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OD2-PPO > Lacrimal disorders and dry eye evaluation > Flashcards

Lacrimal disorders and dry eye evaluation Flashcards

1
Q

what is ephiphora

A

normal amount of tear production w/ impaired tear drainage

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2
Q

what is lacrimation

A

over secretion or production of tears

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3
Q

what does the jones test measure

A

tests patency/blockages btwn the puncta and inf meatus of the nose

  • check puncta all the way to nasolacrimal duct if open, doesnt tell you location but identify presence of blockage
  • fl in eye and have pt blow nose in tissue and look for staining
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4
Q

what does the regurgitation test check

A

patency btwn puncta and lacrimal sac

-fl in eye, pull lower lid, locate puncta and press on nasolacrimal sac

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5
Q

what is dacryocystitis

A

infection of the lacrimal sac and/or obstruction of the naso-lacrimal duct

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6
Q

what can dacryocystitis lead to

A

pre-septal cellulitis

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7
Q

what glands are involvd in the lipid layer

A

meibomian glands

gland of zeiss

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8
Q

what is the purpose of the lipid layer

what is it composed of

A
  • stabilizes tear film
  • reduces evaporation of aqueous component
  • outer layer
  • composisition of cholest, fatty acids, phospholipds
  • lowers surface tension of tear film=> draw water into and thickens aqueous
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9
Q

deficiency of the lipid layer is from

A

lid problems
contact lenses
-bells palsy
-MGD

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10
Q

what is the aqueous layer produced by

A

lacrimal gland and accessory lacrimal gland of kraus and wolfring

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11
Q

what is the thickest layer of tear film

A

aqueous 7-8 microns in thickness

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12
Q

what is the composition of the aqueous layer

A 
salts 
proteins
glucose
lactate
water soluble molec
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13
Q

what is a deficiency of the aqueous layer from

A

decrease in lacrimal gland tear production

trauma

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14
Q

what is the aqueous responsible for

A

basic aqueous secretion, major portion of tear film

  • carrying nutrients and oxygen towards cornea
  • lysozymes prevent infections from reaching cornea
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15
Q

what is the mucin layer produced by

A

goblet cells with crypts of henle, gland of manz

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16
Q

what is a deficiency of the mucin layer caused by

A

vitamin A
trachoma
lasik surgery

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17
Q

what does the mucin layer do

A

converts corneal ep from hydrophobic to hydrophilic

18
Q

what is the contempory model of tear film

A

one continuous layer

varying amounts of mucin throughout tear film w/ higher conc on bottom (mucin layer)

19
Q

why is elevated tear osmolarity a characteristic of dry eye

A

goblet cell number is decreased, which decresaes mucin, which decreases aqueous, lipid, lysozymes which all affect osmolarity

20
Q

what is the role of gycocalyx

A

helps bring mucin to the corneal surface

21
Q

what mucin help to create gycocalyx

A

mucin 1, 4, 16

22
Q

what are the risk factors to dry eye

A
  1. age: atrophy of meidb glands, decrease in hormone production: androgens
  2. hormonal regulatios: adrogens in lacrimal gland/meib glands and an immuno-suppreive effect (women)
  3. environmental factors: air dryness, near task, altitude, smoking
  4. systemic disease: sjogren’s syndrome (triad symptoms, severe dry eye, mouth, rheumatoid arthritis)
23
Q

what is the neurotrophic theory

A

severing of nerves in corneal stroma, takes 3 months to regnerate and may contribute to lack of sensory input back to lacimal and accessory lacrimal glands

24
Q

what are the theories of lasik contributing to dry eye

A
  1. neurotrophic theory: severing nerves in corneal stroma lacrimal and accessory lacrimal glands affected
  2. suction ring during lasik: disrupts goblet cells at limbus, decrease mucin production
25
Q

what are the underlying causes of dry eye

A

evaporative: alters ocular surface=> low grade infl
inflammatory: low grade infl in tears and ocular surface, infl cytokines and T cells in lac glands and conj

26
Q

patients with what diseases are twice as likely to have dry eye

A

blepharitis

meibomianitis

27
Q

classfying bleph as ant are what diseases? post?

A

ant: staph bleph
seborrheic blph

post: meibomian dys

28
Q

what is the relationship btwn dry eyes and: allergies, bleph, eye drops/dry eye disease, conjunctivitis

A
  1. allergies: loss of goblet cells
  2. bleph: impairment of lipid laer=> inc rate of tear evap
  3. eye drops and eye dieases: preservatives are cytotoxic
  4. viral conjunctivitis: loss of goblet cells, release of cytokines
29
Q

what are the inflammatory mediators in dry eye

A

cytokines and leukotrines

30
Q

in lid evaluation for dry eye, what are you looking for

A
  1. examin lid margin (bleph, mgd_
  2. inf corneal staining, blinking patterns
  3. evaluate blink rate and tear flow (dec w/ prolonged near work, incomplete blinking)
  4. examine lacrimal drainage (steonsis of puncta, blockage of nasolacrimal duct)
  5. lid apposition abnormalities (ectropian)
31
Q

what is lagophthalmos

A

inability of lid closure

32
Q

what is the normal tear meniscus height

A

0.2-0.5mm in height and smooth

33
Q

what does schirmer’s test test for

A

tear volume of reflex and baseline tears

>10mm in 5 min is normal

34
Q

what does schirmer’s 2 test test for

A

use anesthetic so only test baseline tears

5mm in 5 min

35
Q

what is the norm for phenol red test

A

> 13mm + or - 4mm 15 sec
OR
10mm in 15 sec

36
Q

what is the norm for TBUT

A

20-30 sec
15-20 young
10 in aging
cl wearers less TBUT, keep environment in mind

37
Q

what kind of staining will a superficial punctate keratitis give

A

isolated loss of ep cells, small diffuse

38
Q

what kind of staining will a moderate to severe dry eye give

A

coalesced areas of ep cell loss, punctate erosions when lose large areas of ep cells

39
Q

what will give a geographic area of fl staining

A

large area of cell loss, very severe dry eye

40
Q

what does rose bengal and lissamine green stain?

which works better

A

stains dead ep cells and mucin

rose bengal picks up on dead cells on cornea better
-lissamine green is less toxic to cells , less cytotoxic

41
Q

how does filamentary keratitis show up

A

“filaments”

dead cells wrapped w/ mucin, on advanced dry eye

OD2-PPO (8 decks)

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