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II. Ocular Pharmacology > Management of Dry Eye and Ocular Surface Disease (F) > Flashcards

Management of Dry Eye and Ocular Surface Disease (F) Flashcards

1
Q

What are the Omega 3 supplements for dry eye that DO NOT contain EPA and DHA (what is in each)?

A
  1. Tears Again Hydrate (1000mg Flaxseed oil(ALA), 500mg primrose oil (GLA), 40mg bilberry extract)
  2. HydroEye (235mg GLA, 235 ALA, 100mg EPA, 70mg DHA)
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2
Q

What is the treatment steps for aqueous deficient dry eye for a CL wearer?

A

1a. Refresh or Blink Contacts QID
1b. Refresh Liquidgel QHS
2a. Consider refit daily disposable CL’s or change to peroxide disinfection
2b. trial Restasis BID 30-60d
3a. trial punctal plugs
3b. add oral Omega 3 supplements
3c. change Liquidgel to Refresh PM QHS

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3
Q

What is the treatment steps for evaporative dry eye from MGD for a non-CL wearer?

A

1a. Ocusoft Plus wipes or other lid cleaner QHS
1b. Dry eye mask with digital massage QD
1c. systane balance, Soothe XP, etc QID
2a. in office debridement of Line of Marx
2b. add oral doxycycline
3. office therapeutic meibomian gland expression
4. Lipiflow

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4
Q

What are the diseases that can cause dry eye?

A
  1. Sjogrens disease
  2. rheumatoid arthritis
  3. Crohn’s disease
  4. Lupus
  5. Thyroid disease
  6. diabetes
  7. acne rosacea
  8. asthma
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5
Q

What are the medium viscosity ocular lubricants/artificial tears?

A
  1. Bion Tears
  2. Systane Ultra
  3. Refresh Liquidgel
  4. GenTeal Gel/Systane Gel
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6
Q

What is the scoring method to determine the severity of MGD in a patient based on the TFOS MGD Workshop?

A
  1. test 8 glands in middle third of lower lid
  2. 0=clear, 1=cloudy, 2=cloudy with granular debris, 3=thick, like toothpaste
  3. add them up: Grade 1= 4 or less; Grade 2= 5-7; Grade 3= 8-12; 13 or over
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7
Q

What are the global principles of dry eye management?

A
  1. treat when symptoms dictate
  2. maintain health of ocular surface
  3. treat primary cause
  4. level of Tx matches degree of symptoms
  5. document indicators of effectiveness
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8
Q

What are the tests to evaluate the patient symptoms of dry eye (amount of questions)?

A
  1. McMonnies questionnaire (14)
  2. Ocular Surface Disease Index (OSDI) (12)
  3. Dry Eye Questionnaire (DEQ) (23)
  4. DEQ-5 (5)
  5. Dry eye speed test (lipiflow)
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9
Q

What are the low viscosity ocular lubricants/artificial tears that are preserved with BAK?

A
  1. Advanced Eye Relief
  2. Soothe
  3. Hypotears
  4. Tears Again
  5. Murine Tears
  6. Visine Tears
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10
Q

What is the treatment steps for evaporative dry eye from MGD for a CL wearer?

A

1a. Ocusoft Plus wipes or other lid cleaner QHS
1b. Dry eye mask with digital massage QD
1c. systane balance, Soothe XP, etc QID
2a. refit hydrogel daily disposable Cls
2b. in office debridement of Line of Marx
2c. add oral doxycycline
3. office therapeutic meibomian gland expression
4. Lipiflow

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11
Q

What are the tests to evaluate functional tears?

A
  1. NaFl staining

2. Rose Bengal/Lissamine green staining

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12
Q

What is the only Rx tear supplement? 1. What is the mechanism of action? 2

A
  1. FreshKote

2. high oncotic pressure to restore epithelial integrity and diminish microcystic edema

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13
Q

What are the low viscosity ocular lubricants/artificial tears that are NOT preserved with BAK (what are they preserved with)?

A
  1. Tears Naturale II (Polyquad)

2. Systane (Polyquad)

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14
Q

What are the risk factors for dry eye?

A
  1. females
  2. increase with age
  3. CL wear
  4. inflammatory disease
  5. medications
  6. environmental
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15
Q

What is the treatment for advanced inflammatory dry eye that has the noncellular component of the patient’s own blood after clotting? 1. What is the percentage and dosing info? 2

A
  1. autologous serum

2. 20-50% for q2-4hr/day

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16
Q

What are the tests to evaluate tear quantity (and what is abnormal in each)?

A
  1. Schirmer (less than 5mm in 5min)
  2. Phenol red thread (less than 10mm in 15sec)
  3. tear meniscus (less than 0.3mm)
17
Q

What are the testing strategies in dry eye diagnosis?

A
  1. evaluate tear quantity
  2. evaluate tear quality
  3. evaluate tear function/ocular surface integrity
  4. evaluate symptoms
18
Q

When is off-label Azasite for the use in MGD management done?

A

orals contraindicated (Coumadin, females on BC or prone to yeast infection)

19
Q

What fatty acids have anti-inflammatory properties?

A

Omega 3 fatty acids

20
Q

What is the surgical narrowing of the eyelids to narrow the palpebral fissure to limit exposure keratopathy for advanced dry eye treatment?

A

tarsorraphy

21
Q

What are the tests to evaluate tear quality/stability?

A
  1. TBUT (less than 10sec)
  2. assessment of tear quality with observation
  3. tear osmolarity (greater than 308)
  4. InflammaDry (detection of MMP-9)
  5. expression of meibomian glands
  6. meibography
22
Q

What is the treatment steps for aqueous deficient dry eye for a non-CL wearer?

A

1a. Systane Ultra or Bion Tears QID
1b. Refresh Liquidgel QHS
2a. Trial Lotemax QID x7-10d, BID x7-10d and if successful Restasis BID
3a. trial punctal plugs
3b. add oral Omega 3 supplements
3c. change Liquidgel to Refresh PM QHS

23
Q

What is the symptoms if the optical function of the tears is hindered? 1. Mechanical function? 2. Flushing and dilution function? 3. Oxygen reservoir function? 4. Immunological function? 5

A
  1. blurred vision
  2. dry, burning, FB sensation
  3. gritty, sandy, itchy
  4. conjunctival injection
  5. prone to infection and inflammation
24
Q

What are the immunological aspects of tears?

A
  1. antibodies to detect microbial antigens
  2. mast cells to detect allergic antigens
  3. lysozyme to denature proteins
25
Q

What are the preferred dosage amounts of oral Omega 3 supplements for dry eye?

A

at least 1000mg of combined EPA and DHA

26
Q

What are the low viscosity ocular lubricants/artificial tears that are LIPID BASED and NOT preserved with BAK (what are they preserved with)?

A
  1. Systane Balance (Polyquad)
  2. Refresh Optive Advanced (Purite)
  3. Soothe XP (Polyquad)
  4. Retaine MGD (non-preserved)
27
Q

What are the advantages of punctal occlusion in the treatment for dry eye?

A
  1. inc the volume of your own tears with the right pH, lysozyme and antibodies
  2. reduce frequency of AT dosing
28
Q

What are the low viscosity ocular lubricants/artificial tears that are non-preserved?

A
  1. Soothe
  2. Systane Ultra
  3. Tears Natural Free
  4. Refresh Optive
  5. TheraTears
29
Q

What are the disadvantages of punctal occlusion in the treatment for dry eye?

A
  1. only effective for aqueous deficiency
  2. not effective for MGD
  3. Not for inflammatory related dry eye
30
Q

What is the best artificial tear/lubricant for post-LASIK? 1. What is the dosage? 2

A
  1. low viscosity non-preserved

2. 8x per day for 12 wks

31
Q

What are the Omega 3 supplements for dry eye that contain EPA and DHA (how much of each)?

A
  1. PRN, DE (1680mg EPA, 560mg DHA)
  2. Retaine OM3 (800mg EPA, 400mg DHA)
  3. Systane Vitamin (528mg EPA, 278mg DHA)
  4. TheraTears Nutrition (450mg EPA, 300mg DHA, 1000mg Flaxseed oil)
  5. Carlson’sFish Oil (800mg EPA, 500mg DHA)
  6. Nordic Naturals (825mg EPA, 550mg DHA)
32
Q

What are the clinical pearls for dry eye management?

A
  1. humidifiers in the winter
  2. lubrication at bedtime
  3. maximize CL material, modality, and care
  4. CL removal midday for rewetting
  5. Treat dry eye induced allergies to dec inflam
  6. reinforce blinking for computer users
33
Q

What are the high viscosity ocular lubricants/artificial tears?

A

Celluvisc (preservative free)

34
Q

What are the low viscosity ocular lubricants/artificial tears that are contact lens rewetting drops (what are they preserved with)?

A
  1. Refresh Contacts (Purite)
  2. Blink Contacts (OcuPure)
  3. TheraTears Contact Lens Comfort Drops (Sodium Perborate)
  4. Systane Contacts (Polyquad)
35
Q

What are the low viscosity ocular lubricants/artificial tears that have a vanishing preservative (what are they preserved with)?

A
  1. Refresh Tears and Optive (Purite, light)
  2. Blink Tears (OcuPure, light)
  3. TheraTears and GenTeal (Sodium Perborate, enzymes in tears)
36
Q

What is a spray used in the treatment of MGD?

A

Liposome spray

37
Q

What are the ointment ocular lubricants/artificial tears (what are they preserved with)?

A
  1. Refresh PM (all below are preservative-free)
  2. Soothe Night Time
  3. Hypotears
  4. Tears Naturale PM
  5. GenTeal PM
38
Q

What is the most important layer of the tears?

A

aqueous

II. Ocular Pharmacology (18 decks)

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