Dry Eye (Yumori)

Question 1

Dry Eye disease

Answer 1

multifactorial disease that results in symptons of discomfort, visual disturbance, tear film instability. With potential damage to ocular surface. Increased osmolarity of tear film and inflammation

Question 2

two main types of dry eye

Answer 2

evaporative or aqueous deficient

Question 3

evaporative dry eye

Answer 3

intrinsic and extrinsic

Question 4

intrinsic dry eye causes

Answer 4

meibomian oil deficiency, disorders of lid aperture, low blink ratio, drug action accutane

Question 5

extrinsic dry eye causes

Answer 5

Vitamin A deficiency, topical drugs preservatives, CL wear, ocular surface disease (allergy)

Question 6

aqueous defficient dry eye

Answer 6

sjogren syndrome and non-sjogren dry eye

Question 7

sjogren’s syndrome

Answer 7

chronic inflammatory disorder which affects lacrimal and salivary gland

Question 8

major long-term concern for sjogren’s syndrome

Answer 8

lymphoma can develop which is threatening. 5% lifetime risk

Question 9

ACR criteria for sjogren’s syndrome

Answer 9

two or more of following features: 1. positive serum anti-SSA/Ro and or anti-SSB/La 2. labial salivary gland biopsy 3. keratoconjunctivitis sicca with ocular staining score 3

Question 10

probe for systemic inflammatory symptoms which include

Answer 10

morning stiffness and dry mouth

Question 11

DED Tests

Answer 11

symptoms survey, tear osmolarity, external exam (lids, meibomian gland), TBUT, staining (cornea with fluorescein and conj with lissamine), tear meniscus height, schirmer w/out anesthetic

Question 12

DED symptoms

Answer 12

burning, foreign body sensations, decreased vision, excess tearing, exacerbated by smoke, wind, heat, humidity, worse later in day, bilateral and chronic

Question 13

which symptom survey do we use?

Answer 13

ocular surface disease index (OSDI)

Question 14

NORM for OSDI

Answer 14

less than 13

Question 15

tearlab norm

Answer 15

308 mOsm/L or less

inter-eye less than 8 mOsm/L

Question 16

external exam norm

Answer 16

negative

Question 17

TBUT norm

Answer 17

greater or equal to 10 sec

Question 18

staining norm

Answer 18

less than or equal to grade 2

Question 19

TMH

Answer 19

greater or equal to 0.10mm, convex

Question 20

Schirmier without anesthetic norm (5 min)

Answer 20

> 5mm

Question 21

environmental modifications

Answer 21

minimize desiccating enviornmental stresses. Add humidifier, avoid air conditioning drafts. add periodic breaks with eye closure when reading or working on comp

Question 22

anti-inflammatories

Answer 22

topical steroids not for topical use because increases IOP and cataract formation. Omega 3, oral tetracycline (doxycycline

Question 23

if Pt responds to steroids we perscribe

Answer 23

Restasis BID OU

Question 24

can’t perscribe doxycycline to

Answer 24

pregnant/nursing women and children

Question 25

level one treatment

Answer 25

education and environmental modifications, elimination of offending systemic meds, artificial tear subs, eye lid therapy

Question 26

level two treatment

Answer 26

add anti-inflammatories, tetracyclins for meibomitis, punctal plugs, secretogogues, moisture chamber spectacles

Question 27

level 3

Answer 27

add serum, contact lenses, permanent punctal occlusion

Question 28

level 4

Answer 28

add systemic anti-inflammatory agents, surgery