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Shared Care and Ocular Therapeutics > Dry Eye and Blepharitis > Flashcards

Dry Eye and Blepharitis Flashcards

1
Q

What Dietary Changes to make in Dry Eye Disease?

A
  • Omega 3 and 6 shown to have anti-inflammatory effects
  • Omega 3 obtained through vegetables, nuts, cereals, poultry
  • Omega 6 obtained through fish
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2
Q

When to Have Caution Before Commencing Supplementation?

A
  • Liver disease
  • Atrial fibrillation
  • Bleeding disorders
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3
Q

Environmental Modifications to make in Dry Eye

A
  • Reduce air con exposure
  • Reduce cigarette smoke exposure
  • Wrap around glasses
  • Lower VDU height
  • Reduce VDU time to increase blink rate
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4
Q

What is Carbomer 980?

A
  • 1st line tear supplement
  • Gel (so harder to instil)
  • Commonly 0.2% concentration
  • Can be generic carbomer, viscotears or clinics gel
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5
Q

What is Hypromellose?

A
  • 1st line tear supplement
  • Watery drop (so poorer retention time)
  • Concentration 0.2-0.8% (commonly 0.3%)
  • Xialin Hydrate
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6
Q

What is Polyvinyl Alcohol?

A
  • 1st line tear supplement
  • Not on many formularies (on Lothian)
  • Concentration 1.4%
  • Liquifilm tears
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7
Q

What is Carmellose Sodium?

A
  • 2nd line tear supplement
  • Can promote epithelial healing
  • Celluvisc 1.0% or Xailin Fresh 0.5%
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8
Q

What is Sodium Hyaluronate?

A
  • 2nd line tear supplement
  • Is a tissue lubricant used naturally in the body
  • Hylo-forte/Hycosan
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9
Q

What is HP Guar?

A
  • 2nd line tear supplement
  • Dispensed at drop but becomes more viscous upon contact with ocular surface
  • Systane Balance
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10
Q

How to Use Ointments

A
  • Protects cornea overnight to prevent recurrent erosions
  • Used at night as it blurs vision
  • Squeeze out 1cm, apply to lower lid, blink and then sleep
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11
Q

Drops for Mucus Dry Eye

A
  • Aceytylcysteine 5% and hypromellose 35%
  • Stings upon instillation
  • 1 or 2 drops on affected eye 4x daily
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12
Q

When to Issue Tear Supplements

A
  • Can be sign or symptom driven
  • Be wary of corneal desensitisation
  • Remember ointment for night time usage
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13
Q

Tear Supplement Dosage

A
  • 3-4x daily is maintenance dose
  • Can be increased to as required if unpreserved
  • With severe staining use every 1-2 hrs until staining under control then reduce to maintenance dose
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14
Q

Punctal Plugs in Dry Eye Management

A
  • Improves tear retention by preventing drainage
  • Risks include infection, migration, loss and epiphora
  • Contraindications are EDE, CL wear (infection) and blepharitis
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15
Q

Contact Lenses in Dry Eye Management

A
  • RGP or low water content SCLs
  • Only tried in sever dry eye when other options have failed
  • Risk of infection and neovascularisation
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16
Q

When to Refer Dry Eye

A
  • Normally no referral
  • Refer routinely if adequate trial of treatment fails
  • Refer if complications e.g neovascularisation, infection
  • Refer suspect Sjogrens to GP
17
Q

Hot Compresses and Lid Cleaning for Blepharitis

A
  • 40-45 degrees
  • Temperature maintained over 5-7 minutes
  • Cleaning can be done with commercial wipes, baby shampoo, bicarbonate of soda, cooled boiled water or in shower.
  • Focus on cleaning at base of lashes
18
Q

What is BlephEx?

A
  • In office cleaning procedure repeated 6 monthly
  • Achieves good baselines hygiene level, patient still needs to continue with lid hygiene
  • Involves rotating spong through lash margin
  • Not painful
19
Q

Demodex Treatment

A
  • Doesn’t respond to lid hygiene
  • Weekly in office 50% tea tree oil treatment where eyes must be kept closed throughout
  • Specialist wipes at home made up of tea tree oil, patient must keep eyes closed for 30s afterwards to avoid toxicity, use morning and night for 6 weeks.
20
Q

Steroid Use for Dry Eye Management

A
  • Use non-penetrating steroid e.g. Loteprednol, fluromethalone or Predsol
  • QID for 1 week and then taper over next 3 weeks
21
Q

Steroid Tapering in Dry Eye Management

A
  • 4x daily for 1 week
  • 3x daily for 1 week
  • 2x daily for 1 week
  • 1x daily for 1 week
  • Stop
22
Q

Steroid Contraindications

A
  • Infection
  • Glaucoma
  • No CL wear at instillation (can be worn 15-30 mins after)
  • Caution in pregnancy and breastfeeding
23
Q

Steroid Side Effects

A
  • Raised IOP (Steroid glaucoma)
  • PSCC
  • Scleral/corneal thinning
  • Headaches
  • Secondary infection
24
Q

How to monitor IOP in Steroid Use

A
  • On day before commencing (baseline) then 2 days after then at 1 week
  • Weekly monitoring likely wise in dry eye patients
25
Q

Cyclosporin in Dry Eye Management

A
  • Immunomodulatory drug with anti-inflammatory properties
  • Initiated by ophthalmologists
  • Ikervis 0.1% concentration
  • 1x daily dosage
  • Stings upon insitllation
26
Q

Chloramphenicol in Blepharitis Management

A
  • Entry Level
  • Not default option, mostly indicated around surgery to clean up
  • 1% ointment rubbed into lid margin bd for 1 week
  • Patient must also continue with lid hygiene
27
Q

Azithromycin in Blepharitis Management

A
  • IP level and off label use
  • Has mild anti-inflammatory properties
  • Azithromycin 1.5%
  • bd for 3 days (same as bacterial conjunctivitis)
28
Q

When to Use Systemic Tetracyclines in Blepharitis Management

A
  • 2nd line management
  • Chronic cases that haven’t responded to treatment
  • When there is associated rosacea (co-manage with GP)
29
Q

Systemic Tetracycline Dosage

A

Doxycycline
-100mg bd for 2 weeks
-100mg 1x daily for 10 weeks
- OR modified release for at least 5 months
Minocycline
- 50mg 1x daily for 2 weeks
- 100mg 1x daily for 10 weeks

30
Q

Systemic Tetracycline Contraindications

A
  • Hypersensitivity to any drug in the family
  • Less than 12 years of age
  • Pregnancy and breastfeeding
  • Kidney or liver impairment
  • Systemic lupus
31
Q

Systemic Tetracyclines Cautions

A
  • Photosensitivity
  • May affect oral contraception
  • Antacids reduce absorption of tetracycline
  • Px taking anticoagulants may require a dose reduction
32
Q

Systemic Tetracyclines Side Effects

A
  • GI disturbances
  • HA
  • Photosensitivity
  • Some can indicate benign intracranial hypertension
    • Blurred vision
    • Field loss
    • Diplopia
    • Discoloration of conjunctiva and lacrimal secretions
33
Q
A

Shared Care and Ocular Therapeutics (10 decks)

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