Anterior segment problems

Question 1

how do tears drain

Answer 1

via the lacrimal puncta, canaliculi, lacrimal sac, lacrimal duct, inferior meatus into nasal passage

Question 2

what can dry eyes be due to

Answer 2

insufficient tear production- deficiency in one of 3 components of the tear film

Question 3

what is keratoconjunctivitis sicca

Answer 3

uncommon but severe cause- aqueous tear deficiency

Question 4

pure kerato sicca what does it involve

Answer 4

lacrimal gland alone

Question 5

lacrimal gland dysfunction

Answer 5

usually inflammation- autoimmune; scaring of secretory ducts; excision of the gland

Question 6

if salivary and other glands are involved what is this

Answer 6

Sjogrens

Question 7

what is mucin deficiency

Answer 7

xerophthalmia- when large numbers of goblet cells are damaged by extensive conjunctival scarring.

Question 8

clinical features dry eyes

Answer 8

poor tear film quality, persistent irritation with a feeling of dryness.

Question 9

signs dry eyes

Answer 9

slit lamp examination. fluorescin dye.

Question 10

what is Schirmers test

Answer 10

for dry eyes- measures the wetting of a strip of filter paper

Question 11

what can severe dry eye lead to

Answer 11

corneal epithelial loss, scarring, vascularisation

Question 12

management dry eye

Answer 12

tear supplement. lacrimal punctal occlusion

Question 13

what can watery eyes be due to

Answer 13

failure of lacrimal gland drainage system, or over secretion of tears

Question 14

causes watery eye

Answer 14

emotion, corneal injury/FB, entropion, conjunctivitis, iritis, acute glaucoma

Question 15

what is the name given to improperly drained tears

Answer 15

epiphora

Question 16

what can cause obstruction to drainage in watery eye

Answer 16

ectropion, drainage system blockage, congenital- incomplete development of nasolacrimal duct. punctual stenosis

Question 17

treatment watery eye

Answer 17

dacryocystorhinstomy for nasolacrimal duct obstruction, surgery for other causes

Question 18

cause of oversecretion tears

Answer 18

ocular irritation eg by eyelashes

Question 19

what is entropion

Answer 19

inwards turning of lid margin

Question 20

causes of entropion

Answer 20

ageing (involutional), conjunctival scarring, spasm orbicular oculi

Question 21

what happens due to the entropion

Answer 21

eyelashes rub against eyeball- FB sensation and reflex watering. may cause corneal abrasion

Question 22

management entropion

Answer 22

botulinium toxin injection. surgery. conjunctival scarring hard to treat

Question 23

what is ectropion

Answer 23

turning outwards of eyelid margin- lower lid

Question 24

causes of ectropion

Answer 24

involutional (ageing), facial nerve palsy, eyelid skin scarring, bulky eyelid tumours

Question 25

what does ectropion cause

Answer 25

irritation, watering, exposure keratitis

Question 26

management ectropion

Answer 26

surgery. if cornea is at risk- eyelids sutured together- temporary lateral tarsorraphy

Question 27

what is blepharitis

Answer 27

lid inflammation eg from staphs, seborrheoic dermatitis, rsacea

Question 28

features blepharitis

Answer 28

burning itching red margins, scales on the lashes

Question 29

treatment blepharitis

Answer 29

clean crusts off lashes +-tears natural, fusidic acid, steroid drops