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Ocular Disease - Lacrimal Disorders > Dry Eye Tests and Treatment > Flashcards

Dry Eye Tests and Treatment Flashcards

1
Q

When doing biomiscropy, what properties are you looking for in the tear meniscus, tear film debris and lipid layer to assess dry eye?

A
  • tear meniscus - 0.2 mm average. helps diagnose aqueous deficiency
  • tear film debris (+1 to +4 moderate to severe), mucus strands early change in dry eye
  • lipid layer: smooth & thick (has bright colors), smooth & thin (grayish color), irregular
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2
Q

When doing biomiscropy, what properties are you looking for in related to blepharitis (bacterial infection) and meibomianitis (inflammation of meibomian gland) related to dry eye?

A
  • blepharitis: scaly exudates around eyelash bases, matted, hard crust around cilium, ulcers of hair follicles, corneal staining
  • dilated blood verssels on the lid margin
    Meibomianitis: inflammation and pouting of glands, solidification of meibomian secretions
  • disrupts tear stability, low TBUT
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3
Q

Describe the Schirmer test. (What results mean, what does Schrimer I, II and basic secretion measure)

A
  • measures aqueous secretion
  • normal 15mm, moderate KCS 5-10 mm, severe KCS < 5 mm wetting
  • Schirmer I: no anesthesia, measures reflect and basic secretion
  • Schirmer II: no anestheia, mesaures max reflex tearing
  • Basic Secretion test: performed with anesthetics, measures basal secretion
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4
Q

Explain Phenyl red test and results

A
  • place phenyl red thread in conjunctival sac for 15 seconds without anesthesia
  • normal wetting 10-20 mm
  • < 10 mm correlates to dryness
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5
Q

Explain tear osmolarity tests

A
  • tear osmolarit elevated with aqueous deficient KCS
  • elevated after use of aritificial tears
  • not routinely used
  • accurate and senstiive to dry eye
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6
Q

Explain lactoferrin assay test and results

A
  • measures lactoferrin to measure tear volume
  • evaluates decrease in lacrimal gland output
  • normal 1.42 mg/ml, abnormal < 1.00 mg/ml
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7
Q

Explain TBUT test and results and tear evaporation rates (when lowest)

A
  • TBUT - may help detect lipid and mucin deficiency
  • normal > 15 s, borderline 10-15 s, abnormal < 10 s
  • Tear evaporation rate: lowest on awakening, rises in first 2 hours and the constant afterwards
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8
Q

Describe the Rose Bengal staining:

A
  • stains dead and devitalized cells
  • staining of exposed bulbar conjunctiva and cornea appears early in patients with dry eye
  • seen most commonly in lower 1/3 of cornea
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9
Q

Describe Lissamine Green

A
  • stains dead and devitalized cells
  • better staining and less discomfort than Rose Bengal
  • discolors skin, examines bulbar and palpebral conjunctiva well
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10
Q

Describe Florescien and impression cytology tests

A
  • penetrates broken epithelial surfaces
  • may reveal punctate epithelial keratopathy in interpalpebral region
    Impression Cytology: done in lab setting. Allows effects of tear deficiency on ocular epithelium to be examined
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11
Q

Describe Jones Test I for lacrimal patency

A
  • fluorescein placed in conjunctival sac

- if dye is present in nostril after 5 minutes, drainage system is normal and test is positive

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12
Q

Describe Jones Test II for lacrimal patency

A
  • irrigate saline in the lacrimal system

- if flurescein passed, system is open but with some functional blockage

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13
Q

What is differences between dry eye severity (1-4) in terms of symptoms and treatments?

A

1) No signs, mild conj signs. Tx: artificial tears
2) mild corneal punctate stain. Tx: gels, ointments, cyclosporine A (RESTASIS)
3) central staining and filamentary keratitis. Tx: tatracyclines and punctal plugs
4) Erosions and conjunctival scarring

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14
Q

List two types of Cellulose Derivative lubricant eye drops and examples of each.

A
  • Carboxymethylcellulose: Refresh Tears, Refresh Lquigel

- Hypromellulose, Tears Naturale, Genteal

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15
Q

Select two that are Hypromellulose type lubricant eyedrops

A. Refresh Tears
B. Visine
C. Tears Naturale
D. Genteal
E. Optive
A

C. Tears Naturale

D. Genteal

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16
Q

List three types of Glycerin containing products lubricant eye drops and examples of each.

A
  • Glycerin: Advance Eye Relief
  • Glycerin with HPMC: Tears Natural Forte, Visine
  • Glycerin with CMC: Optive
17
Q

Which is a glycerin lubricating eye drop?

A. Optive
B. Tears Naturale
C. Advance Eye Care Relief
D. Visine
E. Systane
A

C. Advance Eye Care Relief

18
Q

Which is a glycerin with hypromellulose (HPMC) lubricating eye drop?

A. Optive
B. Tears Naturale
C. Advance Eye Care Relief
D. Visine
E. Systane
A

D. Visine

19
Q

Which is a glycerin with carboymethylcellulose (CMC) lubricating eye drop?

A. Optive
B. Tears Naturale
C. Advance Eye Care Relief
D. Visine
E. Systane
A

A. Optive`

20
Q

List two examples of lipid based emulsion lubricant eye drops

A
  • Refresh Endura

- Soothe

21
Q

Which two are a lipid based emulsion lubricating drop? (Pick two)

A. Refresh Liquigel
B. Soothe
C. Refresh Endura
D. Visine
E. Systane Ultra
A

B. Soothe

C. Refresh Endura

22
Q

List an example of propylethelene gylcol (PEG) or propylene glycol (PG) lubricant eye drops.

A
  • Systane Ultra
23
Q

Describe Artificial Tear treatment (when is it utilized, relief period, main function, is it clinically effective?)

A
  • most common treatment
  • utilized for patient’s with aqueous deficiencies
  • provides relief for short duration
  • does not mimic electrolyte composition of tears
  • functions only as a lubricant
  • not based on clinical efficacy
24
Q

Give an example of an artificial tear spray

A
  • Tears Again Liposome Spray with Vit A & E

- facilitates lubrication and prolong contact time

25
Q

Describe some of the effects seen after 3-6 months of using Restasis (ie. what improvements, what may have caused dry eye, side effects)

A
  • Reduces aqueous deficiency (increased Shirmer wetting)
  • Improvement in conjunctival Rose Bengal stain and SPK
  • Indicates dry eye caused by ocular inflammation
  • may reduce cell-mediated inflammatory response to ocular surface disease (T-lymphocytes)
  • Side effects: burning, conjunctival hyperemia, disharge, epiphora, eye pain, FB sensation, pruritus, blurry VA
26
Q

Describe sustained-released artificial tears insert

A
  • lacrisert
  • rode made of hydroxypropyl cellulose
  • slowly dissolves over time 6-12 hours
27
Q

Describe ointment treatment (when you use it)

A
  • adjunctive therapy to artificial tears before going to bed because it makes vision blurry
  • ribbon placed in inferior cul-de-sac
  • i.e. refresh PM, lacrilube, Moisture eyes
28
Q

Describe punctal plugs

A
  • may require Schrimer test first
  • temporary implants tried before permanent occlusion with electrocautery
  • prevents drainage of tears an increase aqueous component
  • goblet cell density increases gradually (after 1-2 years)
    i. e. Medennium SmartPLUG
29
Q

Describe Blink therapy

A
  • improves keratopathy, decrease friction, tear thinning and evaporation rates by improving tear distribution
  • helps maintain smooth, lubricated and clean CL surface
30
Q

When do you prescribe googles and shields?

A
  • reserved for severe cases controlled with ariticial tears and punctal occlusion (i.e. patient with proptosis)
  • slows tear evaporation
31
Q

Describe tear stimulation (how is it administered, what type of agents)

A
  • oral or topical administration

- cholinergic agents (i.e. oral pilocarpine) used but unsuccessful due to cardiovascular and GI side effects

32
Q

Discuss two nutritional supplements available for treatment and side effect

A
  • Flaxseed oil, reduces T-cell lymphocyte proliferation
  • Problem: transient facial acne
  • Omega 3 Fatty Acids
33
Q

Describe when a bandage contact lens would be used and the side effects

A
  • Reserve for severe cases
  • Development of surface deposits are common
  • Increases risk of infection
  • Stagnation of tears with increased metabolic waste may cause hypoxia of corneal epithelium
34
Q

Describe filamentary keratitis (what is it, when it occurs, treatment)

A
  • Strands of mucous attached to epithelial surface
  • Occurs on patients with extreme dry eye
  • Tx: forceps removal and copious artificial tears
  • unilateral

Ocular Disease - Lacrimal Disorders (4 decks)

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