Artificial tears

Question 1

What are test supplements used for. And tell me a little about this condition

Answer 1

Ocular lubricants- Use when tear dysfunction- dry eye.
Causes of dry eye- are Environment, Age and Allergy,office working conditions, atmospheric pollution, adverse effects of contact lens wear, refractive surgery.
It is Common, Persistent, Distressing + has limited treatment
px don’t always complain of a dry eye, but have tear dysfunction
most common > 50 yrs
can be mild to severe
severe/recurrent/persistent cases should be referred

Question 2

An abnormality that leads to dry eye: Inadequate tear production and drainage. WHY

Answer 2

To supply nutrients to the eye
for moist conditions- evaporation and reduce surface temperature
to maintain osmotic balance
mechanical flushing

Question 3

What does an aqueous deficiency lead to?

Answer 3

burning/itching

also hypertonicity- ocular dammage

Question 4

Dry eye- Mucin deficiency

Answer 4

Mucin cells secrete surfactant mucin which educes surface tension and forms protective layer over cornea
if a reduction in goblet cells- then not a good mucin laer- irregular TBUT

Question 5

Dry eye- Lipid abnormality

Answer 5

lipid layer reduces evaporation of aqueous
lipase- hydrolysis of meibomian gland dysfunction
lipid abnormality- quick TBUT
also blepharitis- due to mgd

Question 6

What ocular abnormalities/ dyfunctions can cause a dry eye

Answer 6

aqueous deficiency
mucin deficiency
something wrong with lipid layer
incomplete blinking
dodgy epithelium layer
adverse reaction
and as a secondary pathology

Question 7

How can incomplete blinking lead to dry eye

Answer 7

full closure of eye- for distribution of tears-

tear deficiency and exposure keratitis

Question 8

Epitheliopathy- posh word for epithelial irregularity- and dry eye

Answer 8

irregular epithelium due to corneal lesions or keratoconus can lead to a thin unstable tear film

Question 9

adverse reactions and dry eye

Answer 9

alters neurohumoral control of epithelial cell turnover- CNS drugs/beta blockers

Question 10

Secondary pathology which results in dry eye

Answer 10

rheumatoid artheritis

derm conditions- acne rosecca/ sorjens disease, psoriarisis, sebohric dermatitis

Question 11

What is available to treat dry eyes

Answer 11

ACETYLCYSTEINE (llube) POM
CARBOMERS (GelTears, Viscotears )
CARMELLOSE SODIUM (e.g. Optive ) HYDROXYETHYLCELLULOSE
HYPROMELLOSE (e.g. Isopto Plain /Alkaline)
LIQUID PARAFFIN (e.g. Lacri-Lube ) P medicine
MACROGOLS (e.g.Systane )
PARAFFIN, YELLOW SOFT (simple eye ointment)
POLYVINYL ALCOHOL (Sno-Tears, Liquifilm tears)
SODIUM CHLORIDE ( Minims NaCl)
SODIUM HYALURONATE (e.g. Hyabak )
SOYBEAN (Emustil)

Question 12

what is acetlysysteine

Answer 12

POM
stings
mucolytic
breaks the linkage in disulphide bonds, to reduce mucous viscosity
also resolves filamentary keratitis- where little strands of degenerated epithetlium stick to the cornea

Question 13

what are carbormers

Answer 13

to treat dry eye
most common
semi-solid formulations of high molecular weight polymers of acrylic acid
v viscous therefore may blur vision
however reduced frequency of instillation
comfort whilst sleeping
longer retention time- x7 compared to polyvinyl alcohol
reduce natural elimination of tears
reduced risk of allergy to benzalkonium chloride

Question 14

whats a carmellose sodium

Answer 14

ocular lubricant
carboxymethylcellulose sodium
makes it unlikely to penetrate healththy cornea
and contact for up to 22 mins

Question 15

whats hydroxyethylcellulose

Answer 15

A substituted cellulose ether – colloids- dissolve in water to produce colourless solutions of diff viscosity and have smoothing and cohesive properties.
Wetting of contact lenses and to prolong contact time of ocular drugs.
The Minims formulation - no preservatives but is formulated as hyetellose 0.44% w/w BP (which is hydroxyethylcellulose) and sodium chloride EP 0.35% w/w.

Question 16

Whats hypomellose

Answer 16

Traditional choice of treatment for tear deficiency.
Hydroxypropyl methylcellulose (HPMC) 
Cellulose ether and has been used for tear dysfunction for over 50 years. 
instilled frequently 
Ocular surface mucin is often abnormal in tear deficiency and the combination of hypromellose with acetylcysteine can be helpful. 
Most widely prescribed tear substitute

Question 17

What’s luiqiud paraffin

Answer 17

it’s a P
lubricates the eye
but gives blurry vision
and don’t use with CL

Question 18

macrogels

Answer 18

novel ph sensitive- becomes moe viscous with ocular ph

Question 19

paraffin yellow soft

Answer 19

semisolid patroleum and mineral oil- and lanolin
melt on eye temp
blurry va- so use at night time ono

Question 20

polyvinyl alcohol

Answer 20

to maintain tear film

and also used when mucin is reduced

Question 21

Sodium chloride

Answer 21

for tear defficieny
and cl comfort
and to remove cl
just put salt in ur CL LOOOOOOOOOOOL

Question 22

sodium hyaluronate

Answer 22

Viscoelastic high-molecular weight polysaccaride polymer.
Increases goblet cell density
reduces inflammation of the ocular surface in dry eye.
lubricates and protects the ocular surface
improves tear film stability
improves corneal wettability

Question 23

what are other preparations available for dry eyes

Answer 23

Povidone (e.g. Oculotect

Question 24

instead of artificial tears, what else can u do to reduce dry eye sx

Answer 24

Dietary manipulation: e.g.Omega-3/-6 fatty acids
Corticosteroids: have anti-inflammatory properties
NSAIDs: reduce formation of endogenous prostaglandins which may produce ocular inflammation that underpins dry eye.

Hormone supplements: e.g. androgens

Change ocular environment: