DED

Question 1

Name and describe the three structures of the tear film?

Answer 1

Mucous layer at the base, followed by a thick mucin-acqueous gradient layer to a lipid layer on surface.

Question 2

What are the risk factors of DED?

Answer 2

Female, age, smoking, caffeine, DM, topical medications with preservatives, steroids and other systemic meds, acne rosacea, autoimmune conditions

Question 3

Define Aqueous Deficient Dry Eye

Answer 3

Failure of tear production by the lacrimal gland. This causes reduced volume of tears, which then leads to hyperosmolarity and inflammation and irritation.

Question 4

Define Sjogrens Acqeous Deficient Dry Eye

Answer 4

This is dry eye caused by damage to the lacrimal glands by sjogrens disease, can occur due to secondary sjogrens dry eye diseae when a patient has RA of Lupus

Question 5

Define non-Sjogrens Acqeous Deficient Dry Eye Disease

Answer 5

This is acqeous deficient dry eye disease in the absence of any systemic inflammatory disease

Question 6

List the possible causes of ADDE?

Answer 6

Familial dysautonomia (problems with reflexes through the body), congenital alacrima, secondary causes such as chemical/thermal trauma, CL wear, DM, CNS damage, systemic medications, obstruction of the gland by tumours or scarring

Question 7

Define Evaporative Dry Eye Disease?

Answer 7

Increased evaporation of tears from the ocular surface, results in reduced tear quantity, rather than reduced tear quality as in ADDE.

Question 8

Define some intrinsic causes of Dry Eye Disease

Answer 8

MGD, congenital lack, malformation, scarring of meibomium glands, proptosis, low blink rate

Question 9

Define some extrinsic causes of dry eye disease

Answer 9

CL wear, ocular surface disease, systemic drug use, topical drug use, vitamin A deficiency, environment

Question 10

What are the main priorities of prospective DED H and S?

Answer 10

Duration, get full details of sx, any attempts at therapy, any systemic conditions that put px at risk, systemic medications, habitual lifestyle, allergies

Question 11

List some sx of DED?

Answer 11

FB sensation, grittiness, pain, itching, blurred vision, photophobia, lacrimation, redness

Question 12

What sx indicate ADDE?

Answer 12

burning gritty sensation

Question 13

What sx indicate EDE?

Answer 13

watery uncomfortable eyes, worse in certain environments

Question 14

What should be the differential diagnosis for DED?

Answer 14

Seasonal allergic conjunctivitis, viral conjunctivitis, bacterial conjunctivitis, eyelid abnormality, nocturnal lagophthalmos

Question 15

Describe the Jones Dry Test

Answer 15

2% fluorescein instilled to each eye, 5 minutes waited, then px blows nose onto white tissue, if positive the tissue should be stained, if negative, assume punctal pathways blocked

Question 16

Describe lacrimal syringing?

Answer 16

A cannula is inserted into lower puncta and washing saline through, if saline comes back up lower or out the upper puncta, then assume blockage.

Question 17

What are some signs of DED?

Answer 17

Corneal and conj staining, reduced TBUT (less than 10 seconds), reduced tear production, conj hyperaemia, LIPCOF, TMH reduced, lid wiper epitheliopathy