Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anterior Seg > Lacrimal Drainage System > Flashcards

Lacrimal Drainage System Flashcards

1
Q

Pt presents to the office with overflow of tears, what is the diagnosis? What could be the cause?

A
  • Epiphora
  • Cause
    • ​Hypersecretion: 2^ ocular surface inflammation/irritation
    • Defective drainage:
      • ​Compromise of drainage system
      • Worse in cold/windy environements
    • Malposition
    • Obstruction
    • Lacrimal pump fail
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What would you evaluate if an overproduction of tears occur?

A
  • SLE
  • Evaluation of the lid or lash abnormalities
  • Cicatrization
  • Proptosis
  • Facial nerve dysfunction
  • Lagophthalmos
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What would you evaluate if there was a decreased outflow?

A
  • Evaluation of lacrimal sac for obstruction
  • Punctal evaluation - patency & position
  • Irrigate nasolacrimal duct
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

A 55 year old female present to the clinic with obstruction of the puncta. You also see that the pt has chronic blepharitis. What is your diagnosis?

A

Punctal Stenosis

  • Anatomical narrowing or obstruction of puncta
  • Congenital occlusion termed punctal agenesis
  • Risk Factor
    • Age
    • Female**
    • Chronic blepharitis
    • Infection
    • Chronic medication use
    • Trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

A 60 yo presents to the clinic with unilateral conjunctival inflammation. The pt reports seeing multiple doctors prior to todays visit and has been put on topical antibiotics. After a SLE you see medial redness on the caruncle with milky yellow dicharge w/ pressure. What is your diagnosis?

  • List the clinical manifestations?
  • Sx?
  • Tx?
A

Canaliculitis

  • Unilateral conjunctival inflammation & discharge refractory to numerous treatments with topical antibiotics
  • Uncommon
  • Elderly
  • Risk:
    • Infection (Bacterial, Viral, Fungal)
    • Dacryolith
    • Punctal plug
  • Clinical Manifestations
    • ​Medial redness or bulbar conjunctiva, caruncle or eyelid
    • Swelling over canaliculus
    • Erythematous & elevated puncta - pouting
    • Milky yellow mucoid discharge with pressure
    • Concretions from puncta
  • Symptoms
    • ​Chronic unilateral red eye
    • Epiphora
    • Discharge
      • Mainly in the nasal part of the ranging from simple watery consistency to full brown mucopurulence
    • Refractory to convential treatment
  • Treatment
    • ​Supportive therapy
      • Warm compresses
      • Digital massage
    • Topical antibiotics
    • Surgical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

40 yo male presents to the clinic w/ a palpable mass in the nasolacrimal sac. The pt also reports pressure sensation in the medial canthal and tearing. What is your diagnosis?

A

Dacryolithiasis

  • Lacrimal stones
  • Concretions formed in lacrimal sac from cellular debris & proteins
  • Symptoms
    • ​Pressure sensation in medial canthal region
    • Tearing
    • Palpable mass in nasolacrimal sac
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A 9 yo female presents to the clinic with inflammation of the nasolacrimal sac w/ infection secondar to obstruction. What is your diagnosis?

  • What are the Risks?
  • What age can this be present in?
  • Acute vs Chronic?
  • Tx?
A

Dacrycystitis

  • Inflammation of nasolacrimal sac
  • Infection secondary to obstruction
    • Mimics normal conjunctival flora
  • Risk
    • ​NLD obstruction
    • Nasal pathologies (deviated septum)
    • Trauma
    • Gradual narrowing with age
    • Dacryolith (lacrimal stones)
    • Female 70-80% – narrow duct diameter
  • Any age possible
    • ​Infants
    • Young adults (mid-30s)
    • Elderly (>65)
  • Congenital vs Acquired
    • ​Congenital
      • Associated with congenital anomalies
      • Significant risk of cellulitis, brain abscess, meningitis, death
      • Blockage of airway possible
    • Acquired
      • May be acute or chronic
  • Acute vs Chronic
    • ​Acute
      • ​Redness
      • Swelling
      • Tenderness of skin overlying sac
      • Associated with abscess or spread of infection
    • Chronic
      • ​Little to no pain
      • Tearing
      • Mild to moderate recurrent unilateral discharge
      • Rarely associated with severe morbidity unless caused by systemic disease
  • Treatment
    • ​Pain relief
    • Warm compresses
    • Antibiotics
      • Topical
      • Oral
    • Surgical
    • Adult = Acute dacryocistitis → Augmentin 875/125 mg Q8hr, oral NSAID for 7-10 days → Monitor for 3 days → Consider dacryocystorhinostomy
    • Pediatric = Acute dacryocystitis in children → Admission to hospital → IV Augmentin 24-48hr, blood culture, CAT scan → Nasolacrimal duct probing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Congenital Nasolacrimal Duct Obstruction

A
  • 5% normal newborns
  • Blockage at valve of Hasner
  • Unilateral or bilateral
  • Spontaneous resolution in 1st year or life - 90%
  • No sex predilection
  • Clinical signs
    • ​Epiphora
    • Increased lacrimal lake
    • Discharge - mucous or mucopurulent
      • Reflux from punctum with pressure
    • Chapping of periocular skin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pt presents to the clinic with diffuse enlargement of lacrimal sac and bluish, cystic, firm mass inferior to medial canthus. What is your diagnosis?

A

Dacryocystocele

  • Variant of NLDO
    • ~1% of all NLDO pts
  • Diffuse enlargement of lacrimal sac due to congenital nasolacrimal duct obstruction
  • Bluish, cystic, firm mass inferior to medial canthus
  • Unilateral or bilateral
  • Blockage
    • Distal = Valve of Hasner
    • Proximal = Valve of Rosenmuller
  • Management
    • Conservative
      • Warm compress
      • Massage
      • Prophylactic antibiotics
    • Surgical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Define dry eye disease (2017 DEW II Report)

A

a multifactoral disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities etiological roles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the characteristics of dry eye disease?

A
  • Inflammation of ocular surface
  • Hyperosmolarity of the tear film
    • Low aqueous flow
    • Excessive tear film evaporation
  • Tear film instability
    • May result from hyperosmolarity or be the inciting factor
    • Leads to increased evaporation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the risk factors for dry eye disease?

A
  • Age
  • W > M (70% increase in W, younger age of diagnosis)
  • MGD
  • CL wear
  • Systemic conditions
    • GVHD
    • Sjogren’s syndrome
    • Diabetes
    • Anxiety/Depression
  • Environmental exposures
  • Malnutrition
    • Vitamin A deficiency
    • Eating disorders
  • Visual display usage
  • Refractive surgery
  • Genetic predisposition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the symptoms of dry eye disease?

A
  • Intermittent burning & tearing
  • Grittiness, FBS
  • Itching
  • Redness
  • Intermittent blurred vision
    • c/o film over eyes/vision
  • Photophobia
    • Mild
  • Mattering of lids & lashes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some aggravating conditions that can cause dry eye?

A
  • Multitude of pt presentations
  • Clinical signs & sx often not correlated
    • Diagnosis/tx oftenlead by pt complaint as opposed to clinical signs
  • Aggravating conditions
    • Low humidity
    • Drafts
    • Wind
    • Smoke
    • AC
    • Atmospheric irritants
    • Meds
    • Decreased tear production at night
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Diagnostic tests: Questionnaires

A
  • Used to assess presence & frequency of sx
    • Sn/sx not linear
    • Sx variable based on disease & individual pt
    • Beneficial for establishing necessity for further dry eye testing
  • Critical for monitoring progression
    • Observe for worsening of disease
    • Monitor response to treatement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is OSDI?

A
  • Ocular Surface Disease Index
  • Measures
    • Frequency of sx
    • Environmental triggers
    • Vision related quality of life
  • Positive result _>_13
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is DEQ-5?

A
  • Short (about eye discomfort)
  • Good discrimination ability
  • Postiive > 6
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the clinical signs of dry eye?

A
  • Decreased lacrimal lake
    • Tear meniscus
  • Debris in tear film
  • Abnormal accumulation of mucus in the inferior cul-de-sac
  • Conjunctival injection
  • Corneal staining
  • Conjunctival staining
  • Dulled appearance of eye
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How would you diagnose dry eye?

A
  • Observation of blink
    • Rate
    • Completeness
  • Biomicroscopy
    • Look for debris
    • Lacrimal lake/tear meniscus
      • Avg heigh of 0.2mm - aqueous deficiency
    • Staining techniques
      • NaFL
      • Rose Bengal
      • Lissamine green
    • TBUT
  • Test of tear film
    • Tear production
    • Schirmer testing
    • Phenol Red testing
    • Tear osmolarity - TearLab
    • Inflammatory markers InflammaDry
  • Lacrimal patency tests
    • Jones I & II
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the homeostasis markers for Diagnositic testing?

A
  • Tear-film integrity
    • NIBUT
    • Positive test results <10 sec
  • Osmolarity
    • Positive result > 308 mOsm/L in either eye OR
    • >8 mOsm/L difference between the eyes
  • Tear film integrity
    • ​TBUT positive results <10 sec
  • Ocular surface staining
    • ​NaFL: Positive result >5 corneal spots
    • Lissamine: Positive result >9 conjunctival spots
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the subtype classifications?

A
  • Tear volume measurement
    • Meniscometry
      • Tear meniscus height (TMH)
      • Schirmer test
        • Used without anesthetic for diagnosis of Sjogren’s syndrome
      • Phenol red thread
        • Variable reliability
        • Arbitrary cut-off point 20mm used for Dx of DED with & without aqueous deficiency
  • Eyelid Aspects
    • Assessment of lid for blepharitis
    • Lid wiper epitheliopathy
    • Interferometry
      • Measurement of lipid layer thickness
      • LipiView
    • Meibography
    • Meibomian gland expressibility/duct assessemnt
    • Blink/lid closure analysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Define Lid Wiper Epitheliopathy

A
  • Staining of the upper & lower lid margin regions that are in contact with the globe/CL
  • Thought to result from an increase in friction throughout blinks
    • Friction between the lid & opposing bulbar conjunctiva, cornea, or CL
  • Procedure
    • Stain with NaFL & Lissamine
    • Use white light & cobalt with wratten filter
    • Look at length, width & pattern of staining
    • Present in 88% of symptomatic DED pt
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe the grade of lid wiper epitheliopathy from 0-3

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the 2 types of causes of dry eye?

A

Aqueous deficient dry eye (ADDE)

  • Sjogren’s syndrome
    • Primary
    • Secondary
  • Non-Sjogren’s syndrome
    • Intrinsic lacrimal gland deficiency
    • Age related dry eye
    • Inflammation or obstruction of lacrimal gland
      • Cicatricial conjunctivitis
      • Systemic diseases or infeciton
    • Hyposecretion
    • Systemic/Ocular meds
    • Refractive/ocular surgeries

Evaporative dry eye (EDE)

  • Meibomian gland dysfunction
    • Primary
    • Secondary
      • Blepharitis
      • CL wear
      • Ocular rosacea
  • Diseases of MGs
    • Agenesis
    • Distichiasis
  • Disorders of lid aperture, congruity, dynamics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What causes obstruction of MGs?

A
  • Decrease lipid on tear surface
  • Decreased stability of the tears
  • Higher rate of evaporation
  • Increased osmolarity
  • Inflammation
26
Q

Disorder of lid aperture & apposition

A
  • Conditions
    • Ectropion
    • Lagophthalmos
    • Proptosis
  • Tears not evenly spread across ocular surface
  • Lid fails to close completely, leavin portions of globe exposed
27
Q

Describe what occurs with low blink rate

A
  • Lengthens time ocular surface is exposed to aqueous loss prior to next blink
  • Feedback loop disrupted
    • Concentrated tasks
      • Reading
      • Computer
      • Driving
      • Watching TV
      • Extrapyramidal disorders
    • Parkinson’s Disease
28
Q

Describe ocular surface disease & causes?

A
  • Exposed corneal surface leading to imperfect wetting, early tear film break up, tear hyperosmolarity, & DES
  • Causes
    • Chronic surface disease
      • Allergic conjunctivitis
      • Blepharitis
    • Nutritional
      • Vitamin A deficiency
    • Medications
      • BAK
29
Q

How does CL wear association with dry eye? What are the 2 types?

A
  • CL Sits in tear film
    • Thinned, patchy lipid layer
    • Decreased TBUT
    • Increased evaporation rate
    • Increased osmolarity
    • Decreased tear meniscus
  • CLIDE (CL induced dry eye)
    • Existence of sn/sx of DED during CL wear
  • CLADE (CL Associated Dry Eye)
    • Existence of sn/sx of DED during CL wear
    • Pts has DED prior to CL wear
    • Worsened with lens wear
30
Q

Sjogren’s Syndrome

A
  • Autoimmune disorder of unknown origin
  • 2nd most common autoimmune rheumatologic disease (1st is RA)
  • Characterized by lymphocytic infilatration & atrophy of the main & accessory lacrimal gland & salivary gland
    • Leads to hyposecretion of tears & saliva
  • Typical patient
    • Predominantly older women
      • >90% of pt female
      • Onset in 4th-5th decade
    • Often with other associated autoimmune disease
  • Triad of findings: KCS, xerostomia, CT disease
    • at least 2 present for diagnosis
  • Forms
    • Primary: develops gradually with salivary & tear gland function progressively decreasing
      • No underlying disorder
    • Secondary
      • ​Pt with autoimmune disorder dvelops KCS & xerostomia
        • RA
        • Sytemic lupus erythematosus
        • Wegner’s granulomatosis
        • Polyarteritis nodosa
        • Primary biliary sclerosis
        • Mixed CT tissue disease
    • Symptoms
      • ​Dry eye
        • Burning, Stinging, FBS, vision fluctuations
      • Dry mouth (xerosomia)
      • Hoarseness
      • Dry skin
      • Pain or weakness in joints
      • Numbness or tingling in extremities
      • Vaginal dryness
      • General fatigue
31
Q

What are the ocular and nonocular signs of sjogrens disease?

A

Non-ocular

  • Erythema, cracking, bleeding of gums, lips or tongue
  • Increased incidence of dental problems
  • Bilateral parotid &/or submandiublar gland enlargement

Ocular

  • Decreased tear meniscus & tear volume
  • PEK
  • Low TBUT
  • Conjunctival staining in interpalpebral zone
  • Mucous strands or filaments
  • Staph blepharitis & or MGD
32
Q

How would you diagnose for Sjogren’s?

A
  • often delayed ~5 years
  • Dry eye WU
    • Including scirmer testing if referred by another provider
  • SJO blood test
    • In-office finger prick test
    • Evaluates 7 biomarkers to aid diagnosis
  • Lip biopsy
    • Gold standard
    • Refer to dentistry or rheumatology
    • Painful
33
Q

What are the 2 types of congenital aqueous deficiency?

A

Riley Day syndrome

  • Rare
  • AR
  • Abnormal parasympathetic innervation of the lacrimal gland
    • Reduced tears while crying
    • Reflex tearing absent (response to irritants - dust, smells, etc)
  • Histologically lacrimal gland is normal

Hypoplasia of lacrimal gland ​

  • AKA congenital alacrima
  • Rare
  • Absence of hypoplasia of lacrimal gland, or anomalies of innervation that normally stimulate lacrimation
34
Q

Describe Age related atrophy

A
  • Gradual deterioration that occurs with aging
    • W>M
  • Lacrimal dysfunction
    • Leads to hyposecretion of tears
    • Up to 33% pts over 40
  • Severity of sx depends on environment
35
Q

Describe inflammatory & neurologic deficits associated with dry eye

A

Inflammatory

  • Secretion decreases because of infiltration of lacrimal gland
  • Collagen vascular disorders, viral dacryoadenitis, TB, sarcoidosis, syphilis, trachoma

Neurological deficits

  • Rate & completeness of blink may decline
  • Lesions of the brainstem, cerebellopontine angle, middle fossa floor, & sphenopalatine ganglion
  • Trauma
  • Tumors
36
Q

Describe Dacryoadenitis

Sx?

Tests?

A
  • Inflammatory enlargement of lacrimal gland
  • Acute/Chronic presentation
    • Etiology different
  • Symptoms
    • Swelling of lateral UL with possible redness & tenderness/pain
    • Excess tearing
    • Preauricular node
  • Tests
    • ​Complete eye exam, including, evaluation of lids
    • Imaging studies - CT
    • Biopys
37
Q

Describe Acute dacryoadenitis

A
  • Generally infectious in nature
  • Rapid onset - hrs to days
  • Plapate lobe of lacrimal gland often prolapsed & enlarged
38
Q

What are the ocular signs of acute dacryoadenitis?

A
  • Unilateral, severe pain
  • Redness
  • Swelling over lateral 1/3UL
    • S-shaped lipd
    • Pressure in supratemporal regions of the orbit
  • Chemosis
  • Conjunctival injection
  • Mucopurulent discharge
  • Erythema of lids
  • Proptosis
  • Lymphadenopathy
  • EOM restriction
  • Globe displacement
    • Inferior & medially
39
Q

What are the systemic signs of dacryoadenitis?

A
  • URI
  • Malaise
  • Feverish
  • Parotid gland enlargement
40
Q

What is chronic dacryoadenitis?

A
  • Less severe presentation
  • Generally pain is absent
  • Enlargement of gland - immobile
  • Minimal ocular signs
  • Mild ptosis 2^ gland enlargement
  • Mild-severe dry eye
  • Usually noninfectious, inflammatory cause
41
Q

What infection causes Dacryoadenitis?

A
  • Viral
    • Most common
    • Mumps
    • Epstein-Barr virus
    • Herpes Zoster
    • Mononucleosis
    • Cytomegalovirus echoviruses
    • Coxsackievirus A
  • Bacterial
    • Staphylococcus aureus
    • Streptococcus
    • Neisseria gonorrhoeae
    • Treponema pallidum
    • Chlamydia trachomatis
    • Mycobacterium leprae
    • Mycobacterium tuberculosis
42
Q

Deacryoadenitis causes

A
  • Fungal
    • Rare
    • Histoplasmosis
    • Blastomycosis
    • Parasite (rare)
    • Schistosoma haematobium
  • Inflammatory
    • ​Sarcoidosis
    • Graves disease
    • Sjogren syndrome
    • Orbital Inflammatory syndrome Benign lymphoepithelial lesion
43
Q

What are some treatements for Dacryoadenitis?

A
  • Depends on etiology
  • Viral:self-limiting
    • Pallative
      • Cool compresses
      • Analgesic prn
    • Antiviral if severe
  • Bacterial: Culture to determine antibiotic (oral)
    • May require hospitalization if severe
  • Inflammatory: Treat according to cause
    • Gland biopsy
    • Steroids
      • Consultations with PCP or internist
44
Q

What is ocular cicatrical pemphigoid?

A
  • Inflammatory disease of an autoimmune process
  • type II hypersensitivity disorder
  • Incidence 1:20,000 to 1:46,000
  • Women 2:1
  • Average age of onset 58 yo
  • Chronic blisteriing disease affecting the eyes, oral mucosa, skin vagina & rectum
    • Bilateral, progressive
    • Classic ocular lesions
      • Conjunctival shrinkage, fornix shortening & symblepharon
    • Other: entropion, trichiasis, xerosis & corneal opacification - leads to vision loss
    • Progression is variable with periods of exacerbation & remission
    • Early disease mimics many ocular surface disorders
    • Mouth ulcers present in 75-100% of pts
    • Blistering skin in 25%
45
Q

What are the stages of ocular cicatricial pemphigoid?

A
46
Q

How would you dx ocular cicatricial pemphigoid & what are some treatements?

A
  • Dx: conjunctival biopsy
  • Treatment
    • Immunomodulators
    • Oral steroids
    • Ocular surface optimization
      • Prevent of scarring
    • Surgical
      • Mucous membrane grafting
      • PKP
      • Boston K-Pro
47
Q

What is Steven’s Johnson Syndrome?

A
  • Severe form of erythema multiforme
  • Immune complex mediated hypersensitivity disorder
  • Affects children & young adults
  • Precipitated by drugs, viral infection, malignancies
    • 50% unknown etiology
  • 3-15% cases fatal
  • Refer to dermatologist or internist
  • Non-specific upper respiratory infection
  • 1-14 day prodrome: fever, sore throat, chills, HA, cough, red eyes, & malaise
    • Vomiting & diarrhea occasionally present
  • Mucocutaneous lesions abruptly develop
    • Cluster of outbreaks lasts 2-4 weeks
      • Skin vesicles, bullae & maculopapular lesions on hands & feet
      • Erythematous patches on hands, arms, face & neck
      • Bulls-eye lesions
      • Hemorrhagic crustion on lips
      • Bilateral conjunctivitis
    • Lesions generally non-pruritic
  • Oral & mucous membrane involvement may be severe enough to prevent pts from eating
  • Pts with genitourinary involvement may complain of dysuria
48
Q

What are the risks & treatments for Steven’s Johnson Syndrome

A
  • Risks
    • Sepsis
    • Damage to internal organs
    • Scarring - may be disfuring
    • Cellulitis
  • Treatment
    • Intensive care burn unit
    • Prone to secondary infections
  • 2-6 week duration
    • Possible to return with repeat exposure or exposure to similar offending agent
49
Q

What are some treatments for dry eye disease?

A
  • Treatment
    • Variable - needs to be tailored to the pt
  • Option
    • Tear substitutes
    • Punctal plugs
    • Anti-inflammatory agents
    • Nutritional supplements
    • CL
    • Sleep aids
    • In-office procedures
    • Surgical options
50
Q

Describe Tear substitutes

A
  • Artificial tears
  • Gels
  • Ointments
  • Sustained release tear inserts
  • Autologous serum
51
Q

Describe Artifical tears & gels

A
  • Temporary increase in tear volume
  • Many different formulations/thickness
52
Q

Describe release tear inserts

A
  • Lacrisert
    • Sterile hydroxypropyl cellulose insert
    • Translucent, rod shape, water-soluble
    • Preservative free
    • Indicate for pts with moderate to severe dry eye
    • Insert into lower culdesac, dissolves throughout the day releasing lubricant
    • Slowly dissolves over 6-12 hours
      • Provides continuous relief while in eye
      • Generally require 1 per day
    • Cause lots of irritation
      • May cause FBS or Corneal abrasion
    • Need less frequently than tears
53
Q

Describe Autologous serum

A
  • Serum extracted from pts blood & formulated into eye drops
    • Anti-inflammatory factors in serum have capability to inhibit inflammation
    • Studies have shown improved ocular irriation sx, decreased corneal & conjunctival staining
  • Dosed TID to Q1hr
  • Pros
    • ​Non-preserved
    • Biocompatible - pts own serum
  • Cons
    • ​Risk of microbial growth in drops
      • High protein content & non-preserved
    • Expensive
      • Poorly covered by insurance
    • Can be difficult to obtain
54
Q

Describe Punctal Plugs

A
  • Blocks/slow drainage of tears throug the puncta
    • Good option for pt that cant or wont put drops in frequently or those that have insufficient response to ATs
  • May block on eor both depending on severity
  • Types
    • Temporary: Collagen plugs
      • Dissolves in 1-2 weeks
      • Helpful in determination of effectiveness of occlusion
    • Reversible silicone plugs
      • Longer duration Can be removed if necessary (epiphora) discomfort
      • May cause granuloma formation, extrusion or distal migration
    • Permanent: cautery
      • ​only in severe cases
55
Q

Describe Anti-inflammatory agents

A
  • Low-dose corticosteroids
  • Topical immunomodulators
    • Topical cyclosporine (restasis)
    • Xiidra
  • Systemic tetracyclines
    • Doxycycline
56
Q

Corticosteroids

A
  • Bind to glucocorticoid receptors & inhibits the expression of proinflammatory molecules, promotes the expression of anti-inflammatory molecules, & stimulate apoptosis of lymphocytes
  • Symptomatic relief almost immediately
  • Caution with long-term tx
    • Increased IOP
    • Cataract development
  • Examples: FML, Loteprednol, Prednisolone
57
Q

Describe Immunomodulators

A
  • Restasis
    • ​How it works: activation & downregulates inflammatory cytokines
    • Increases goblet cell density & decreases epithelial cell apoptosis
    • Symptomatic relief after 3-6 months
      • Lifespan of T cells = 120 days (4 moths)
      • continued sx improvements after 2 years
    • Clinical signs begin improving much sooner
    • Dosage
      • BID - may need to increase frequency in pt with severe disease
    • Complications
      • Burning & stinging on instillation
  • Xiidra
    • ​How it works: Blocks binding of LFA-1 & ICAM-1 to decrease inflammation
    • Symptomatic relief in as fast as 2 weeks
    • Dosage BID
    • complications:
      • Burning & stinging on instillation
      • Dysgeusia
58
Q

Describe Doxycycline

A
  • Inhibits activity of MMPs, primarily MMP-9, promoting ocular surface integrity - anti-inflammatoyr property
  • Used frequently in tx of dry eye caused from blepharitis & ocular rosacea
  • Complications: increase sensitivity to sun, tooth discoloration
  • Avoid in children & pregnancy
59
Q

Describe nutritonal supplements

A
  • Essential fatty acids
    • Omega 3 (a-linolenic acid)
      • Block production of proinflammatory eicosanoids (prostaglandins E2 & leukotriene B4) & Cytokines (IL-1 & TNF)
      • Frequently recommended in tx of sjogren syndrome & other immunomediated disease
60
Q

Descirbe CL

A
  • Reserved fo severe cases
  • Development of surface deposits are common
    • Increase cleaning or lens replacement often necessary
  • Increased risk of infection
  • Specialty CL
    • Types
      • scleral lenses
      • PROSE device - boston foundation for sight
    • Creates tear reservoir provides constant lubrication while lens is on the eye
61
Q

Sleeping aids

A
  • Goggles & shields
    • Tranqileyes
    • Onyix/Quartz
    • NITEYE bubble bandages - single use
    • Lid taping
  • Retard tear evaporation
  • Used in severe cases, nocturnal lagophthalmos, sleep apnea
  • Other considerations: humidifier, avoid fans/heat/AC
62
Q

Other treaments for DED? (in-office produces & surgical options)

A
  • In-office procedures
    • Lipiflow
      • Thermal pulsation system
      • heat used to unblock meibomian glands
      • Very expensive, no insurance coverage at this time
    • Surgical options
      • Nonspecific to dry eye
        • Tarsorrhaphy - partial or complete
        • Entropion/Ectropion repair

Anterior Seg (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions