Dry Eye Syndrome Flashcards
List 4 functions of the tear film
- Maintains cornea and conjunctiva in normal state
- provides oxygen and lubrication for cornea and conjunctiva
- ensure smooth refractive surface
- pathway for movement of cytokines and proteins secreted by lacrimal gland
Describe aqueous deficient dry eye
- Dryness from reduced lacrimal tear secretion and volume
- cause tear hyperosmolarity -> causes hyperosmolarity of epithelial surface -> causes inflammatory events
List characteristics of Anhidrotic ectodermal dysplasia (congenital)
- diminished perspiration
- loss of eyelashes
- defective dentition (teeth)
- absense of sebaceous glands
List 7 different causes of Aqueous deficiency. (2 are congenital)
- Anhidrotic ectodermal dysplasia
- Hypoplaia of lacrimal gland
- trauma
- tumors
- Inflammation (most common is rhumatoid arthiritis)
- neurological defects
- Sjogren’s syndrome
Describe Sjogren;s syndrome: (Characteristics and triad of findings)
- most commonly found in post-menopause women
- Characteristics: lympathic infiltration and atrophy of main lacrimal gland, accessory lacrimal gland and salivatory gland
- high frequency of meibomian gland dysfunction
- Triad of findings: Keratoconjunctivitis sicca, xerostomia (dry mouth), connective tissue diseases
Describe the difference between Primary and Secondary Sjogren’s syndrome
Primary Sjogren’s: Keratoconjunctivitis sicca (KCS) and xerostomia
Secondary Sjogren’s: connective tissue disease with KCS and xerostomia
List three type of Non-Sjogren’s Syndrome dry eye and which one is most common.
- Lacrimal dysfunction
- Age related dry eye (most common form)
- Keratoconjunctivitis sicca (KCS)
List three types of Primary Lacrimal Gland deficiencies (Non-Sjogren’s Dye eye) and a secondary lacrimal gland deficiency
1) age related dry eye
2) congenital alacrima (dry eye in youth)
3) familial dysautonomia (Riley Day Sundrome)
- caused by autonomic dysfunction. general insentivity to pain accompanied by marked lack of emotion and reflex tearing
Secondary: lacrimal gland infiltration
What is the main cause of lacrimal gland duct obstruction and 4 different ways this can occur.
- Caused by cictrising conjunctivitis, may cause cicatricial obstructive MGD
Types: - trachoma
- cicatricial pemphigoid & mucous membrane pemphigoid
- erthema multiforme
- chemical & thermal burns
Describe Ocular Pemphigoid
- average onset 58 years
- chronic blistering disease that affects eyes, oral mucosa, skin, vagina & rectum
- bilateral, progressing shrinking of the conjunctiva, entropian, trichiasis, xerosis and visual loss by corneal opacification.
You have a patient that presents with chronic blistering over their eyes, mouth and skin bilaterally and a complaint of vision loss. Upon SLE you see progressive shrinking of the conjunctiva, entropian and corneal opacification. What is the disease?
A. Ocular Pemphigoid
B. Eryhtema multiforme
A. Ocular Pemphigoid
Describe Erythema multiforme
- mucocutaneous disorder
- affects children and young adults
- Characterized by: skin vesicles, bullae, maculopapular lesions on hand and feet
- erythematous patches on hands, arm, face and neck
- bulls eye lesions
- hemorragic crusting of lips
- bilateral conjunctivitis
- refer to dematologist and internist
You have a patient that presents with skin vesicles, bullae and maculopapular lesions on their hand and feet as well as patches on their hands, arm, face and neck and “bulls eye” lesions. Upon SLE you see bilateral conjunctivitis. What is the disease?
A. Ocular Pemphigoid
B. Eryhtema multiforme
B. Eryhtema multiforme
List three examples of reflex sensory block (reflex hyposecretion) and explain how it induces dry eye
- Contact Lens Wear
- Diabetes
- Neurotrophic Keratitis (Brady Turner)
- Reduction in sensory drive from ocular surface decreases reflex-induced lacrimal secretion
- reduces blinking rate and increases evaporation loss
List three examples of reflex motor block (reflex hyposecretion)
- CN VII damage
- Multiple Neuromatosis
- Exposure to systemic drugs
List two infective causes of Ocular Sensory Loss
Hint: Herpes
- Herpes Simplex Keratitis
- Herpes Zoster Opthalmicus
List three corneal surgery causes of ocular sensory loss
- limbal incision (cataract extraction)
- Keratoplasty
- Refractive Surgery (PRK, Lasik, RK)
List topical/pharmaceutical/systemic conditions that can cause ocular sensory loss.
- Topical anesthesia
- Beta blockers, atropine-like drugs
- Chronic C/L wearer reduce corneal sensitivity
- diabetes mellutis
- neurotrophic keratitis
List three causes of reflex motor block
nerve related and drug related
- CN VII damage - lacrimal hyposecretion
- Multiple neuromatosis
- Systemic drugs that decrease lacrimal secretion
List three intrinsic evaporative causes
Hint: Glands, Lids, Blink rate)
- Meibomian Gland Dysfunction (posterior blepharitis) - most common
- Disorders of lid aperature & lid/globe conguity or dynamic
- Low blink rate
Describe Meimbomian Gland Dysfunction as it relates to dry eye (association, diagnosis based on, how it increases tear evaporation)
- most common cause of evaporative dry eye
- Associated with: Acne roascea, seborrhoeic dematitis, atopic dermatitis
- Diagnosis based on: presence of orifice plugging, thickening or absense of excreta
- Deficient lipid layer of tear film
List six possible lid aperature disorders & lid/globe congruity that cause dry eye
- noturnal lagopthalmos
- CN VII paresis
- entropian/ectropian
- symblepharon (adhesion of palpbral conj to bublar conj)
- dellen (tear film does not cover eye)
List four extrinsic evaporative causes of dry eye
- Ocular surface disorders (Vita A deficiency, topical drugs)
- Contact Lens Wear
- Ocular Surface Disease
- Allergic Conjunctivitis
Is diagnosis of dry eye based on subjective complaints or objective findings?
Subjective complaints
How can milieu exterieur (external environment) aggrevate dry eye? (List 4 environmental factors - think air quality)
- low relative humidity
- draft
- wind
- Occupational environment (smoking, air conditioning, low tear production at night, etc.)
List three ways tears exit the eye
- Absorption into conjunctival capillaries
- evaporation
- drainage into puncta down into lacrimal canal
Describe the symptoms of dry eye
- intermittent burning and tearing
- grittiness, foreign body sensation
- itchiness
- redness
- intermittent blurred vision
- photophobia
- matting of lids/lashes
List five clinical signs of dry eye
- reduction in height of inferior tear meniscus
- cellular debris in tear film
- abnormal mucus accumulation in inferior cul-de-sac
- conjunctival injection
- dull appearance of the eye
