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Anterior Segment 2 > Higa: Dry Eye 2 > Flashcards

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
Q

What are the goals of tx dry eye?

A
  1. Restore homeostasis

2. Break cycle of disease

26
Q

What issues should be addressed first when treating DED?

A

Lid issues

unless risk for corneal perforation

27
Q

When treating for poor lid-globe congruity, what 2 things could you do?

A
  1. Refer to oculoplastics

2. Aggressive lubrication w/ lid taping

28
Q

What disorders would cause you to refer to oculoplastics?

A
  1. Entropion
  2. Ectropion
  3. Floppy eyelid synd.
29
Q

Artificial tears supplement what layer of the tear film?

A

Lipid layer

30
Q

What are the types of topical treatment for MGD?

A
  1. Artificial Tears

2. Antibiotics

31
Q

This treatment aims at decreasing production of toxic bacterial productis (i.e. lipases)

A

Antibiotics

32
Q

What are the external txs for MGD?

A
  1. Lid Hygiene
  2. Heat therapy
  3. Intense Pulse Light
33
Q

The inner eyelid must be heated to ___ degrees Celcius to melt meibum

A

32-40 degrees celcius

34
Q

What are the internal treatments for MGD?

A
  1. Oral Antibiotics

2. Omega-3 fatty acids

35
Q

Which oral antibiotics are better for use of MGD due to better lipophilic properties?

A

Doxycycline and Minocycline

36
Q

What is the dose or tetracycline, doxycycline and minocycline for MGD?

A

Tetra: 250mg QD to QID

Doxy + Mino: 50-100mg QD to BID

37
Q

What is the daily therapeutic level of DED for Omega 3’s?

A

2000mg/day

over 4000 a day increases bleeding risk

38
Q

What are the 2 treatments for demodex?

A
  1. Cliradex lid scrubs (QD x 6-8 wks)

2. Tea tree shampoo, lid scrubs daily with tea tree oil x 4 weeks

39
Q

What are the treatments for scurf/matting lashes?

A
  1. Lid Hygiene

2. Antibiotic/Steroid Ointment

40
Q

Lid margin biofilm is created by what bacteria?

A
  1. S. aureus

2. S. epidermidis

41
Q

What are some examples of medication tx for scurf/matting of lashes?

A
  1. Maxitrol
  2. Tobradex
  3. Blephamide
42
Q

How do you treat lid wiper epitheliopathy?

A

Debridement of lid margin

43
Q

How do you treat eyelid telangiectasia?

A

Oral Doxycyline 100mg, BID x 6 wks then taper

44
Q

How do you treat a sjogren’s patient?

A

Refer to rhematology for co-management or Sjo Testing

45
Q

What are the tx in modified step 1 of DED?

A
  1. Educate patient
  2. Look at current meds
  3. Modify environment
  4. Artificial tears
46
Q

What are the txs in modified step 2 of DED?

A
  1. PF ATs
  2. Punctal Plugs
  3. Overnight gel/ung
  4. Topical Steroids
47
Q

Restasis is what type of inhibitor?

A

Calcineurin inhibitor

- inhibits T-cell activation by decreasing IL-2 production

48
Q

What medication should we consider using in conjunction w/ restasis?

A

a soft steroid

49
Q

Xiidra is an LFA-1 antagonist that inhibits t-cell binding to what?

A

ICAM-1 (this decreases the release of inflammatory cytokines)

50
Q

What is the main side effect of xiidra?

A

bad taste

51
Q

What is the main side effect of restasis?

A

burning sensation

52
Q

What are the tx in the modified step 3 for DED?

A
  1. Autologous Serum

2. Scleral Lenses

53
Q

What are the tx for modified step 4 of DED?

A
  1. Amniotic Membranes
  2. Systemic Steroids
  3. Surgery

Anterior Segment 2 (14 decks)

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