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Ocular Health Assessment 2 > Dry Eyes > Flashcards

Dry Eyes Flashcards

1
Q

List the causes of Dry Eye

A

Increased evaporation
Hyposecretion
Ocular surface disorder

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2
Q

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

A

Lipid Layer deficieny

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3
Q

What causes the lipid layer to be deficient ?

A

MGD - Meibomian Gland Dysfunction

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4
Q

What is the function of the Meibomian Gland ?

A

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

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5
Q

What can cause MGD?

A

Swollen or blocked MG

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6
Q

How can the MG become blocked?

A

Overtime from debris caught in eyelid for example from makeup

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7
Q

What can occur after a prolonged Gland blockage ?

A

Notching

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8
Q

Hyposecretion is linked to which layer ?

A

Aqueous layer - middle

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9
Q

List the causes of hyposecretion

A 
Age
Sjögren’s syndrome 
Lacrimal gland destruction 
Scarring 
Neurological
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10
Q

Explain how age impacts the aqueous layer of the tear film

A

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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11
Q

Define Sjögren’s syndrome (showgrins)

A

Autoimmune disease

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

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12
Q

Name some symptoms of Sjögren’s syndrome

A

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

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13
Q

What can cause lacrimal gland destruction ?

A

Thyroid disease
Inflammation
Radiation - leading to cell degeneration

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14
Q

How can scarring affect the lacrimal gland ?

A

Eg. Surgery may cause obstruction of flow from the gland

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15
Q

What could cause a deficient mucin layer ?

A

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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16
Q

Define EMBD

A

Epithelium membrane basement disorder

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

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17
Q

Define Xerophthalmia

A

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

18
Q

List clinical procedures you could do to test for dry eyes

A

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

19
Q

Name three dyes you could use on the eye

A

Flourescein
Lisamine green
Rose Bengal

20
Q

What can the flourescein dye be for?

And How ?

A 
Identify damages tissues 
Instill equal amount in both eyes 
cobalt blue 
high mag and illumination 
Wratten 12
21
Q

What could you use Lissamine Green for ? And How ?

A

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

22
Q

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

A 
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
23
Q

List other investigations for Dry Eyes

A

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

24
Q

Explain what the NIBUT is.

A

Grid pattern projected onto cornea

Look for time elapsed for distruption of pattern

25
Q

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

A

Keratometer

Tearscope

26
Q

What is the tear thinning time.

A

Time from blink to first distort the keratometer mires.

27
Q

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

A 
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
28
Q

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

A

Hz of tears on meniscus on lower lid

Use slit lamp to look at regularity

29
Q

State the values in relation to the tear meniscus height

A
  1. 2mm irregular and deficient

0. 3mm regular and normal

30
Q

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

A

Phenol red thread

Schirmer test

31
Q

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

A

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

32
Q

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

A

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

33
Q

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

A

10-15 mm NORMAL
< 5 mm DRY EYE

Repeated measures need to confirm

34
Q

State the treatment options for a Dry Eye

A

Lid hygiene
Punctal plugs
Ocular lubricants

35
Q

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

A

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

36
Q

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

A

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

37
Q

Name some examples of medications associated with dry eyes.

A 
Propranolol - B blocker 
Antihistamines - clarityn 
Setraline - SSRI antidepressant 
Premarin - oestrogen replacement 
Enalapril - ACE inhibitor 
Amitriptyline - trycyclic antidepressant 
Chlorpromazine - antipsychotic
38
Q

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

A 
Orphenadrine - for Parkinsonism 
Amiodorone - anti arrhythmic 
Bendroflumethazide - diuretic 
Retinapol- tx for psoriasis 
Isoretinoin- acne tx
39
Q

Name systemic conditions associated with dry eyes

A 
Affect Aqueous layer 
Rheumatoid arthritis 
Systemic lupus erythematosus 
Sarcoidosis 
Sjögren’s syndrome 
Radiotherapy
40
Q

Name some systemic conditions associated with dry eyes

A

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

41
Q

Define ‘ autoimmune disease’

A

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

42
Q

What is ‘ systemic lupus evythmatosus’

A

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

Ocular Health Assessment 2 (4 decks)

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