Dry Eye Tests and Treatment Flashcards
When doing biomiscropy, what properties are you looking for in the tear meniscus, tear film debris and lipid layer to assess dry eye?
- 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
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?
- 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
Describe the Schirmer test. (What results mean, what does Schrimer I, II and basic secretion measure)
- 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
Explain Phenyl red test and results
- place phenyl red thread in conjunctival sac for 15 seconds without anesthesia
- normal wetting 10-20 mm
- < 10 mm correlates to dryness
Explain tear osmolarity tests
- tear osmolarit elevated with aqueous deficient KCS
- elevated after use of aritificial tears
- not routinely used
- accurate and senstiive to dry eye
Explain lactoferrin assay test and results
- measures lactoferrin to measure tear volume
- evaluates decrease in lacrimal gland output
- normal 1.42 mg/ml, abnormal < 1.00 mg/ml
Explain TBUT test and results and tear evaporation rates (when lowest)
- 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
Describe the Rose Bengal staining:
- 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
Describe Lissamine Green
- stains dead and devitalized cells
- better staining and less discomfort than Rose Bengal
- discolors skin, examines bulbar and palpebral conjunctiva well
Describe Florescien and impression cytology tests
- 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
Describe Jones Test I for lacrimal patency
- fluorescein placed in conjunctival sac
- if dye is present in nostril after 5 minutes, drainage system is normal and test is positive
Describe Jones Test II for lacrimal patency
- irrigate saline in the lacrimal system
- if flurescein passed, system is open but with some functional blockage
What is differences between dry eye severity (1-4) in terms of symptoms and treatments?
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
List two types of Cellulose Derivative lubricant eye drops and examples of each.
- Carboxymethylcellulose: Refresh Tears, Refresh Lquigel
- Hypromellulose, Tears Naturale, Genteal
Select two that are Hypromellulose type lubricant eyedrops
A. Refresh Tears B. Visine C. Tears Naturale D. Genteal E. Optive
C. Tears Naturale
D. Genteal
List three types of Glycerin containing products lubricant eye drops and examples of each.
- Glycerin: Advance Eye Relief
- Glycerin with HPMC: Tears Natural Forte, Visine
- Glycerin with CMC: Optive
Which is a glycerin lubricating eye drop?
A. Optive B. Tears Naturale C. Advance Eye Care Relief D. Visine E. Systane
C. Advance Eye Care Relief
Which is a glycerin with hypromellulose (HPMC) lubricating eye drop?
A. Optive B. Tears Naturale C. Advance Eye Care Relief D. Visine E. Systane
D. Visine
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. Optive`
List two examples of lipid based emulsion lubricant eye drops
- Refresh Endura
- Soothe
Which two are a lipid based emulsion lubricating drop? (Pick two)
A. Refresh Liquigel B. Soothe C. Refresh Endura D. Visine E. Systane Ultra
B. Soothe
C. Refresh Endura
List an example of propylethelene gylcol (PEG) or propylene glycol (PG) lubricant eye drops.
- Systane Ultra
Describe Artificial Tear treatment (when is it utilized, relief period, main function, is it clinically effective?)
- 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
Give an example of an artificial tear spray
- Tears Again Liposome Spray with Vit A & E
- facilitates lubrication and prolong contact time
