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PHARMACY PRACTICE II > DRY EYE DISEASE > Flashcards

DRY EYE DISEASE Flashcards

1
Q

Dry eye disease

A

disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface.

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2
Q

Ocular surface

A

Cornea
Conjucntivitis
Accessory lacrimal glands

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3
Q

Meibomian glands

A

Specific sebaceous glands of the eyelid margin that produce the outer lipid film of the tear film

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3
Q

Structures affected in dry eye disease

A

Occular surface
Meibomian glands
Lacrimal gland

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4
Q

Layers of the tear film

A

Superficial thin lipid layer (0.11um)
Middle thick aquoeus layer (7um)
Innermost hydrophilic mucin layer (0.02-0.05um)

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5
Q

Antimicrobial proteins in healthy tears

A

Lysozyme
Lactoferrin

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6
Q

Growth factors and antinflammatory components in tears

A

ECF
IL-1RA

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7
Q

Role of soluble mucin 5AC in tears

A

For viscosity

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8
Q

Which cells secrete soluble mucin 5AC

A

Goblet cells

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9
Q

Role of electrolytes in tears

A

For osmolarity

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10
Q

Components of healthy tears

A

Complex mixture or proteins, mucin, electrolytes

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11
Q

Features of tears in chronic dry eye

A

Decreased in proteins
Decreased growth fatcors
Decreased solule mucin 5AC
Altered cytokine balance promoting inflammation
Increased electrolytes

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12
Q

Why is there reduced soluble mucin 5AC in chronic dry eye

A

Goblet cell loss

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13
Q

Reason for increase in dry eye syndrome among young adults aged 18-34 years

A

Increased use of soft contact lenses
Frequent smartphone and computer usage

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14
Q

Causes or Aetiology of dry eye disease

A

Decreased tear production
Sjogren syndrome
Excessive evaporation
Structural abnormalities of eyelid position or Decreased blink function

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15
Q

Cause of decreased tear production

A

Lacrimal gland dysfunction or destruction

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16
Q

Causes of excessive tear evaporation

A

Meibomian gland dysfunction or posterior blepharitis

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16
Q

Sjogren syndrome

A

Chronic autoimmune inflammatory characterised by diminished lacrimal and salivary gland function

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17
Q

How does decreased blink function increase
evaporation of tear film

A

By increasing the area or the time of tear film exposure

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18
Q

Core mechanism of dry eye disease

A

Evaporation-induced tear hyperosmolarity

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18
Q

Pathogenic triggering mechanisms for dry eye disease

A

Environmental factors
Infection
Endogenous stress
Antigens
Genetic factors

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18
Q

Conditions that initiate tear film instability

A

Vitamin A deficiency
Eye allergies
Preservatives in topical medications
Contact lens
Certain cosmetics
Low humidity
Blowing air
Computer vision syndrome

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18
Q

Clinical types of dry eye disease

A

Evaporative Dry eye disease (EDE)
Aqueous deficient dry eye disease (ADDE)

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19
Q

Mechanism of ADDE

A

Damage to lacrimal gland
Reduced tear secretion
Tear hyperosmolarity despite normal tear evaporation rate

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19
These factors lead to expansion of autoreactive helper T cells which infiltrate ocular surface and lacrimal gland
Proinflammatory cytokines Chemokines Matrix metalloproteinases
20
Mechanism of EDE
Dysfunction of meibomian gland Deficiency of tear film lipid Excessive evaporation of tear film Tear hyperosmolarity despite normal lacrimal function
21
Two types of evaporative dry eye
Intrinsic Extrinsic
21
Causes of intrinsic evaporative dry eye
Meibomian oil deficiency Disorders of lid aperture Low blink rate Drugs
21
Environmental factors that cause extrinsic evaporative dry eye
Humidity Allergy
21
Causes of extrinsic evaporative dry eye
Vitamin A deficiency Topical drug preservatives Contac lens Environmental factors
21
Symptoms of dry eye disease
Redness Burning Stinging Pruritis Photophobia
21
A drug that causes intrinsic evaporative dry eye
Isotretinoin
22
Diagnostic investigations in drye ey
Schirmer test Tear film break up time Ocular surface staining Examination of eyelids margins and meibomian gland orifices
22
Schirmer score
Measures tear secretion
22
Types of dry eye disease according to the TFOS DEWS classification
Aqueous deficient Evaporative/ Tear film instability Combination
22
Two main types of aqueous deficiennt dry eye disease
Sjogren syndrome dry eye Non-sjogren dry eye
23
What is used to determine taer film break up time
FLuorescein
23
Types of sjogren syndrome dry eye
Primary Secondary
23
Ocular surface staining is done with......
Fluorescein and Lissamine green
24
Causes of non-sjogren dry eye
Lacrimal deficiency Lacrimal gland duct obstruction Reflex block Systemic drugs
25
Non-pharmacological treatment oprions for dry eye
Eyelid hygience Punctal plugs Tarsorrhaphy Amniotic membran transplantation Keratoplasty Salivary gland transplantation
26
Tarsorrhaphy
Joining part or all of the upper and lower eyelids so as to partially or completely close the eye
27
Punctal plugs
Devices inserted into the tear ducts to prevent tear drainage
27
Keratoplasty
Corneal transplant is a surgery where a damaged cornea is replaced by a donated corneal tissue
27
Lipid containing supplements are used in .........
Meibomian gland dysfunction
28
What is used to treat demodicosis
Tea tree oil
28
Tear conservation therapies
Punctal occlusion Moisture chamber spectacles/goggles
28
Demodicosis
Parasitic infection of the skin caused be Demodex spp.
29
ALgorithms for managing dry eye
TFOS DEWS II treatment protocol CEDARS algorithm ASCRS algorithm
30
CEDARS meaning
Corneal External Disease and Refractive Society
30
Categories of dry eye based on the CEDARS algorithm
Aqueous deficiency Blepharitis or Meibomian Gland dysfunction (Evaporative and Non-evaporative) Goblet cell dysfunction/ Mucin deficiency Exposure related Dysfunctional Tear Syndrom (DTS)
31
Which algorithm is used to manage dry eye based on cause and not severity
CEDARS
32
ASCRS meaning
American Society of Corneal and Refractive Surgery
32
Which algorithm is used when correct diagnosis has been made
ASCRS algorithm
32
Pharmacological treatments in dry eye
Artificial tears Antiinflammatory agents Topical corticosteroids Topical cyclosporine A Tacrolimus/ Pimecrolimus Tetracyclines Macrolides Omega fatty acids
32
Mainstay therapy for dry eyes
Artificial eyes
33
Benefits of artificial eyes
Increases tear film stability Reduces ocular surface stress Improves contrast sensitivity Improves optical quality of the surface Increases quality of life
33
Examples of artificial eyes
Acetylcysteine Carmellose sodium Hypromellose Polyvinyl chloride
33
Brand names for acetylcysteine
Ilube
33
Frequency of aplication for acetylcysteine
Apply every 6-8 hours
34
Brand names for carmellose sodium
Aqualube
35
Why corticosteroids are used for short term in dry eye
Raised intraocular pressure Cataract
35
Brand names for hypromellose
Artelac Cool eyes Natural tears
35
Corticosteorids used in dry eye diseases
Betamethasone Dexamethasone Fluorometholone Hydrocortisone Prednisolone
35
Frequency of application for betamethasone in dry eye
Apply 6 hourly
36
Dexamethasone frequency of application in dry eye
Apply 4-6 hourly
36
Fluorom etholone frequency of application in dry eye
Apply 1 hourly for 24-48 hours
37
Frequency of application for hydrocortisone in dry eye
Apply 6-12 hourly
37
Frequency of application for prednisolone in dry eye
Apply 1-2 hourly
37
MOA of cyclosporine A
Inhibits calcineurin-phosphatase pathway by complexing with cyclophilin Reduces transcription of T cell activating cytokines eg: IL-2
38
How does topical cyclosporine A increase tear production
Local release of parasympathetic neurotransmitter
39
Frequency of application of cyclosporine A
One drop at bedtime
40
MOA of tetracyclines in dry eye
Anti- inflammatory effect Reduce the synthesis and activity of MMP Reduce production of IL-1, TNF Reduce collagenase activity Reduce B-cell activation.
41
Meibomian gland dysfunction and rosacea have been successfully treated with............
Tetracyclines
41
Tetracyclines used for dry eye
Tetracycline Doxycycline Minocycline
41
Why are topical tetracyclines preferred
GIT adverse reactions Skin problems
41
Omega fatty acids
Omega-3 Omega-3
41
Tacrolimus preparation and dosing
0.03% tacrolimus eyedrops plus/minus olive oil Apply 12 hourly for 14-90 days
41
MOA of omega fatty acids
Blocks eicosanoids Reduces cytokines
42
This has been successfully used to treat blepharitis and meibomian gland dysfunction
Azithromycin 1%
43
Benefits of azithromycin in dry eye
Improves meibomian gland function and symptoms Reduces bacterial colonization of the eyelid margins Normalizes the meibomian gland secretion lipid profile

PHARMACY PRACTICE II (17 decks)

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