of ocular surfaces with tear supplements

Surgical correction

27
Q

List 4 signs and symptoms of entropion (aside from lid alignment).

A

Gritty/watery eye
No visible lashes
Epithelial disturbances (SPK/ulcers)
Hyperaemia of the bulbar conjunctiva

28
Q

List three treatment options for ectroption.

A

Tear supplements
Tape lower lid
Surgical correction

29
Q

Can entropion be epilated?

A

Only if localised

30
Q

Are optometrists generally able to treat underlying causes if epiphora is due to poor tear film movement?

A

Rarely, although topical therapeutic management with eyedrops may be necessary

31
Q

List 5 obstructions that can result in impaired tear drainage.

A 
Punctae
Canaliculae
Lacrimal sac
Nasolacrimal duct
Intranasal obstruction
32
Q

List 6 possible causes ofimpaired tear drainage.

A 
Congenital
Trauma
Inflammation/scarring
Drug-related
Infection
Tumours
33
Q

What is the general management of impaired tear drainage (2)?

A

Identify and treat underlying cause as appropriate (referral if necessary)
Lacrimal probing and irrigation under topical anaesthesia

34
Q

What can repeated lacrimal probing/irrigation lead to?

A

Further stenosis

35
Q

Is canaliculitis a common or rare condition? Is it unilateral or bilateral?

A

Rare, unilateral

36
Q

List 5 signs and symptoms of canaliculitis.

A

Unilateral epiphora
Chronic mucopurulent conjunctivitis that resists treatment
Pouting of puncta
Chalky granules expressed from canaliculi
Lavage indicating canalicular obstruction

37
Q

Consider canaliculitis. If lavage indicates an obstruction, is further probing recommended?

A

Contraindicated

38
Q

What is the treatment for canaliculitis (2)?

A

Refer

Appropriate antibiotic treatment

39
Q

Define dacryocystitis and whether or not it is unilateral.

A

Unilateral infection of the lacrimal sac

40
Q

List 4 signs and symptoms of dacryocystitis.

A

Pain
Swelling
Cellulitis
Mucopurulent discharge

41
Q

What can be said of chronic dacryocystitis? What is it often secondary to?

A

It may have painless welling and is often secondary to a blockage of the nasolacrimal duct.

42
Q

What is the treatment for dacryocystitis (3)?

A

Refer
Topical and systemic antibiotics
Warm compresses

43
Q

Is lacrimal lavage/probing recommended in dacryocystitis? Explain.

A

Contraindicated due to risk of infection spread

44
Q

List 5 causes of nasolacrimal duct obstruction in children. List the most common one first.

A

Failure of the valve of hesner to open normally at or near the time of birth
Absent punctum
Narrow/stenotic system
Infection
Nasal bone that obstructs the tear duct from entering the nose

OD2 - Applied Clinical Training & Research Studies in Vision and Optometry (174 decks)

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