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BOARDS2: conjuntiva/cornea > Dry Eyes > Flashcards

Dry Eyes Flashcards

1
Q

Is photophobia always from uveitis

A

No, any ocualr surface problems can cause this

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2
Q

What is considered chronic

A

3m

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3
Q

Common ocular findings with SLE

A

Dry eyes

Disc edema

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4
Q

MOA of plaquenil

A

Decrease PAL-2, increase heme

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5
Q

Things that can cause chronic bilateral red eyes

A

Chlamydia
DED
Rosacea

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6
Q

Tests for aqueous deficient dry eye

A

Schirmer

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7
Q

Tests for evaporative DED

A

MG description

Meibomagraphy

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8
Q

What are the main categories of DED

A

Aq deficient

Evaporative

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9
Q

What are the types of aq deficient dry eye

A

Sjogrens

NonSjogrens

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10
Q

Sjogrens aq deficient DED

A

Primary (without AI)

Secondary (with triad, AI)

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11
Q

Primary non Sjogrens AQ def dry eye

A

Age atrophy of ducts

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12
Q

Secondary non Sjogrens dry eye

A 
Attacked ducts (sarcoidosis) 
Blocked ducts (trachoma, pemphigoid)
Cut signal (LASIK)
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13
Q

Intrinsic evaporative dry eye

A

MGD

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14
Q

Extrinsic evaporative dry eye

A

CL (friction)

Vit A deficiency

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15
Q

Nonspecific dry eye tests

A

tear lab and TBUT

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16
Q

Drugs that cause dry eye

A

Cholinergic antagonists

  • STOPACH
  • antidepressants
  • antipsychotics
  • antihistamines (1st gen)
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17
Q

Dry eye definition

A

Multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbances, and tear film instability with potential damage to the ocular surface

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18
Q

Vitamin A and DED

A

Vit A essential for goblet cells and glycocalyx development. Deficiency can cause aq def DED as as result of lacrimal gland acinar damage as well. It is associated with bitots spots on the conjunctiva

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19
Q

Appx ___% of CL wearers have dry eye symptoms

A

50%

20
Q

Tear lab readings indicating dry eye

A

> 308 or >8 differnece

21
Q

What is the height of tear meniscus indicative of DED

A

0.3mm

22
Q

Schirmer 1

A

Without anesthetic
Measures basal and aq
Abnormal is <5mm wetting in 5m

23
Q

Schirmer 2

A

With anesthetic
Basal only
<5mm in 5m

24
Q

PRT findings and DED

A

<10mm in 15s

25
Q

DED Tx

A 
Soft steroids with restasis Q12H (lotEmax)
Fish oil 2000mg/day
Doxy 50/100mg
Azasite BID x 2 days then QD x 12 days 
Filaments-BCL or mucomyst
26
Q

AIC signs

A

Unilateral huge follicles with chronic red eye

27
Q

Treatment fo AIC

A

Doxy100mg BID x 10 days

Azithromycin 1000mg

28
Q

What drugs can you take on an empty stomach

A

PCN
Azithrmycin
Tetras (not doxy though)

29
Q

Premarin

A

Estrogen only HRT that can lead to severe aq def dry eye. Patients may be switched to a combo hormone replacement therapy by their PCP if warranted

30
Q

Rosacea keratitis

A 
Sebaceous gland disease (zeiss, meibomian)
Findings
-hordeolum
-phlyctenules
-blepharitis
-SPK
-staph marginal keratitis
31
Q

Salzmanns nodular degeneration

A

Rare conditio nthat is most often associated with significant corneal inflammtory disease (eg. MGD, trachoma, phlyctenulosis, VKC, keratoconjunctivitis sicca, IK. Usually asymptomatic, hyperemia uncommon.

Bowmans, blue, bad dry eye

32
Q

SLE

A 
Type 2 HS
(+) ANA
DED
Papilledema 
Episcleitis (30% of all cases come from RA, SLEm UCRAP, the rest idiopathic)
33
Q

Systemic symptoms of SLE

A

Butterfly rash, raynauds, discoid lupus, arthritis, renal disorders, neurological disorders, immunological disorders, and hemolytic anemia

34
Q

Ocular findings of SLE

A

DED, photosensitivity, peripheral keratitis, recurrent spiscleritis, photophobia, and neuro-ophthalmic complications (disc edema, papilledema)

35
Q

Treatment for DED

A

Avoidance of contributing environmental factors (ceiling fans, dry and dusty environments, wind, smoke, heat, AC, allergens)
Counsel on activities that reduce blink rate (computers)
AT q1-6h. If more than QID, use PFAT
Thicker ointments at bedtime
Topical restasis 0.05% Q12H
Fish oil 2000mg/day
punctal plugs (start inferior since 60% of drainage occurs here)
Treatment of underlying disease
Eval for underlying systemic disorders
Treatment of corneal filaments Ruth acetylcysteine 10%
Autologous serum QID
Lateral tarsorrhaphy

36
Q

Lacrisert

A

Insert placed in the inferior conjunctival sac to treat DED in conjunction with or as an alternative to artificial tears

37
Q

Restasis

A

Q12H
T cells decrease from being born
Takes 3m to kick in, give steroid (lotemax or FML) with it until then

For Aq def dry eye

38
Q

Treatment of MGD/bleph

A
  • warm compresses with fingertip massage 5-10m QID
  • eyelid scrubs BID or TID until the condition stabilizes, then QD
  • topical ABX/steroid combo (tobradex) for short term care (avoid long term)
  • AzaSite BID x 2 days then QD x 12 days
  • oral doxy 100mf BID for 4 weeks, then 100mg QD for 3-6m, or 40-50mg QD for approximately 6-12m. Oral minocycline 50mgBID x 2m as alternative
39
Q

Oral tetracyclines for DED

A

Convert glandular neutral fats to physiological free FA, allowing for steady improvement of inspissated meibomian glands

40
Q

Treatment of AIC

A

Oral azith 1000mg and oral doxy 100mg BID x 10 days

41
Q

Treatment of salzmanns

A

Depends on severity
Mild observed or AT or steroid

Severe
-SK or PTK

42
Q

Treatment of acne rosacea

A
  • Oral doxy 100mg BID until symptoms are relieved (2-6weeks), followed by a taper of 100mg QD or 50mg QD for several weeks thereafter. Severe cases may rewuire long term treatment with periostat, a low dose (20mg) doxy tablet. Oral erythromycin is an alternative to doxy
  • metronidazole
  • fish oil and omega 3 FA
  • warm compresses, eyelid scrubs and DE therapy
  • topical ophthalmic Abx/steroid combo
  • telangiectasia can be treated with green tinted cosmetics or pulsed dye laser
  • rhinphyma can be treated with carbon dioxide laser, incisional surgery, or electrocautery
43
Q

Treatment of corneal filaments

A

Mucomyst of BCL

  • replace every week for 1-2 months
  • treat with doxy/fish oil/restasis while BCL
44
Q

Order of events when testing causes of papilledema

A 
check BP first, if normal..
Then send for MRI 
Then send for lumbar puncture 
-look at cells for inflammation
-check CSF pressure
45
Q

Papilledema

A

Bialteral disc edmea DUE TO INCREASED INTRACRANIAL PRESSURE. Use term bilateral disc edema until you know for sure it is form increased intracranial pressure

BOARDS2: conjuntiva/cornea (7 decks)

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