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Anterior Segment > Dry Eye Disease > Flashcards

Dry Eye Disease Flashcards

1
Q

how many people in the US have been diagnosed w/ dry eye disease?

A

16.4 million ppl

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2
Q

what % of people ≥ 50 years old are affected by dry eye disease?

A

30%

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3
Q

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)

A

aq. deficient— non-Sjogren’s keratoconjunctivitis sicca (KCS)

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4
Q

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)
A

evaporative — intrinsic

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5
Q

what are these characteristics indicative of?

  • vitamin A deficiency (xerophthalmia)
  • topical drugs including preservatives effect
  • CL wear
  • ocular surface disease (e.g. allergic conjunctivitis)
A

evaporative — extrinsic

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6
Q

list the tests of dry eye diseases

A
  • 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
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7
Q

what are signs of dry eye disease?

A

meibomitis, conjunctivitis, debris in tear film, SPK

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8
Q

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)

A

dry eye disease

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9
Q

what are abnormal findings for OSDI, NIBUT, & Tear Lab?

A

OSDI — ≥ 13
NIBUT — < 15 sec
Tear Lab — ≥ 308 mOsm/L either eye/Inter-eye > 8 mOsm/L

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10
Q

what are abnormal findings for external exam, & TBUT?

A

external exam — positive

TBUT — < 10 sec

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11
Q

what are abnormal findings for corneal staining, conjunctival staining, & lid margin?

A

corneal staining — > 5 corneal spots
conjunctival staining — > 9 conjunctival spots
lid margin — ≥2 mm length & ≥25% width

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12
Q

what are abnormal findings for TMH & Schirmer w/o anesthetic (5 min)?

A

TMH — < 0.10 mm, concave

Schirmer w/o anesthetic (5 min) — <5 mm

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13
Q

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
A

step 1

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14
Q

what is the education regarding dietary modification — omega 3 in step 1 of DED treatment?

A

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

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15
Q

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
A

step 2

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16
Q

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

A

step 3

17
Q

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

A

step 4

18
Q

Treatment options of DED

A
  • FreshKote
  • Lacrisert
  • punctal plugs
  • oral macrolide/tetracycline antibiotics
  • cyclosporine BID
  • Xiidra (lifitegrast BID)
  • thermal pulsation therapy
  • secretagogues (nasal neurostimulation)
19
Q

treatment: punctal plugs (collagen vs silicone)

A

collagen: dissolvable
silicone: non-dissolvable

20
Q

treatment: oral macrolide/tetracycline antibiotics

A

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
21
Q

which dry eye treatment is this?

  • shown to increase tear production
  • restasis 0.05%
  • single vials
  • multi-dose
A

cyclosporine BID

22
Q

what dry eye disease treatment is this?

  • only artificial tears that requires Rx
  • intended to stabilize the lipid layer
A

FreshKote

23
Q

what dry eye disease treatment is this?

  • slow release prescription lubricant
  • preservative-free
  • prolongs TBUT
A

Lacrisert

24
Q

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?

A

dry eye

25
Q

which tear film layer is secreted by meibomian glands?

A

lipid layer

26
Q

which tear film layer is secreted by lacrimal glands?

A

aqueous layer

27
Q

which tear film layer is secreted by conjunctival goblet cells?

A

mucous layer

28
Q

when does dry eye occur?

how common is it?

A

when there is inadequate tear volume/function → resulting in unstable tear film & ocular surface disease

extremely common, esp. in postmenopausal women & elderly

29
Q

what type of dry eye disease has issues w/ aqueous layer?

A

aqueous deficient

30
Q

what type of dry eye conditions commonly has abnormalities w/ meibomian glands?

A

evaporative

31
Q

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)

A

aq. deficient — Sjogren’s syndrome

32
Q

what is the OSDI formula?

A

OSDI = [(sum of scores) x 25] / (# of questions answered)

Anterior Segment (37 decks)

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