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Higa: Dry Eye 2 Flashcards

1
Q

Grade 1 of MG expression?

A

Clear expression

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2
Q

Grade 2 of MG expression?

A

Gloudy, turbid expression

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3
Q

Grade 3 of MG expression?

A

Granular, fluid and turbid w/ particulate matter

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4
Q

Grade 4 of MG expression?

A

Inspissated, semi solid plug or curled thread

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5
Q

What determines the aggressiveness of the treatment?

A

Symptoms and severity

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6
Q

What is the main test used to determine a patient’s symptoms/severity of DED?

A

Ocular surface disease Index

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7
Q

What is the cutoff number for OSDI ?

A

13

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8
Q

When performing the tear lab, anything over ___ mOsm or a difference of ___mOsm in both eyes is abnormal

A

> 308mOsm

8mOsm

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9
Q

Inflammadry determins the presence of?

A

MMP-9 concentration on ocular surface

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10
Q

A “yes” after inflammadry testing means what?

A

> 40 ng/mL of MMP-9 (inflammation is present)

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11
Q

If someone has an inadequate tear prism, what disease may they have?

A

ADDE or Sjrogrens

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12
Q

This dye stains where there has been epithelial compromise

A

Fluorescein

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13
Q

This dye stains dead and devitalized celsl

A

Rose Bengal/Lissamine green

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14
Q

If patient has interpalpebral/inferior staining, what 2 diseases do you want to check for?

A

Lagophthalmos or MGD

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15
Q

Lid wiper epithelialopathy is found in what disorder?

A

Incomplete blinkers

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16
Q

What machine measures bulbar redness

A

Oculus Keratograph

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17
Q

Shirmer one test ___ tearing while Shirmer 2 test ___ tearing.

A 
Reflex tearing
Basal Tearing (use of anesthetic)
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18
Q

Which shirmer test is indicated since a low value under irritating conditions is indicative of sub-normal aqueous production?

A

Schirmer I

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19
Q

What are the abnormal measurements for schirmer I and II?

A 
I = < 10mm in 5 mins
II = < 5mm in 5 mins
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20
Q

What is the normal test result of phenol red thread test?

A

10mm or greater of thread wetting

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21
Q

The overstimulation of the trigeminal ganglion can present as DED in these 3 disorders?

A
  1. Convergence insufficiency
  2. Vertical Disparity
  3. Fixation Disparity
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22
Q

The overproduction of mucin an present as DED in these 2 disorders?

A
  1. Allergic Conjunctivitis

2. GPC

23
Q

The difference in level of the ocular surface an present as DED in these 2 disorders?

A
  1. EBMD

2. Pingueculitis

24
Q

The degeneration of the cornea an present as DED in this disorder

A

Salzmann’s Nodular Degeneration

25
What are the goals of tx dry eye?
1. Restore homeostasis | 2. Break cycle of disease
26
What issues should be addressed first when treating DED?
Lid issues | unless risk for corneal perforation
27
When treating for poor lid-globe congruity, what 2 things could you do?
1. Refer to oculoplastics | 2. Aggressive lubrication w/ lid taping
28
What disorders would cause you to refer to oculoplastics?
1. Entropion 2. Ectropion 3. Floppy eyelid synd.
29
Artificial tears supplement what layer of the tear film?
Lipid layer
30
What are the types of topical treatment for MGD?
1. Artificial Tears | 2. Antibiotics
31
This treatment aims at decreasing production of toxic bacterial productis (i.e. lipases)
Antibiotics
32
What are the external txs for MGD?
1. Lid Hygiene 2. Heat therapy 3. Intense Pulse Light
33
The inner eyelid must be heated to ___ degrees Celcius to melt meibum
32-40 degrees celcius
34
What are the internal treatments for MGD?
1. Oral Antibiotics | 2. Omega-3 fatty acids
35
Which oral antibiotics are better for use of MGD due to better lipophilic properties?
Doxycycline and Minocycline
36
What is the dose or tetracycline, doxycycline and minocycline for MGD?
Tetra: 250mg QD to QID | Doxy + Mino: 50-100mg QD to BID
37
What is the daily therapeutic level of DED for Omega 3's?
2000mg/day | over 4000 a day increases bleeding risk
38
What are the 2 treatments for demodex?
1. Cliradex lid scrubs (QD x 6-8 wks) | 2. Tea tree shampoo, lid scrubs daily with tea tree oil x 4 weeks
39
What are the treatments for scurf/matting lashes?
1. Lid Hygiene | 2. Antibiotic/Steroid Ointment
40
Lid margin biofilm is created by what bacteria?
1. S. aureus | 2. S. epidermidis
41
What are some examples of medication tx for scurf/matting of lashes?
1. Maxitrol 2. Tobradex 3. Blephamide
42
How do you treat lid wiper epitheliopathy?
Debridement of lid margin
43
How do you treat eyelid telangiectasia?
Oral Doxycyline 100mg, BID x 6 wks then taper
44
How do you treat a sjogren's patient?
Refer to rhematology for co-management or Sjo Testing
45
What are the tx in modified step 1 of DED?
1. Educate patient 2. Look at current meds 3. Modify environment 4. Artificial tears
46
What are the txs in modified step 2 of DED?
1. PF ATs 2. Punctal Plugs 3. Overnight gel/ung 4. Topical Steroids
47
Restasis is what type of inhibitor?
Calcineurin inhibitor | - inhibits T-cell activation by decreasing IL-2 production
48
What medication should we consider using in conjunction w/ restasis?
a soft steroid
49
Xiidra is an LFA-1 antagonist that inhibits t-cell binding to what?
ICAM-1 (this decreases the release of inflammatory cytokines)
50
What is the main side effect of xiidra?
bad taste
51
What is the main side effect of restasis?
burning sensation
52
What are the tx in the modified step 3 for DED?
1. Autologous Serum | 2. Scleral Lenses
53
What are the tx for modified step 4 of DED?
1. Amniotic Membranes 2. Systemic Steroids 3. Surgery

Anterior Segment 2 (14 decks)

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