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Contact Lenses > dry eye and contact lens wear > Flashcards

dry eye and contact lens wear Flashcards

1
Q

What is the pre lens tear film (PLTF)?

A

Tear film that sits above the lens and is associated with comfort

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2
Q

Does the pre lens tear film protect against deposits?

A

Yes

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3
Q

What is the post-lens tear film (PoLTF)? + what is it associated with?

A

Under the cls, associated with fit + lubrication + movement

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4
Q

What layer of the tear film does a cl sit in?

A

Aqueous layer

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5
Q

Is a PLTF always present?

A

No

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6
Q

Why is tear exchange important?

A

To remove debris + metabolic waste products

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7
Q

What are three effects a cl has on tear film?

A
  • Tear film instability + evaporation (this is sue to wetability)
  • Tear film mucins, electrolytes + increased osmolarity
  • blinking
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8
Q

What does reduced mucin lead to?

A

More friction

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9
Q

What will happen to vision due to an unstable tear film?

A

Vision may fluctuate

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10
Q

Is a higher or lower osmolarity associated with dry eyes?

A

Higher

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11
Q

If a px has contact lens associated dry eyes (CLDE), what may you see on glands?

A
  • secretions (MGD)
  • Expression
  • blockages
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12
Q

If a px has contact lens associated dry eyes (CLDE), What should you examine in relation to lids and lashes?

A
  • disease
  • lid position
  • blink rate
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13
Q

If a px has contact lens associated dry eyes (CLDE), What should you examine in relation to ocular surface?

A
  • staining
  • inflammation
  • redness
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14
Q

If a px has contact lens associated dry eyes (CLDE), What should you examine in relation to tears?

A
  • tear prism height
  • TBUT
  • quality
  • osmolarity
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15
Q

What are three ways to assess tear volume ?

A
  • phenol red thread test
  • schrimer
  • tear scope
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16
Q

How do you measure NIBUT?

A

Using a keratometer

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17
Q

Describe the phenol red thread test.

A
  • thread impregnated with phenol red
  • colour changes from yellow to red
  • thread hangs 1/3 from lateral canthus
  • CANNOT touch cornea
  • record after 15s
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18
Q

What result will indicate dry eye with the phenol red thread test?

A

<9mm

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19
Q

How long does schirmer test take ?

A

5 mins

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20
Q

What is a disadvantage of the schirmer test?

A

Strips can feel uncomfortable= stimulate tearing reflex

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21
Q

How does the tearscope work?

A
  • diffuse white reflection over whole cornea
  • lipid layer can be assessed
  • patterns can be observed
  • inserts can be placed to asses corneal distortion + damage
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22
Q

What patterns can be observed with a tear scope? (There are 5)

A
  • open meshwork
  • closed meshwork
  • wave
  • amorphous
  • colour fringes
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23
Q

What are another four instruments can assess tears?

A
  • Oculus Keratograph 5M
  • Lipview
  • InflammaDry
  • TearLab- tear osmolarity
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24
Q

What is an Oculus Keratograph 5M?

A

Topographer

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25
Q

What can Oculus Keratograph 5M assess?

A
  • MGD
  • Non-invasive TBUT
  • Tear meniscus
  • Lipid layeR
26
Q

What can does Lipview do?

A

Measures lipid layer + MG imaging

27
Q

What does InflammaDry do?

A

Detect inflammatory marker of DED. Takes 10 mins to do

28
Q

What reading on a TearLab-tear osmolarity will indicate abnormality?

A

> 300mOsm/L

29
Q

Why does the lid epithelium change with CLRDE (contact-lens related dry eye)?

A

Due to friction- this friction is caused a thin tear film between ocular surface and lid wiper

30
Q

What is lid wiper epitheliopathy?

A

disruption to the surface epithelium of the lid wiper

31
Q

What is the lid wiper?

A

Area of epithelium in contact with the cls and wipes across the cl/eye

32
Q

How can you observe lid wiper epitheliopathy?

A

Evert lids + staining with lissamine green

33
Q

What is lid parallel conjunctival fold (LIPCOF)?

A

Breakdown in elastic fibres in loose conjunctiva

34
Q

What causes LIPCOF?

A

Ageing or mechanical forces between conjunctiva and lower lid

35
Q

What other signs may you see with LIPCOF?

A

Tear deficiency and inflammation of the conjunctiva

36
Q

How is LIPCOF graded?

A

By number and height of folds

37
Q

How can LIPCOF be managed?

A
  • change lens type
  • change wearing schedule
  • manage tear quality issues
  • consider rewetting drop
38
Q

What is MGD?

A

Blocked meibomian glands

39
Q

What are two types of dry eye?

A

Evaporative and aqueous deficient dry eye

40
Q

Do the two types of dry eye have the same management?

A

No

41
Q

What is computer vision syndrome? CVS

A

prolonged screen use –> reduced blink rate/incomplete blinks –> eye discomfort or visual discomfort

42
Q

What are some sx someone with CVS may complain of?

A
  • dry eye
  • eye strain
  • HAs
  • blurred vision
  • neck and shoulder pain
43
Q

What is the average blink rate?

A

12 blinks per min

44
Q

When reading what may the blink rate drop to?

A

4.5 blinks per min

45
Q

What does a reduced blink rate result in?

A

Tear film is replenished less frequently and evaporates quicker —> leads to ocular discomfort

46
Q

What are some solutions to a reduced blink rate?

A
  • blinking exercises
  • 20-20-20 rule
47
Q

How should you manage dry eye in practice ?

A
  • lens change
  • changes to environment
  • eye drops
  • lid hygiene
  • warm compress
  • diet
48
Q

What changes to environment can you do for dry eyes?

A

AC not directed in the face in the car as lower humidity = increased evaporation

49
Q

What does eye drops do for dry eye?

A

Immediate relief, more viscous agent = better for end of day as it can effect Vision

50
Q

What must you check with the eye drops?

A

That they are compatible for cls + preservative free

51
Q

What advice can you give to someone to manage MGD?

A

Warm compress for 10 mins twice a day

52
Q

Before manage dry eye, what must you do?

A

Identify the cause

53
Q

In terms of environment, what can contact lens discomfit be increased by?

A
  • low humidity
  • increased air flow
  • computer use
54
Q

What diet info can you give to patients with dry eyes?

A

Take essential fatty acids such as omega 3 and omega 6 rich foods such as avocado, tuna ect

55
Q

Why should px take essential fatty acids?

A

The body cannot make them, it will help to enhance the lipid layer by reducing evaporation

56
Q

Can too much consumption of omega 6 negate the effects of omega 3?

A

Yes- balance is key

57
Q

Should you recommend ur px to drink more water for dry eyes?

A

You can do but few studies have looked into this , you can tell them to limit alcohol and caffeine consumption

58
Q

What is viscosity?

A

Fluids internal resistance to flow

59
Q

What does a high viscous agent aim to do?

A
  • increase retention time
  • reduce friction
  • soothe irritated membranes
60
Q

What lid hygiene tips can you give to someone with dry eyes and bleph?

A
  • clean lid margins x2 a day while condition bad and then can be decreased to x1 a day
  • clean with lid cleaning solution
  • avoid makeup on eyes
61
Q

How would you find out which dry eye they?

A

Through h&s + anterior eye assessment

62
Q

Should you follow up a dry eye px ?

A

Yes- book a follow up or phone call

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