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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
Q

These factors lead to expansion of autoreactive helper T cells which infiltrate ocular surface and lacrimal gland

A

Proinflammatory cytokines
Chemokines
Matrix metalloproteinases

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20
Q

Mechanism of EDE

A

Dysfunction of meibomian gland
Deficiency of tear film lipid
Excessive evaporation of tear film
Tear hyperosmolarity despite normal lacrimal function

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21
Q

Two types of evaporative dry eye

A

Intrinsic
Extrinsic

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21
Q

Causes of intrinsic evaporative dry eye

A

Meibomian oil deficiency
Disorders of lid aperture
Low blink rate
Drugs

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21
Q

Environmental factors that cause extrinsic evaporative dry eye

A

Humidity
Allergy

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21
Q

Causes of extrinsic evaporative dry eye

A

Vitamin A deficiency
Topical drug preservatives
Contac lens
Environmental factors

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21
Q

Symptoms of dry eye disease

A

Redness
Burning
Stinging
Pruritis
Photophobia

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21
Q

A drug that causes intrinsic evaporative dry eye

A

Isotretinoin

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22
Q

Diagnostic investigations in drye ey

A

Schirmer test
Tear film break up time
Ocular surface staining
Examination of eyelids margins and meibomian gland orifices

22
Q

Schirmer score

A

Measures tear secretion

22
Q

Types of dry eye disease according to the TFOS DEWS classification

A

Aqueous deficient
Evaporative/ Tear film instability
Combination

22
Q

Two main types of aqueous deficiennt dry eye disease

A

Sjogren syndrome dry eye
Non-sjogren dry eye

23
Q

What is used to determine taer film break up time

A

FLuorescein

23
Q

Types of sjogren syndrome dry eye

A

Primary
Secondary

23
Q

Ocular surface staining is done with……

A

Fluorescein and
Lissamine green

24
Q

Causes of non-sjogren dry eye

A

Lacrimal deficiency
Lacrimal gland duct obstruction
Reflex block
Systemic drugs

25
Q

Non-pharmacological treatment oprions for dry eye

A

Eyelid hygience
Punctal plugs
Tarsorrhaphy
Amniotic membran transplantation
Keratoplasty
Salivary gland transplantation

26
Q

Tarsorrhaphy

A

Joining part or all of the upper and lower eyelids so as to partially or completely close the eye

27
Q

Punctal plugs

A

Devices inserted into the tear ducts to prevent tear drainage

27
Q

Keratoplasty

A

Corneal transplant is a surgery where a damaged cornea is replaced by a donated corneal tissue

27
Q

Lipid containing supplements are used in ………

A

Meibomian gland dysfunction

28
Q

What is used to treat demodicosis

A

Tea tree oil

28
Q

Tear conservation therapies

A

Punctal occlusion
Moisture chamber spectacles/goggles

28
Q

Demodicosis

A

Parasitic infection of the skin caused be Demodex spp.

29
Q

ALgorithms for managing dry eye

A

TFOS DEWS II treatment protocol
CEDARS algorithm
ASCRS algorithm

30
Q

CEDARS meaning

A

Corneal External Disease and Refractive Society

30
Q

Categories of dry eye based on the CEDARS algorithm

A

Aqueous deficiency
Blepharitis or Meibomian Gland dysfunction (Evaporative and Non-evaporative)
Goblet cell dysfunction/ Mucin deficiency
Exposure related Dysfunctional Tear Syndrom (DTS)

31
Q

Which algorithm is used to manage dry eye based on cause and not severity

A

CEDARS

32
Q

ASCRS meaning

A

American Society of Corneal and Refractive Surgery

32
Q

Which algorithm is used when correct diagnosis has been made

A

ASCRS algorithm

32
Q

Pharmacological treatments in dry eye

A

Artificial tears
Antiinflammatory agents
Topical corticosteroids
Topical cyclosporine A
Tacrolimus/ Pimecrolimus
Tetracyclines
Macrolides
Omega fatty acids

32
Q

Mainstay therapy for dry eyes

A

Artificial eyes

33
Q

Benefits of artificial eyes

A

Increases tear film stability
Reduces ocular surface stress
Improves contrast sensitivity
Improves optical quality of the surface
Increases quality of life

33
Q

Examples of artificial eyes

A

Acetylcysteine
Carmellose sodium
Hypromellose
Polyvinyl chloride

33
Q

Brand names for acetylcysteine

A

Ilube

33
Q

Frequency of aplication for acetylcysteine

A

Apply every 6-8 hours

34
Q

Brand names for carmellose sodium

A

Aqualube

35
Q

Why corticosteroids are used for short term in dry eye

A

Raised intraocular pressure
Cataract

35
Q

Brand names for hypromellose

A

Artelac
Cool eyes
Natural tears

35
Q

Corticosteorids used in dry eye diseases

A

Betamethasone
Dexamethasone
Fluorometholone
Hydrocortisone
Prednisolone

35
Q

Frequency of application for betamethasone in dry eye

A

Apply 6 hourly

36
Q

Dexamethasone frequency of application in dry eye

A

Apply 4-6 hourly

36
Q

Fluorom etholone frequency of application in dry eye

A

Apply 1 hourly for 24-48 hours

37
Q

Frequency of application for hydrocortisone in dry eye

A

Apply 6-12 hourly

37
Q

Frequency of application for prednisolone in dry eye

A

Apply 1-2 hourly

37
Q

MOA of cyclosporine A

A

Inhibits calcineurin-phosphatase pathway by complexing with cyclophilin
Reduces transcription of T cell activating cytokines eg: IL-2

38
Q

How does topical cyclosporine A increase tear production

A

Local release of parasympathetic neurotransmitter

39
Q

Frequency of application of cyclosporine A

A

One drop at bedtime

40
Q

MOA of tetracyclines in dry eye

A

Anti- inflammatory effect
Reduce the synthesis and activity of MMP Reduce production of IL-1, TNF
Reduce collagenase activity
Reduce B-cell activation.

41
Q

Meibomian gland dysfunction and rosacea have been successfully treated with…………

A

Tetracyclines

41
Q

Tetracyclines used for dry eye

A

Tetracycline
Doxycycline
Minocycline

41
Q

Why are topical tetracyclines preferred

A

GIT adverse reactions
Skin problems

41
Q

Omega fatty acids

A

Omega-3
Omega-3

41
Q

Tacrolimus preparation and dosing

A

0.03% tacrolimus eyedrops plus/minus olive oil
Apply 12 hourly for 14-90 days

41
Q

MOA of omega fatty acids

A

Blocks eicosanoids
Reduces cytokines

42
Q

This has been successfully used to treat blepharitis and meibomian gland dysfunction

A

Azithromycin 1%

43
Q

Benefits of azithromycin in dry eye

A

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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