NON-INFX CORNEAL DZ

Question 1

symptoms of dry eye?

Answer 1

• gritty & FBS sensation
• burning sensation
• stinging
• tearing
• fluctuating vision
• symptoms worse at night / when its windy / or after reading/watching tv

Question 2

signs of dry eye?

Answer 2

• PEE
• reduced TBUT (<10s)
• reduced tear meniscus (0.20mm)
• tear osmolarity >316mOsm/L or difference greater than 8mOsmL between eyes.
• abnormal schirmer’s test: expected findings (>15mm w/o anesthesia) or (>10mm w/ anesthesia).
• abnormal phenyl red

Question 3

Tx for dry eye?

Answer 3

• all types of dry eye benefit from OTC ATs + omega-3 fatty acids.

Aqueous deficient dry eye:
* chronic use of restasis or xiidra / punctual plugs / temporary use of steroids.

Evaporative dry eye:
* intrinsic causes – surgery to correct the eyelid abnormality ot treat the underlying cause of the proptosis / lid hygiene, hot compress, erthromycin, xiidra, restasis for MGD.
* Extrinsic causes – supplement pt’s dieat with vitamin A if deficient / may benefit from punctual plugs.

Question 4

what is exposure keratopathy?

Answer 4

it is when cornea recieves mechanical traction

Question 5

what causes exposure keratopathy?

Answer 5

eyelid abnormailty that prevent proper eyelid closure:
* ectropion /
* entropion /
* thyroid eye dz /
* parinaud’s ocular syndrome /
* HZV /
* globe sybluxation /
* lagopthalmos.

Question 6

symptoms for exposure keratopathy?

Answer 6

• ocular irritation
• FBS
• burning
• tearing

Question 7

signs of exposure keratopathy?

Answer 7

• hyperemia
• PEE of the inferior cornea
• corneal ulcer – in severe case

Question 8

tx for exposure keratopathy?

Answer 8

fix eyelid abnormality:
* tape the lids at night
* partial tarsorrhaphy
* eyelid reconstruction
* gold weight

tx to heal cornea:
* PF ATs up to q1h
* ATs ung qhs
* amniotic membrane graft
* serum tears
* if ulcer - tx abx

Question 9

what is the % of patients that undergo corneal graft rejection/failure within 1 year?

Answer 9

30%

Question 10

symptoms of corneal graft reject?

Answer 10

• blur
• pain
• photophobia

Question 11

signs of corneal graft rejection?

Answer 11

• KPs
• corneal edema
• conjunctival injection
• epithelial & endothelial rejection line
• subepithelial infiltrates (SEIs)
• neovascularization on to the graft

Question 12

tx for corneal graft rejection?

Answer 12

treatment is reducing the immune response:
* steroids – to reduce autoimmune response
* if pt does not respond to steroids – use immunosuppressant (cyclosporine)
* monitor every 3-7 days
* taper steroids slowly upon signs of improvement

Answer 13

PP