Dry Eyes Flashcards by Falak Jabeen

List the causes of Dry Eye

Increased evaporation
Hyposecretion
Ocular surface disorder

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What does the ‘ increased evaporation ‘ in the eye indicate ?

Lipid Layer deficieny

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What causes the lipid layer to be deficient ?

MGD - Meibomian Gland Dysfunction

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What is the function of the Meibomian Gland ?

Secretes meibum responsible for the formation of the tear film outer layer .
Meibum aids in reducing evaporation of tears

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What can cause MGD?

Swollen or blocked MG

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How can the MG become blocked?

Overtime from debris caught in eyelid for example from makeup

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What can occur after a prolonged Gland blockage ?

Notching

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Hyposecretion is linked to which layer ?

Aqueous layer - middle

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List the causes of hyposecretion

Age
Sjögren’s syndrome 
Lacrimal gland destruction 
Scarring 
Neurological

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Explain how age impacts the aqueous layer of the tear film

With age the aqueous layer deteriorates
The aqueous layer is secreted by the lacrimal glands which with increasing age undergo structural and functional alterations

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Define Sjögren’s syndrome (showgrins)

Autoimmune disease

A condition that affects part of the body that produce fluids like tears and saliva

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Name some symptoms of Sjögren’s syndrome

Dry mouth , eyes , skin
Affects 1-3% of population
Also affect kidney , lungs and blood vessels

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What can cause lacrimal gland destruction ?

Thyroid disease
Inflammation
Radiation - leading to cell degeneration

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How can scarring affect the lacrimal gland ?

Eg. Surgery may cause obstruction of flow from the gland

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What could cause a deficient mucin layer ?

LASIK surgery
Shaves anterior layer of cornea , slices through some corneal nerves causing goblet cells to die away ( atrophy )
Reduces number of functioning goblet cells = reduced mucin layer

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Define EMBD

Epithelium membrane basement disorder

EMBD occurs when EBM develops abnormally resulting in folds in the tissue

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Define Xerophthalmia

Eye fails to produce tears - could be due to vitamin A deficiency

List clinical procedures you could do to test for dry eyes

Sx Evaluation LOFTSEA
Slit lamp routine - normal anatomy ?
Any ocular surface damage - dyes x3

Name three dyes you could use on the eye

Flourescein
Lisamine green
Rose Bengal

What can the flourescein dye be for?

And How ?

Identify damages tissues 
Instill equal amount in both eyes 
cobalt blue 
high mag and illumination 
Wratten 12

What could you use Lissamine Green for ? And How ?

Stain devitalised cells
Instill 10-20ml into lower fornix
View after 1min no later than 4mins
Enhance view using wratten 25 (RED) - shows black

What could Rose Bengal dye be used for ? And How?

Stain devitalised cells
Less popular as it stings 
Instill 10-20ml into lower fornix 
View after 1min no later than 4mins
Shows red on slit lamp

List other investigations for Dry Eyes

NIBUT- non invasive tear breakup time
Tear thinning time
TBUT - tear breakup time
Tear meniscus height

Explain what the NIBUT is.

Grid pattern projected onto cornea

Look for time elapsed for distruption of pattern

What could you use to carry out NIBUT on a patient ?

Keratometer | Tearscope

What is the tear thinning time.

Time from blink to first distort the keratometer mires.

How would you asses the tear break up time of a patient ?

``` Instill flourescein into BE Pt to blink then stop and stare Use parallelepiped (2-4) Cobalt blue Low mag Time disappearance of dark spots or streaks to appear in tear film ```

What and how would you look at the tear meniscus height ?

Hz of tears on meniscus on lower lid | Use slit lamp to look at regularity

State the values in relation to the tear meniscus height

0. 2mm irregular and deficient | 0. 3mm regular and normal

State the two tests you would do to asses the tear volume in a patient

Phenol red thread | Schirmer test

How would you carry out the phenol red test on a patient ?

3mm thread section bent over Thread is placed on lower conj sac for x15 seconds Red portion measured in mm

Explain how would you carry out a schirmer test on a patient ?

Bend strip at notch Place in lower conj sac Remove after five mins Measure the wet portion in mm

In relation to the the schirmer test state the value ranges .

10-15 mm NORMAL < 5 mm DRY EYE Repeated measures need to confirm

State the treatment options for a Dry Eye

Lid hygiene Punctal plugs Ocular lubricants

Explain the ‘ lid hygiene ‘ treatment option often given to patients who suffer from Dry eye .

Obstruction of MG + inflammation of lid margins TX: Apply warm compress - removes collaretes and softens meibomian secretion Apply lid scrubs gently - clean lids , use buds + warm water and Massage lids Continue with regular lid scrubs

Explain the ‘ punctal plugs ‘ treatment option often given to patients who suffer from Dry eye .

Place plug in to punctum to stop drainage STT: Collagen plugs LT: copolymer or silicone Perforated : allow drainage for wet eyes

Name some examples of medications associated with dry eyes.

``` Propranolol - B blocker Antihistamines - clarityn Setraline - SSRI antidepressant Premarin - oestrogen replacement Enalapril - ACE inhibitor Amitriptyline - trycyclic antidepressant Chlorpromazine - antipsychotic ```

Name some examples of medication associated with dry eyes (2)

``` Orphenadrine - for Parkinsonism Amiodorone - anti arrhythmic Bendroflumethazide - diuretic Retinapol- tx for psoriasis Isoretinoin- acne tx ```

Name systemic conditions associated with dry eyes

``` Affect Aqueous layer Rheumatoid arthritis Systemic lupus erythematosus Sarcoidosis Sjögren’s syndrome Radiotherapy ```

Name some systemic conditions associated with dry eyes

Reduced hormone levels Rosacea Steven Johnson syndrome Sjögren’s - due to secondary MGD

Define ‘ autoimmune disease’

A disease in which the immune system fails to recognise parts of the body as belonging to that individual Antibodies are produced to fight the ‘ foreign ‘ tissue leading to inflammation and destruction of tissue An example - rheumatoid arthritis

What is ‘ systemic lupus evythmatosus’

Autoimmune disease Chronic inflammation of the skin and joints May be mild - severe Increased incidence in black and Asian populations