Dry Eye Flashcards
1
Q
Properties of the tear film
A
- antibacterial
- transports nutrients to cornea
- optical performance
- successful contact lens wear
2
Q
Dry eye definition
A
Multifaceted condition characterised by a loss of homeostasis of the tear film, accompanied by ocular symptoms in which tear film instibility and hyperosmolarity, ocular surface inflammation and damage, and neurosensory conditions
3
Q
Risk factors
A
- female
- age
- smoking
- caffeine
- diabetes
- topical medications
- systemic meds
- acne
- history of arthritis
4
Q
Types of dry eye
A
- aqueous deficient
- Evaporative
- intrinsic
- extrinsic
- sjogrens
- non sjogrens
5
Q
What is aqueous deficient dry eye
A
- failure in tear production
- reduced tear volume
- causes inflamed ocular surface
- can be sjogrens or non-sjogrens
6
Q
What is sjogrens dry eye , primary + secondary
A
- autoimmune condition
- damage to secretary glands throughout the body
- primary SSDE occurs independently of other autoimmune condition
- secondary SSDE occurs with autoimmune condition
7
Q
What’s non-sjogrens dry eye
A
- acinar atrophy and periductal fibrosis can cause an obstruction affecting tear production
- secondary causes include obstruction of the lacrimal glands duct from chemical trauma or contact lens wear etc
- secondary obstruction of the gland itself due to lymphoma or secoidosis
8
Q
What causes intrinsic dry eye
A
- MGD
- proptosis
- low blink rate
9
Q
What’s extrinsic DED
A
- contact lens wear
- ocular surface disease
- systemic drug use
- Topical drug use
- Vitimin A deficiency
- environment
10
Q
Differential diagnosis
A
- Viral conjunctivitis
- bacterial conjunctivitis
- allergic conjunctivitis
- eyelid abnormality
- nocturnal lagophthalmos
11
Q
Level 1 managment of dry eye
A
Education and environmental modifications
- chronic nature
- omega 3 - vegetables
- omega 6 - fish
- environmental modifications
- tear supplements
12
Q
What is carbomer 980
A
- tear supplement
- increases tear film thickness
- protects against desiccation
13
Q
What’s hypromellose
A
- lubricant for mild to moderte DED
- used in combination with lots of other ingredients
14
Q
Second line lubricant
A
- carmellose sodium
- sodium hyaluronate
- Ointments
15
Q
What is carmellose sodium
A
- viscosity enhancing agent
- can bind to corneal epithelial cells promoting epithelial cell healing
16
Q
What is sodium hyaluronate
A
- functions as tissue lubricant
- increases viscosity
- binds to epi cells and potential wound healing
17
Q
Dosage of topical lubricants
A
- standard 3-4 x a day
- with preservative free then as much as necessary
- if significant staining ask for every 1-2 hours
18
Q
Other managment options
A
- punctual plugs
- moisture chamber specs
- reduce CL wear time
19
Q
When to refer
A
- normally no referral
- referral if adequate period of topical treatment or punctal plugs
- secondary complications like vascularisation, corneal scaring or infection
20
Q
Methods of eyelid therapy
A
- lid hygiene for blepharitis
- hot compress
- lid massage
21
Q
How to manage demodex
A
- don’t respond to regular lid hygiene
- tea tree oil has been shown to be mitacidal but toxic to the ocular surface
- 50% tea tree oil mixed with macadamia nut oil
22
Q
Level 2 topical anti-inflammatory meds
A
- steroids
- cyclosporin
23
Q
Which steroids to use
A
- loteprednol
- dexamethasone
- prednisolone
- flouromethalone
24
Q
What steroid dosage would be employed
A
- QID for 1 week
- then taper
25
Contraindications of steroid use
- infection
- CL wear
- glaucoma
- pregnancy and breast feeding
26
What is cyclosporin
Immuno-modulator drug with anti inflammatory properties
- initiated by ophthalmologists
27
When to use topical antibiotics
- level 2
- short term to reduce blepharitis in extreme cases
- can be used pre surgery
28
Which antibiotic drugs can be used
- chloramphenicol
- azithromycin
- fuscidic acid
-
29
What are systemic tetracyclines , and indications for use
- anti infectives
- anti inflammatory effects
- for longstanding blepharitis
- for chronic cases who haven’t responded to normal measures
30
Which tetracyclines to use
- doxycycline
- minocycline
- tetracycline
31
Dosage
- doxy - 100mg bds for 2 weeks then once daily for 2-3 months
- minocycline once daily for 2 wks then ods for 10 wks
32
Contraindications for tetracyclines
- hypersensitivity
- pregnancy or breast feeding
- under 12
- Renal impairment
33
Side effects of tetracyclines
- blurred vision/field loss
- diplopia
- GI disturbance
- hypersensitivity
- headaches
34
When to use oral azythromycin, and dose
- when tetracyclines are contraindicated
- may improve unresponsive blepharitis
- 500mg on day one, 250mg for 4 days
35
When to refer blepharitis
- if carcinoma is suspected
- in patients that don’t respond to treatment
- immune mediated diseases
36
Symptoms of ADDE vs EDE
ADDE - burning gritty sensation
EDE - watery uncomfortable eyes
37
Anterior eye assessment of DE px
- tear meniscus height
- LIPCOF
- lid wiper epitheliopathy
- TBUT
- Lids/lashes
38
What is LIPCOF
- lid parallel conjunctival folds
- 0.1mm in width
- combine nasal and temporal for score
39
Advice to give about chronic nature
- no cure
- explain condition on first visit
- talk about management options
- may be managing for life
- why not to ignore
- risk of blurred vision/infection/scarring
40
What environmental modifications can be made
- wrap around glasses
- reduce temp of house
- room humidifiers
- lower VDU height
- breaks from VDU
41
What is HP-Guar
- thickener
- dispensed as a drop but thickens when in contact with the tear film
- reduction in pH
42
Indication and mechanism for lipid based treatment (second line)
- primary evaporative
- replace the lipid layer to try and prevent evaporation
43
Examples of combination drops
Optive fusion - mixture of CMC, sodium hyaluronate (SH) and glycerine
Thealoz Duo - SH and trehalose
HyloCare - SH and dexpanthenol
44
Why use hot compress
• To attempt to melt/soften the meibum to then manually express the glands
• Temperature recommended is 40°C (that is the temp of the palpebral conj/glands)
• The more severe the blockage, the higher the temperature required (45°C considered the maximum to avoid thermal damage)
• Research is divided on whether a wet or dry compress will heat more effectively (wet can help soften crusts in anterior bleph)
45
Steroid side effects
- raised iop
- PSCC formation
- headache
- secondary infection
46
Cyclosporin contraindications
Hypersensivity to the agent
• Active or suspected ocular infection
• Ocular or peri-ocular malignancies
• Pregnancy/breast feeding
• No trials have been done in children
• Glaucoma
• Ocular herpes
• Contact lenses
47
Chloramphenicol forms and dose
- 1% ointment
- rub into lid margin BD for 1 week
- continue with lid hygiene
- entry level
48
Azythromycin forms and dose
- 1.5% azithromycin dehydrate
- anti-inflammatory properties
- BD for 3 days
49
Fuscidic acid dose
- BD for 1 week
50
Advice to px about tetracyclines
Limit time in the sun and use high factor suncream
• No tanning equipment
• Alternative forms of contraception should be used during treatment
• To return if they experience any side effects
51
Contraindications for oral azythromycin
- pregnancy and breast feeding
- hepatic and renal impairment
- MG
52
Oral azythromycin side effects
- arthralgia - joint pain
53
What are topical secretagogues
- stimulate production of aqueous, lipid and mucin
54
Topical secretagogues examples (level 3)
- topical diquafosol
- topical rebamipide Suspension
- topical testosterone
55
Example of systemic secretagogues and its effect
- oral pilocarpine
- improve signs and symptoms of DED, but with associated nausea and sweating
56
What is an amniotic membrane (level 4)
- promotes corneal healing in severe dry eye
- derived from layer in amniotic sac
- made from extra cellular matrix with anti-inflammatory, anti bacterial and anti-scarring properties
57
Cyclosporin forms and dose
- ikervis is 0.1%
- once daily
