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Eye Disease > Dry Eye Disease > Flashcards

Dry Eye Disease Flashcards

1
Q

What is the definition of dry eye disease in simple terms?

A

Disease of ocular surface which causes a disruption of the tear film which causes tear film instability and ocular symptoms, inflammation and damage

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2
Q

What does osmolarity mean?

A

Concentration of a solution

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3
Q

What are the two types of dry eyes?

A

Aqueous-deficient and evaporative

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4
Q

What does aqueous deficient dry eye mean?

A

Not enough tears are being produced due to lacrimal gland and accessory lacrimal gland having a low output

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5
Q

What are the two sub categories of the causes of aqueous deficient dry eyes?

A

Sjogrens syndrome and non-sjogrens syndrome

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6
Q

What are some key features of people with Sjögren’s syndrome?

A

Dry eyes and dry mouth
*Autoimmune disease causes destruction of the glands
- associated with systemic lupus and rheumatoid arthritis

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7
Q

Can people have both evaporative dry eyes and aqueous deficient dry eyes?

A

YES!!!!!!!!

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8
Q

What is the epidemiology of dry eyes?

A

5-50% of the population due to what your definition of dry eye is
It increases with age and women have a higher prevalence and Asian ethnicity (east Asia)

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9
Q

What are risk factors of dry eye disease?

A

-Age
-Female
- Asian race
- Underlying issues due to autoimmune disease
^non-modifiable

  • Medication
  • Computer use
  • Contact lenses wear
    ^modifiable
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10
Q

What is the aetiology of dry eye disease?

A

Damage or disease to any component of the lacrimal functional unit which leads to tear film instability

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11
Q

What is the lacrimal functional unit?

A

What maintains the tear film and this includes the lacrimal glands, meibomian glands, goblet cells, the sensory innervation which all controls the integrity of tear film, transparency of the cornea and quality of the image on the retina

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12
Q

What is the suggested pathogenesis of dry eye disease?

A

Secretory dysfunction of meibomian glands and lacrimal glands- the results of this leads to hyperosmolarity of the tears(high conc.) —> hyperosmolarity of the ocular surface —> inflammation —> this causes damage to the cells.

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13
Q

What does the lacrimal gland secrete?

A

Tear fluid

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14
Q

What does the meibomian gland secrete?

A

Polar and non-polar lipids

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15
Q

If a px has dry eye what other question MUST you ask to ensure they are not symptomatic of Sjogren’s syndrome?

A

Do they have dry mouth (if so assume they may have Sjogren’s syndrome esp if they have other autoimmune diseases)

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16
Q

What is another word for dry mouth?

A

Xerostomia

17
Q

How is Sjogrens syndrome identified?

A

A blood sample is taken and auto antibodies against the antigens in the lacrimal and salivary gland are found

18
Q

What gland does primary sjogrens syndrome effect?

A

Lacrimal gland only

19
Q

Is aquired sjogrens syndrome age related?

A

Yes

20
Q

What is the most common cause of evapourative dry eye?

A

Meibomian gland dysfunction

21
Q

What primarily is the role of the lipid layer if the tear film?

A

Reduce evaporation

22
Q

Which systemic drugs have been found to cause dry eye?

A

Beta blocker
Anti histamines
Hormone replacement therapy
Anti-psychotic medication
Isotretinoin

23
Q

What is Lasik surgery and why is it thought to be painless?

A

Refractive surgery which changes the shape of the cornea (steepening it for myopes) which is painless due to anaesthetic usage but also all the ties to the corneal nerves are cut off

24
Q

What is a major symptom which is experienced after LASIK surgery? + why does this symptom happen?

A

Dryness and discomfort- px are given lubricating drops to get them through this period
*The dry eye is due to corneal denervation

25
Q

What is a contraindication of LASIK surgery?

A

Pre-existing dry eye

26
Q

What are the sign of dry eye (there are 8)?

A
  • Conjunctival staining
  • Conjunctival injection
  • Corneal staining
  • Reduced tear meniscus
  • Filaments
  • Reduced TBUT
  • Reduced Schirmer score (uses filter paper)
  • MGD
27
Q

What are two dry eye disease questionnaires that you may give to your patient?

A

OSDI (Ocular surface disease index) and DEQ-5 (dry eye questionnaire 5)

28
Q

What are some points in your history you should include which may indicate the patient has dry eye diasese?

A
  • Dry eye questionnaires
  • Exacerbations
  • Duration
  • Severity
  • Ocular medicinal and medication history
29
Q

What are some examinations you may want to include which could indicate they have dry eye disease?

A

Slit lamp examination, tear meniscus height, TBUT, staining, Schirmer test, tear osmolarity

30
Q

What is an issue with lissamine green right now?

A

You shouldnt really be using it

31
Q

What grading system can grade dry eye?

A

Oxford system

32
Q

Look at the dry eye diagnosis flow diagram

A

Look at the dry eye diagnosis flow diagram

33
Q

What is the management of step 1 dry eye?

A
  • Educating px regarding condition
  • Modify local environment (blink more often/ 20-20-20 rule)
  • Nutritional advice (include fatty acid into diet)- LITTLE EVIDENCE
  • Modify/ eliminate systemic and topical medication)
  • Ocular lubricants
  • Lid hygiene + warm compress
34
Q

What is the management of step 2 dry eye?
Six points

A
  • Non-preserved lubricants
  • Tear conservation E.g Punctal plug
  • Non-medicated ointment at night
  • Topical antibiotics for anterior bleph (if present)
  • Oral antibiotics
  • Topical immunomodulatory drugs
35
Q

Is dry eye chronic?

A

Yes- there is no cure, you just have to manage symptoms

36
Q

What are management of step 3 and step 4 dry eye (hes related)?

A
  • Autologous serum (from the blood)
  • Surgical punctal occlusion
  • Amnionic membranes (from placenta)
37
Q

What nutritional advice can you give to patient to help with dry eyes?

A

Intake more omega 3 and omega 6 fatty acids

38
Q

what is the most common cause of tear deficient dry eye? and why does this disease come about?

A

Acquired primary lacrimal disease normally due to age related changes in lacrimal gland

Eye Disease (48 decks)

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