Dry Eye Disease Flashcards
how many people in the US have been diagnosed w/ dry eye disease?
16.4 million ppl
what % of people ≥ 50 years old are affected by dry eye disease?
30%
which dry eye condition are these characteristics indicative of?
-lacrimal deficiency —
—primary (e.g. age-related)
—secondary (e.g AIDS, inflammatory & neoplastic lacrimal gland infiltration)
-lacrimal duct obstruction (e.g. trachoma, pemphigoid, SJS)
reflex hyposecretion —
—sensory block (e.g CL wear, DM, refractive surgery, neurotrophic keratitis)
—motor block (e.g. CN7 damage, systemic drugs)
aq. deficient— non-Sjogren’s keratoconjunctivitis sicca (KCS)
what are these characteristics indicative of?
- meibomian gland deficiency (eg, post bleph, rosacea)
- lid aperture disorders (eg, proptosis, CN7 palsy, lid retraction)
- low blink rate (eg, Parkinson’s, excessive computer use, reading)
- drug action (eg, antihistamines, beta-blockers, diuretics, antispasmodics)
evaporative — intrinsic
what are these characteristics indicative of?
- vitamin A deficiency (xerophthalmia)
- topical drugs including preservatives effect
- CL wear
- ocular surface disease (e.g. allergic conjunctivitis)
evaporative — extrinsic
list the tests of dry eye diseases
- symptoms survey: Ocular Surface -Disease Index (OSDI)
- non-invasive tear break-up time (NIBUT) — <10s
- tear osmolarity: Tearlab
-external exam — lids, meibomian glands
-tear break-up (TBUT)
ocular surface staining — cornea, conj. , lid margin.
- tear meniscus height
- Schirmer w/o anesthetic
what are signs of dry eye disease?
meibomitis, conjunctivitis, debris in tear film, SPK
what are these symptoms indicative of?
- morning stiffness
- dry mouth
- grittiness & burning that worsen over course of the day
- stringy discharge
- transient blurring of vision
- redness & crusting of lids
- usually bilateral & chronic
-symptoms are frequently exacerbated on exposure to conditions assoc. w/ increased tear evaporation (eg, air-conditioning, wind & central heating) or prolonged reading or video display unit use (when blink frequency is reduced)
dry eye disease
what are abnormal findings for OSDI, NIBUT, & Tear Lab?
OSDI — ≥ 13
NIBUT — < 15 sec
Tear Lab — ≥ 308 mOsm/L either eye/Inter-eye > 8 mOsm/L
what are abnormal findings for external exam, & TBUT?
external exam — positive
TBUT — < 10 sec
what are abnormal findings for corneal staining, conjunctival staining, & lid margin?
corneal staining — > 5 corneal spots
conjunctival staining — > 9 conjunctival spots
lid margin — ≥2 mm length & ≥25% width
what are abnormal findings for TMH & Schirmer w/o anesthetic (5 min)?
TMH — < 0.10 mm, concave
Schirmer w/o anesthetic (5 min) — <5 mm
what step of DED treatment is this?
- education on condition, management, treatment, prognosis
- environmental modification
- education regarding dietary modification — omega-3
- identification, modification of offending systemic & topical meds
- lid hygiene & warm compresses w/ lid massage
- ocular lubricants
step 1
what is the education regarding dietary modification — omega 3 in step 1 of DED treatment?
AHA —
—healthy folks: at least 2 portions of salmon/week
—coronary heart disease: 1g DHA + EPA combined
FDA — 3g/day DHA + EPA max
w/ PCP: omega-3 fatty acid index blood test for at-risk pts
what step of DED treatment is this?
- non-preserved ocular lubricants
- tea tree oil
- tear conservation
- overnight treatments
- in-office physical findings heating & expression of -meibomian glands
- in-office intense pulsed light therapy
- prescription drugs
step 2
what step of DED treatment is this?
oral secretagogues: nasal neurostimulation
therapeutic CL options — soft bandage lenses, rigid scleral lenses
autologous/allogeneic serum eye drops
step 3
what step of DED treatment is this?
topical corticosteroid for longer duration: NOT for chronic use
—increases IOP & facilitates cataract formation
—amniotic membrane
—surgical punctal occlusion
—other surgical approaches
step 4
Treatment options of DED
- FreshKote
- Lacrisert
- punctal plugs
- oral macrolide/tetracycline antibiotics
- cyclosporine BID
- Xiidra (lifitegrast BID)
- thermal pulsation therapy
- secretagogues (nasal neurostimulation)
treatment: punctal plugs (collagen vs silicone)
collagen: dissolvable
silicone: non-dissolvable
treatment: oral macrolide/tetracycline antibiotics
macrolides —
- controls bacterial flora, lid inflammation
- azithromycin 500mg qd x 3 days, 3 cycles w/ 7-day intervals
tetracyclines —
- decrease bacterial lipase production
- doxycycline 50
which dry eye treatment is this?
- shown to increase tear production
- restasis 0.05%
- single vials
- multi-dose
cyclosporine BID
what dry eye disease treatment is this?
- only artificial tears that requires Rx
- intended to stabilize the lipid layer
FreshKote
what dry eye disease treatment is this?
- slow release prescription lubricant
- preservative-free
- prolongs TBUT
Lacrisert
what is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, & accompanied by ocular symptoms, in which tear film instability & hyperosmolarity, ocular surface inflammation & damage, & neurosensory abnormalities play etiological roles?
dry eye
which tear film layer is secreted by meibomian glands?
lipid layer
which tear film layer is secreted by lacrimal glands?
aqueous layer
which tear film layer is secreted by conjunctival goblet cells?
mucous layer
when does dry eye occur?
how common is it?
when there is inadequate tear volume/function → resulting in unstable tear film & ocular surface disease
extremely common, esp. in postmenopausal women & elderly
what type of dry eye disease has issues w/ aqueous layer?
aqueous deficient
what type of dry eye conditions commonly has abnormalities w/ meibomian glands?
evaporative
which dry eye condition is an autoimmune disorder characterized by lymphocytic inflammation & destruction of lacrimal & salivary glands ?
-primary when it exists in isolation & secondary when assoc. w/ other diseases (commonly SLE & rheumatoid arthritis)
aq. deficient — Sjogren’s syndrome
what is the OSDI formula?
OSDI = [(sum of scores) x 25] / (# of questions answered)
