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HEENT > Dry eyes > Flashcards

Dry eyes Flashcards

1
Q 
What is the lacrimal functional component composed of?
1. 
2. 
3. 
4.
5.
A
  1. lacrimal glands
  2. ocular surface
  3. meibomian glands
  4. eyelids
  5. sensory and motor nerves
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2
Q

What are the three layers of the tear film?

A

Mucous layer
aqueous layer
lipid layer

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3
Q

What do goblet cells produce?

A

mucin

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4
Q

What is the function of the mucous layer?

a) supplies oxygen and electrolytes to the ocular surface,
b) provides antibacterial defence and wound healing
c) Enhances tear film spreading
d) Traps and removes waste materials

A

d) Traps and removes waste materials

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5
Q

What layer of the tear film is produced by the lacrimal gland?

a) aqueous layer
b) mucous layer
c) lipid layer

A

a) aqueous layer

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6
Q

What is the purpose of the aqueous layer?

a) Traps and removes waste materials
b) Hydrate mucous layer, supplies oxygen and electrolytes to the ocular surface, provides antibacterial defence and wound healing
c) Enhances tear film spreading, provides a smooth surface and stabilizes the tear film

A

b) Hydrate mucous layer, supplies oxygen and electrolytes to the ocular surface, provides antibacterial defence and wound healing

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7
Q

Which layer of the tear film is produced by the meibomian gland?

a) aqueous layer
b) mucous layer
c) lipid layer

A

c) lipid layer

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8
Q

Purpose of the lipid layer?

a) Traps and removes waste materials
b) Hydrate mucous layer, supplies oxygen and electrolytes to the ocular surface, provides antibacterial defence and wound healing
c) Enhances tear film spreading, provides a smooth surface and stabilizes the tear film

A

c) Enhances tear film spreading, provides a smooth surface and stabilizes the tear film

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9
Q

Dry eye is a multifactorial ___________ of the ocular surface characterized by a loss of _________ of the tear film, and accompanied by ocular__________, in which tear film instability and __________, ocular surface _________ and damage, and ___________abnormalities play etiological roles.

disease
homeostasis
symptoms
hyperosmolarity inflammation
neurosensory
A 
disease
homeostasis 
symptoms 
hyperosmolarity inflammation
neurosensory
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10
Q

What are the two types of dry eyes?
1.
2.

A
  1. aqueous-deficient dry eye (ADDE)

2. evaporative dry eye (EDE).

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11
Q

tear hyperosmolarity arising from reduced lacrimal secretion due to excessive drainage or impaired/reduced lacrimal gland tear production

A

aqueous-deficient dry eye (ADDE)

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12
Q

What causes aqueous-deficient dry eye (ADDE)?

A

Sjogren’s Syndrome , systemic drugs, reflex block

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13
Q

hyperosmolarity due to excessive evaporation from the exposed tear film surface

A

evaporative dry eye (EDE).

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14
Q

What causes evaporative dry eye (EDE)?

A

Meibomian gland dysfunction, vitamin A deficiency, topical preservatives, ocular allergy

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15
Q

List some risk factors of dry eye

A 
Aging
•Female
•Asian
•MGD
•Connective tissue diseases 
•Sjogren’s syndrome
Low androgen
•Computer use
•Environment
•Contact lens wear
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16
Q

What kind of drugs can cause dry eye?

A 
NSAID Aspirin*, ibuprofen*
 (THC)*
Morphine*
Antihistamines: 
Antiarrhythmic/Bronchodilating 
Antidepressants 
And more...
Decongestant Pseudoephedrine, phenylephrine
Antihypertensive 
Diuretic 
Antineoplastic Cyclophosphamide*,
CNS Depressant 
Acne Treatment Isotretinoin*
Hormone-based Therapy
Finasteride*, estrogen/progesterone, 
medroxyprogesterone
Neurotoxin
17
Q

Symptoms of dry eye

A 
Dry or foreign body sensation
Mild itching
Burning or stinging 
“sandy” or “scratchy” feeling 
Irritation or soreness
Blurry vision 
Contact lens intolerance
18
Q

Signs of dry eye

A

Redness
Mucus discharge
Increased blink frequency
Intermittent tearing (increased tearing such as to the wind or reading/computer work results from a reflex tearing that does little to increase comfort)

19
Q

What are the four screening questions

A
  1. Do your eyes feel uncomfortable?
  2. Do you have watery eyes?
  3. Does your vision fluctuate, especially in a dry environment?
  4. Do you use eye drops?
    Refer to optometrist if yes to any of the above
20
Q

When to refer patient to doctor

A

Pain, photophobia, any disturbances of vision, blunt trauma, chemical exposure, imbedded foreign body, heat exposure (e.g. welder’s arc), eye protrusion, or contact lens wear

signs and symptoms of acute angle-closure glaucoma (e.g. red, painful eye with
increased IOP, blurred vision, headache, vomiting)

History of iritis, scleritis, angle-closure glaucoma

Symptoms secondary to medication or to an undiagnosed condition (e.g.
blepharitis)

Symptoms worsen or persistent (e.g. >5 days)

21
Q

3 ways to manage DED

A

Environment methods
Supportive methods
Tear supplements
Diet (e.g. omega-3 fatty acids)

22
Q

replenishing tear volume, tear stabilization, reduction in tear osmolarity, reduction in friction between eyelids and cornea, preservation of smooth refracting surface

A

OCULAR LUBRICANTS

23
Q

Adding ________ may better mimic natural tears

A

electrolytes

24
Q

The function of lipids: To replace _________ and prevent tear evaporation

A

To replace low lipid levels and prevent tear evaporation

25
Q

What is the role of a buffer in medication?

A

control pH

26
Q

Disrupts the lipid layer as a detergent by affecting the surface tension and
Cytotoxic to corneal epithelial cells (disrupts tight junctions), goblet cells

A

BENZALKONIUM CHLORIDE (BAK)

27
Q

Role: enhance lubrication

increase tear thickness
increase adhesion to the mucus layer of tears àprolong retention time on the ocular surface
protecting against desiccation; protecting the ocular surface

A

VISCOSITY

28
Q

List 2 viscosity agents

A
  1. Cellulose derivatives
  2. Dextran Polymers
  3. Polyvinyls
  4. Polyols
  5. Glyco-amino-glycan
  6. Ointment
  7. Carbomer resins
28
Q

List 2 viscosity agents

A
  1. Cellulose derivatives
  2. Dextran Polymers
  3. Polyvinyls
  4. Polyols
  5. Glyco-amino-glycan
  6. Ointment
  7. Carbomer resins
29
Q

T or F: A diet rich in omega-3 fatty acids may or may not help.

A

T

30
Q

Pharmacological therapy
•Short-term topical _____
•Long-term topical ______
•Long-term topical _____

A

Pharmacological therapy
•Short-term topical corticosteroid
•Long-term topical cyclosporine
•Long-term topical lifitegrast

31
Q

Dry eye symptoms should improve within ______

A

3 to 5 days

HEENT (14 decks)

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