Dry Eye Flashcards
Define dry eye disease
Multifactorial disease of the tears and ocular surface that results in discomfort, visual disturbances and tear film instability with potential damage to the ocular surface. Accompanied by increased osmolarity of the tear film and inflammation of the ocular surface
What are the two types of dry eye disease
Evaporative dry eye:
Lack of quality tears, leading to their quick evaporation on the surface. Worse in the morning. Often due to meibomian gland dysfunction
Aqueous deficient dry eye:
Lack of aqueous tear production by the lacrimal gland. Often has overlapping signs of evaporative DED. Common causes are sjogren’s syndrome, aging, and systemic drugs
What are characteristics of different grades of evaporative dry eye?
Mild: good secretions
Moderate: plugging of the gland, vascularization of eyelid margins
Severe: blocked meibomian glands
Grade 0 is the least severe, grade 3 is the most
What is part of the first step of managing dry eye disease?
Educate on the condition and what modifications they can make
Educate on how to identify and eliminate offending medications
Lid hygiene and warm compresses
What is part of the second step of managing dry eye?
Use of non-preserved ocular lubricants
If demodex infection, tea tree oil
Tear conservation: punctal occlusion, moisture chamber goggles
Overnight treatments
In the doctor’s office, physical heating and expression of meibomian glands, intense pulsed light therapy.
Prescription drugs: topical treatments or oral macrolide/tetracycline antibiotics
What is part of the third step of treating dry eye?
Oral secretagogues
Autologous/allogenic serum eye drops
Therapeutic contact lens options
What is part of the 4th step of managing dry eye?
Topical corticosteroid for a longer time
Amniotic membrane grafts
Surgical punctal occlusion
Other surgical approaches
What is the mainstay of therapy in treating dry eye?
Tear supplements or lubricants. Supplement anti-inflammatory treatments and contribute to ocular healing (but do not reverse damage)
What are the downsides of artificial tears?
Do not address the underlying inflammation
Do not contain all the components of healthy tears
Provide only temporary relief
Do not restore normal tear composition
Do not reverse damage
What is hyaluronate?
An ingredient in most artificial tear solutions, it’s a naturally occurring polysaccharide that adds viscoelasticity
Contrast ointments and gels in treating dry eye
Ointments: have mineral oil and petrolatum. Do not support bacterial growth, and thus don’t require preservatives, which may be toxic to the cornea.
Gels are less viscous but provide increased retention time. May cause blurry vision
Describe lipid based emulsions
Have a long residence time, reduce tear evaporation and improve ocular bioavailability
