Lec 10

Question 1

What gland(s) produce the lipid layer?

Answer 1

Meibomian glands

Question 2

What gland(s) produce the aq layer?

Answer 2

Accessory and main lac lacrimal gland

Question 3

What gland(s) produce mucous layer?

Answer 3

conj goblet cells

Question 4

What are the 3 components of the tear system

Answer 4

Production, Distribution, Drainage

Question 5

How much of our tears are passed via the nasolacrimal drainage system?

Answer 5

75%

Question 6

__ gland = basic secretion

___ gland = reflex and psychogenic stimulation

Answer 6

accessory gland = basic, main lacrimal gland = reflex/psychogenic

Question 7

Basic secretion ___ the normal volume of aq layer and ____ with age

Answer 7

maintains, declines

Question 8

What is the efferent pathway?

Answer 8

General Visc Efferent fibers from CN 7 –> pterygopalatine ganglion –> hitchhike with V2 (zygomatic)—> infaorbital fissure –> lacrimal N (v1)

Question 9

What cranial nerve predominantly carries the efferent pathway for lacrimation?

Answer 9

CN 7

Question 10

What cranial nerve predominantly carries the afferent pathway for lacrimation?

Answer 10

CN 5

Question 11

What is the afferent pathway for reflex tears?

Answer 11

Cornea/nasal mucous –> long/short ciliary n –> nasociliary n –> V1 –> pain signal to Trigeminal Ganglion –> lacrimal nucleus –> facial n

(then Efferent pathway)

Question 12

What is the corneal reflex triad

Answer 12

Lacrimation, blinking (due to facial n. nucleus stimulation), Miosis (stimulation of EW nucleus)

Question 13

What are the possible causes of epiphora?

Answer 13

Hypersecretion of tears (2ndary to irritation of ocular surface), outflow obstruction at level of puctum or nasolac duct or sac
Overall = imbalance between production, distribution, drainage

Question 14

What is another word for tear meniscus

Answer 14

tear prism

Question 15

What is the set up to examine tear prism?

Answer 15

thin parallelpiped, med illum, tall beam, 10-1x, white (though enhanced with fluorescein and cobalt blue)

Question 16

What is a normal tear meniscus height?

Answer 16

~0.2 mm

Question 17

High viscosity is more like water or peanut butter?

Answer 17

peanut butter

Question 18

Soapy tears is indicative of what?

Answer 18

increased fatty acids in tears, MGD

Question 19

Describe: Schirmer Tear Tests

Answer 19

gross estimate of aq volume of tears, indicator of tear production (typically to confirm lack of tear production)

Question 20

What does Schirmer I test for?

Answer 20

tear production of basic + reflex?

Question 21

What would a Schirmer I value of 4 mm indicate? Would you hve to do a Basic secretion test too?

Answer 21

severely abnormal. Nope

Question 22

What tools do you need to perform Schimer II compared to I

Answer 22

II also requires topical anesthetic, cotton tipped applicator

Question 23

What are normal/mild/mod/severe for Schirmer I?

Answer 23

Normal >15, Mild reduction 10-15, Moderate 5-10, Severe <5mm

Question 24

What is a normal value for basic secretion?

Answer 24

> 10 mm

Question 25

What is a normal value for SchirmerII

Answer 25

Normal > 15 mm

Question 26

What does Schirmer II test for?

Answer 26

basic

Question 27

What does TBUT identify areas of?

Answer 27

evap’d tears

Question 28

T/F: TBUT of > 10 is normal

Answer 28

T

Question 29

T/F: It’s better to use Fluress than a fluorescein strip for TBUT

Answer 29

False