Dry Eye & Amniotic membrane

Question 1

Dry eye is a multifactorial disease of the ocular surface characterized by a ________ of the tear film, in which tear film instability and ______, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.

Answer 1

loss of homeostasis; hyperosmolarity

Question 2

What are critical diagnostic tests according to DEWSII?

Answer 2

symptoms, NIBUT, osmolarity, & cornal/conjunctival/lid margin staining

Question 3

What are subtype classification aetiologies of dry eye?

Answer 3

MGD imaging/observation & expression, lipid thickness, and tear volume tests

Question 4

Low tech diagnostic test: Ocular surface staining

Answer 4

more than 5 corneal spots
more than 9 conjunctival spots
lid margin ≥ 2mm & 25% width

Question 5

Low Tech Diagnostic Tests: Tear Volume Testing

Answer 5

Tear Meniscus Height (TMH)
Schirmer’s
Phenol Red Thread Test

Question 6

What does the Tear Meniscus Height indicate?

Answer 6

tear volume

Question 7

What is normal TMH?

Answer 7

0.3-0.4mm

Question 8

What does decrease in TMH and accumulation of debris indicate?

Answer 8

lacrimal deficiency, unstable tear film

Question 9

How long does Schirmer’s last?

Answer 9

5 minutes

Question 10

What does Schirmer’s /Jones I measure?

Answer 10

measures total tear secreation (reflex and basal)

Question 11

What does Schirmer’s/Jones II measure?

Answer 11

measures basal secretion

Question 12

Which tear volume testing requires anesthesia?

Answer 12

Jones II/modified Schirmer III

Question 13

What tear measurement is considered borderline for Phenol Red Thread Test?

Answer 13

10-20mm

Question 14

What tear measurement is considered dry eye for Phenol Red Thread Test?

Answer 14

0-10mm

Question 15

What tear measurement is considered normal for Phenol Red Thread Test?

Answer 15

more than 20mm

Question 16

How long does the Phenol Red Thread Test last?

Answer 16

15 secs

Question 17

Which test is a Medium Tech Diagnostic test and is an objective, repeatable and quantifiable test for dry eyes?

Answer 17

tear osmolarity

Question 18

What measurement of osmolarity is considered loss of homeostasis (dry eyes)?

Answer 18

Osmolarity > 300 mOsm/L
Inter-eye difference of >8 mOsm/L

Question 19

Which test is a high tech diagnositic test?

Answer 19

non-invasive tear breakup time(NIBUT): Keratograph 5M

Question 20

Which condition might result in alteration of the tearfilm, symptoms of eye irritation, clinically apparent inflamation, and ocular surface disease?

Answer 20

MGD

Question 21

What are clinical findings of MGD?

Answer 21

keratin plugging of gland openings
thickening of secretion
posterior displacement of MG
telangiectasia of posterior lid margins
notching of lid margin — MG atrophy
tear film instability
fluctuating vision

Question 22

What are some MGD tests?

Answer 22

-meibum expressibility
-meibum quality
-tear film interferometry
-meibography

Question 23

What is a low tech diagnostic test for MGD?

Answer 23

• meibum expressibility
• meibum quality

Question 24

What is the grading scale for meibum expressibilty (5 glands in lower or upper lid)

Answer 24

0 = all glands expressed
1 = 3-4 glands expressible
2 = 1-2 glands expressible
3 = no glands exprresible

Question 25

What is the grading scale for meibum quality?

Answer 25

8 glands on the central 1/2 of LL on 0-3 scale for each gland total score range 0-24 0 = clear 1 = cloudy fluid 2 = cloudy particulate fluid 3 = inspissated, like tooth paste

Question 26

If a patient presents with no asymptomatic, and no corneal staining, but there is minimal altered expressibility and secretion quality, what stage is this?

Answer 26

stage 1

Question 27

If a patient presents with, minimal to mild symptoms, and little to nothing corneal staining, what stage is this?

Answer 27

stage 2

Question 28

If a patient presents with moderate symptoms with corneal staining mainly in the periphery, what stage is this?

Answer 28

stage 3

Question 29

If a patient presents with marked symptoms with marked corneal staining centrally in addition, what stage is this?

Answer 29

stage 4

Question 30

Explain the meibography scale.

Answer 30

0 = no dropout 1 = ≤ 25% 2 = ≤ 50% 3 = ≤ 75% 4 = >75-100%

Question 31

Explain the Tear Film Interferometry test

Answer 31

Thicker oil layer, the more colorful the tear film.

Question 32

The keratography 5m for Lipid Layer Thickness, the thicker the layer the ___ vibrant the colors

Answer 32

more

Question 33

What is a new treatment used to increase basal tear film production to improve tear film homeostasis?

Answer 33

Tyrvaya nasal spray

Question 34

What are some side effects of Tyrvaya nasal spray?

Answer 34

82% sneezing 6-16% cough throat irritation nose irritation

Question 35

What technique is used to treat cutaneous hemanigomatous lesions on the face?

Answer 35

intense pulsed light (IPL)

Question 36

IPL is not sutiable for those with ____ pigmented skin.

Answer 36

darker

Question 37

IPL is absorbed with _____

Answer 37

pigment melanin

Question 38

Infrared light _____ inflammation and ____ clogged MG

Answer 38

reduces; loosen

Question 39

Which technique uses light energy to soften blockages of MG orifices?

Answer 39

iLUX