Ocular Disease Flashcards
1
Q
In orbital blow-out fracture, what are ALL of the findings associated?
A
trapped IR, damaged infraorbital nerve, periorbital crepitus, (+) forced duction test
2
Q
Why should a pt. who experienced orbital blow-out NOT blow their nose within 48 hours of accident?
A
Decrease risk for orbital infection
3
Q
What is damaged in commotio retinae?
A
causes disruption of RPE and photoreceptor outer segments
4
Q
What are the most common ocular infections associated with pre-septal cellulitis?
A
Hordeolum and dacrocystitis
5
Q
What are all of the signs of pre-septal cellulitis?
A
eyelid edema, erythema, ptosis, NO PAIN to mild tenderness, warmth, hard bump on the eyelid
6
Q
What is one of the leading causes of exophthalmos in children?
A
Orbital cellulitis
7
Q
What are some of the most common causes of Orbital cellulitis?
A
Sinus infection»ethmoid sinus (lamina papricyea), dacroadenitis, dacrocysitits, progression of pre-septal cellulitis, dental infection, or ocular trauma
8
Q
What are all of the signs and symptoms of Orbital cellulitis?
A
APD, pain on EOM’s, diplopia, proptosis, red eye, decreased vision, HEADACHE, FEVER, general malaise, reduced color vision, eyelid edema, redness
9
Q
What can a patient develop if orbital cellulitis is not treated appropriately?
A
Cavernous sinus thrombosis, brain abscess, and/or meningitis
10
Q
What are the epidemiological characteristics of thyroid eye disease?
A
F:M ratio is 8:1, usually in 4th-5th decade, smoking greatest risk factor!
11
Q
Thyroid eye disease occurs in what % of Grave’s disease patients?
A
30-70%
12
Q
What is the most common cause of unilateral or bilateral proptosis in middle-aged patients?
A
Thyroid eye disease
13
Q
What is the sign called for unilateral lid retraction in thyroid eye disease?
A
Dalyrymple’s sign
14
Q
Upper eyelid lag during upgaze is called what sign?
A
Von Graefe’s sign
15
Q
List all the possible ways to diagnose thyroid eye disease…
A
Forced ductions, CT/MRI for EOM swelling, exophthalmometry, visual fields to detect optic nerve compression, and blood work to measure thyroid activity (TSH)
16
Q
What is the clinical triad for Carotid Cavernous Fistula?
A
Pulsatile proptosis, ocular bruit, and chemosis
17
Q
What is the most common etiology of carotid cavernous fistula? other etiologies?
A
TRAUMA, followed by ruptured ICA aneurysm, or from cavernous sinus pathology
18
Q
What is the pathophysiology of carotid cavernous fistula?
A
High-pressure blood from carotid artery builds up in cavernous sinus»impeding the return of venous blood back to cav. sinus
»therefore, build up of pressure behind the globe causing CCF
19
Q
What is the most common benign orbital tumor in adults?
A
Cavernous Hemangioma
20
Q
What is the most common benign orbital tumor in children?
A
Capillary hemangioma
21
Q
What are some of the concern with capillary hemangioma?
A
Can cause proptosis and form deprivation amblyopia»also has spontaneous resolution
22
Q
What is Rhabdomyosarcoma?
A
Rapid bone-destructing tumor that causes progressive unilateral proptosis»average age of onset 7 years old
23
Q
What genetic disorder is optic nerve glioma associated with?
A
Neurofibromatosis type 1 in up to 30-50% of patients
24
Q
What is the most common benign brain tumor?
A
Meningioma»typically occurs in middle aged women
25
What is the epidemiology of Orbital Pseduotumor (Idiopathic Orbital Inflammatory Syndrome)?
young to middle-aged patients (20-50 years old), can present like thyroid eye disease, or orbital cellulitis
26
What are the symptoms of orbital pseudotumor?
acute onset UNILATERAL pain, red eye, diplopia, and/or decreased vision
27
What are the signs of orbital pseudotomor?
Proptosis, EOM restrictions, periobrbital swelling, chemosis, lacrimal gland enlargement, lid ptosis, hyperopic shift, optic nerve swelling, increased IOP on involved side, reduced corneal sensation
>>Remember, Chemosis is typically associated with allergic symptoms, so if it is UNILATERAL AND it is not associated with allergies.... be sure to include orbital pseudotumor in differentials
28
What do patients present with in Tolosa-Hunt syndrome?
Acute and painful exophthalmoplegia and diplopia due to ipsilateral palsies of CN 3, 4, and 6.
>>may lose sensation from V1 and V2 as well since they all pass through the cavernous sinus and superior orbital fissure
29
Bilateral orbital pseudotumor in adults should raise suspicion for systemic ________ or _________.
Vasculitis or Lymphoma
30
What is Evisceration?
Removal of the inner contents of the eye; sclera and other orbital contents remain.
31
What is Exenteration?
Removal of ALL contents of the orbit, including EOMs and orbital fat.
32
Who is most affected by Ocular Rosacea?
middle-aged adults of Northern European ancestry mostly, women affected more than men
>>affects ~ 10% of the population, including an estimated 50% with acne rosacea
33
What is the cause/pathophysiology of Ocular Rosacea?
It affects the sebaceous glands (including meibomian glands), resulting in chronic ocular surface disease
34
What are the symptoms of Ocular rosacea?
Redness, burning, foreign body sensation, and ocular irritation
35
What are the SIGNS of Ocular Rosacea?
Telangiectasia, rhinophyma (sebaceous gland hyperplasia of the nose), Facial flushing (butterfly rash that is usually triggered by alcohol, or spicy foods)
36
What type of reaction is Contact Dermatitis? What are the signs and symptoms?
Type 4 hypersensitivity reaction--delayed T lymphocyte
>>Symptoms include periorbital swelling, redness, itching, tearing
>>Signs include unilateral or bilateral erythema and crusting of the lid and periorbital tissues and significant conjunctival chemosis
37
What type of reaction is Cicatricial Pemphigoid? What is the epidemiology?
Type II reaction involving autoantibodies directed against the conjunctival basement membrane
>>F>M, average age of diagnosis is 65 years old, 10-30 years after bilateral blindness
38
What is this pathophysiology of Cicatricial Pemphigoid?
Chronic, systemic, idiopathic mucous membrane disorder that commonly affects the oral and ocular mucous membranes
>>can also be drug induced from Timolol, Epinephrine, and Pilocarpine
39
What are the signs and symptoms of Cicatricial Pemphigoid?
redness, dryness, foreign body sensation, decreased vision
>>Conjunctival fibrosis and scarring, bilateral SYMBLEPHARON,
>>PROGRESSION: results in destruction of goblet cells, meibomina glands, glands of Krause & Wolfring, and ducts of main lacrimal gland--causing SEVERE ocular surface disease
40
What type of reaction is Stevens-Johnson syndrome? What is the pathophysiology?
Type 3 sensitivity reaction that affects mucous membranes (typically oral and ocular)>>commonly drug induced (sulfonamide) or from an infectious agent
41
What are the ocular signs and symptoms of Stevens-Johnson syndrome?
Prodrome of fever, malaise, headache, nausea, and vomiting
>>skin lesions, severe bilateral diffuse conjunctivitis associated with PSEUDOMEMBRANES, also bacterial conjunctivitis
>>Chronic signs include SYMBLEPHARON, entropion, ectropion, trichiasis, corneal ulcers, neovascularization
42
What are the 2 main types of Blepharitis?
1. Staphylococcal
| 2. Seborrheic
43
How does Seborrheic differ from Staphylococcal blepharitis?
Seborrheic is associated w/ less lid inflammation, more oily, greasy scales with flaking, and more eyelash loss.
44
Chalazion is often associated with which 2 skin conditions?
Acne Rosacea and Seborrheic dermatitis
45
What is the pathophysiology of Chalazion as well as signs and symptoms?
Chronic, sterile inflammation of a Meibomian gland due to retention of normal secretions
>>Hard, painless, immobile nodule without redness, asymptomatic
>>Recurrent chalazia warrant an evaluation for possible malignancies (i.e. sebaceous gland carcinoma)
46
What can be used to treat Demodex infections in the meibomian glands?
Tea tree oil
47
What drug can be used to treat Staph Blepharitis infections?
Maxitrol (tobramycin, neomycin, and dexamethasone)
48
What drug can be used to treat Sebhorric blepharitis?
Dandruff shampoo, Hypochlor, or Havanova
49
Why is Ectropion most commonly caused by old age?
Loss of muscle tone of the orbicularis oculi
| >>other causes are mechanical (tumor), cicatricial (scar tissue), paralytic (facial nerve palsy), and congenital (rare)
50
If a patient had Exposure Keratopathy due to Bell's palsy what would you prescribe them?
Antibiotic ointment
51
What is Trichiasis? Distichiasis? Tristichiasis?
1. Eyelashes grow posteriorly from their site of origin
2. A second row of lashes arise from the meibomian gland openings
3. A third row of lashes growing
52
How most commonly has floppy eyelid syndrome? What are possible reasons that it occurs?
Obese men w/ obstructive sleep apnea
| >>Possible correlation with NAION and LT glaucoma
53
What is Benign Essential Blepharospasm? Who is affected by it?
Women 2X more common than men, ages 50-70, Spasms of orbicularis oculi, procerus, and corrugator musculature
54
What is Meige's syndrome?
characterized by BEB AND lower facial abnormalities (diff. chewing, opening mouth, jaw spasms)
55
What is the most common pre-cancerous skin lesion and is a precursor to squamous cell carcinoma?
Actinic Keratosis
56
Which is more aggressive SCC or BCC?
SCC>>13-24% of SCCs undergo metastasis to nearby lymph nodes
57
What is the most common eyelid cancer?
Basal cell carcinoma
| >>affects males more than females
58
What are the signs of Basal cell carcinoma? Where is it most commonly located?
shiny, firm, pearly nodule with superficial telangiectasia (ocular rosacea)
>>most commonly located on lower eyelid and medial canthus
59
Who is affected by Squamous cell carcinoma? Signs?
more common in males (2:1), variable presentation, often appears similar to BCC but WITHOUT telangiectasia
>>rough, scaly, ulcerated and may be flat or elevated
60
What is Keratoacanthoma? Is it dangerous?
similar to BCC and SCC, often a central plaque or ulcer that grows very quickly to a large size (1-2 cm) before slowly shrinking and often spontaneously resolve.
61
What is the epidemiology of Sebaceous Gland Carcinoma?
Similar incidence to SCC. More common in elderly females>>associated with chronic unilateral blepharitis or recurrent chalazia.
62
What is the prognosis of Sebaceous gland carcinoma?
POOR PROGNOSIS>>If the lid lesion is greater than 2 cm, the mortality rate is 60%
>>the tumor is often hard and yellow as well as patient has lymphadenopathy
63
What are the 2 most important prognostic factors for malignant melanoma?
1. Depth of invasion
| 2. Lesion size
64
What is the most common ACUTE cause of Dacryoadenitis?
What is the most common CHRONIC cause?
1. Bacteria (mostly staph or strep)
| 2. Inflammatory disorders incluidng Sarcoidosis, TB, Graves, and IOI
65
What are some of the signs of Dacryoadenitis?
Swelling of outer 1/3 temporal upper eye lid, presents with S-shaped ptosis, redness, swelling, preauricular lymphadenopathy, (+) elevated WBC count
66
What do you treat Dacryoadenitis with?
First, try Keflex, then Augmentin, Doxycycline, or Bactrim
--These 4 drugs can be used for almost any lid disease!
67
What is the cause of Canaliculitis?
Actinomyces Israeli--characterized by yellow sulfur granules
--look for "pouting puncta" sign
68
How to differentiate between Canaliculitis and Dacryocystitis?
Dacryocystitis typically has more swelling, tenderness and pain than Canaliculitis
--Remember, don't try to irrigate lacrimal system! Always try treating w/ antibiotics first
69
What is the most common cause of nasolacrimal duct obstruction in adults?
What about in newborns?
1. Involutional stenosis
| 2. Membranous blockage at the valve of Hasner
70
If a Jones II test fails to open the nasolacrimal drainage system (from a NLDO), what is the next best treatment option
Dacryocystorhinostomy (DCR)
71
What is another term for Conjunctival concretions?
Ocular Lithiasis
72
If a teenager is found to have a conjunctival nevus, should this raise concern?
BENIGN, unilateral proliferation of melanocytes--during puberty not uncommon for size and darkness to increase
--most common location is Juxtalimbal area
73
What can Primary Acquired Melanosis turn into?
30% cases can progress to Malignant Melanoma!
74
Malignant Melanomas of the conjunctiva most commonly arise from __________.
Primary Acquired Melanosis
75
What is the most common Conjunctival Malignancy? and what is it also known as?
Conjunctival Intraepithelial Neoplasia (CIN)
--Also known as Bowen's disease (conjunctival squamous dysplasia)
76
Conjunctival Intraepithelial Neoplasia can progress to which condition?
Squamous cell carcinoma
77
What are the most common culprits of Bacterial conjunctivitis in children & adults, respectively?
1. H. Influenzae
| 2. S. epidermidis & S. aureus
78
What are the signs and symptoms associated with Bacterial Conjunctivitis?
>>Acute onset of redness begins in 1 eye and becomes bilateral + lids stuck together upon awakening
>>symptoms typically subside in 10-14 days even without treatment
>>Mucopurulent discharge, no preauricular lymphadenopathy, corneal signs RARE
79
What is the most common cause of Bacterial Conjunctivitis worldwide?
Staph aureus
80
Which type of agar is used to culture and detect Neisseria gonorrhea bacteria?
Thayer-Martin agar
81
What are signs and symptoms associated w/ Gonococcal conjunctivitis?
HYPERACUTE onset of severe purulent discharge, redness, FB sensation, begins in 1 eye, becomes bilateral over time
>>conj. chemosis, severe papillary reaction, marked (+) PAN, tender swollen eyelids, pseudomembranes
82
What is the most common co-infection with gonorrhea?
Chlamydial infection
83
How long is Adenoviral Conjunctivitis contagious for?
12-14 days
84
What is the cause of most adenoviral infections?
Result from Upper Respiratory Tract or nasal mucosal infections
85
What are the Symptoms of Acute non-specific follicular conjunctivitis?
Diffuse red eye, FOLLICLES inf. conj, tearing, mild discomfort, rare to have corneal involvement
86
What are the symptoms of swimming pool conjunctivitis? (PCF)
Triad of acute follicular conj, low grade fever, and pharyngitis (sore throat)
87
What are the symptoms of EKC?
Most serious form of adenoviral conjunctivits
>>well known for PAIN and CORNEAL involvement
>>symptoms occur 8 days after exposure, sup. keratitis common during first 1-2 weeks while SEI's occur in the 3rd week
(+) PAN almost always present in EKC pts.
>>pseudomembrane formation also possible
>>Remember, once SEI's are present, pt. is no longer contagious
88
What is the cause of Molluscum Contagiosum?
DNA pox virus
>>multiple nodules may point towards HIV
>>Remember, Herpes simplex can also cause viral conjunctivitis
89
What is Perennial allergic conjunctivitis?
Less common type 1 reaction to household allergens (dust mites, animals etc.)
90
What are all the symptoms of allergic conjunctivitis?
Chemosis, papillae, itching, tearing, and watery discharge
91
What is the epidemiology of Vernal Keratoconjunctivitis?
young males under the age of 10, occurs for 2-10 years before resolving around puberty
92
What is the pathophysiology of VKC?
occurs in patients predisposed to atopic systemic conditions (eg. rhinitis or asthma)
>>look for family history!!!
93
What are the signs and symptoms of VKC?
--INTENSE itching, photophobia, thick mucus discharge, prominent papillae on limbus (Trantas-Dots) or Cobblestone
>>Shield ulcer formed by initial punctate epithelial keratitis, eventually forming large erosions leading to plaque formation
94
Who is affected by AKC and which type of reaction is it?
affects young to middle aged adults w/ history of atopic dermatitis
>>Combination fo Type 1 & 4
95
What are symptoms found in AKC?
Bilateral itching of eyelids (main symptom), watery discharge, redness, photophobia, and pain
96
What SIGNS are associated with AKC?
Dennie's line (extra crease under eyelid), "atophy shiners" (constant rubbing), inf. papillae, corneal neovascularization, cataracts and keratoconus, as well as symblepharon
>>Remember, toxicity to topical meds or CL solutions can result in allergic conjunctivitis, that is characterized by a follicular reaction
>>Also, remember PAPILLAE are NON-SPECIFIC to any condition
97
What is the cause of Superior Limbic Keratoconjunctivitis?
Due to a contact lens hypersensitivity reaction or a poor contact lens fit
98
Deposits on GP lenses will appear as _________, while deposits on soft contact lenses will appear as __________.
Plaques, Jelly bumps
99
What is a common complication of contact lenses that ride too high?
Corneal warpage
100
What is a common complication of contact lenses that ride too low?
3 and 9 o'clock staining
101
Why does SEAL occur? (Superior Epithelial Arcuate Lesion)?
Extended wear hydrogel lenses that are too tight
| >>can also be caused by loose CL that chafe below the upper lid, or poor wettability
102
What is Dimple Veiling?
small bubbles get trapped under a contact lens (usually GP). The contact then pushes the bubbles into the cornea, creating a divot for fluorescein to pool
>>it is NOT staining of the cornea!
103
Adult Inclusion Conjunctivitis is caused by which chlamydia serotypes?
D-K
104
What are the symptoms of Adult Inclusion Conjunctivitis?
Acute follicular conjunctivitis that becomes chronic!--the infection can persist for 3-12 months if not treated
105
What are the signs of Adult Inclusion Conjunctivitis?
Follicles on inf. palp conj, (+) PAN, mucopurulent discharge, matting of the lids, 30-85% corneal involvement including SPK, superior pannus, and SEI's
106
___________ is the leading cause of preventable blindness in the world.
Trachoma
107
Which serotypes cause Trachoma Conjunctivitis?
What are the signs & symptoms?
Serotypes A-C, most prevalent between ages of 1 to 5.
EARLY SIGNS=follicular and papillary conjunctivitis on SUPERIOR conjunctiva, mild sup. pannus, (+) PAN, mucopurulent discharge
LATE SIGNS= Arlt lines (white scarring of sup. tarsal conjunctiva and Herbert's pits (depression on limbal conjunctiva)
108
What are 3 possible causes of Superior Limbic Keratoconjunctivitis?
1. Keratoconjunctivitis Sicca
2. Thyroid Disease
3. Contact lens wearers
109
What type of reaction is Phlyctenular Keratoconjunctivitis and what is the most common cause?
Teenage years, female, Type 4 hypersensitivity reaction commonly caused by blepharitis
>>Patients likely will have history of TB
110
What is Ligneous conjunctivitis and what is it most commonly associated with systemically?
"woody" membranous plaques on the superior tarsal conjunctiva, caused by PLASMINOGEN deficiency!
111
What are the main causes of Parinaud's Oculoglandular Syndrome?
Cat-scratch fever, Tularemia (ticks, rabbits), TB and Syphilis
112
What are the common signs of Parinaud's Oculoglandular Syndrome?
Unilateral, Granulomatous, follicular palp. conjunctivitis, as well as VISIBLY swollen PAN/ submandibular nodes
113
What should be done if a patient has recurring subconjunctival hemorrhages?
Consider ordering CBC, PT/PTT especially in patients w/ African or Mediterranean descent.
114
What is pterygium?
fibrovascular growth of bulbar conjunctiva onto the cornea>>destroys Bowman's membrane
>>causes WTR astigmatism due to flattening of horizontal meridian
>>look for Stocker's line at leading edge of pterygium
115
What is the pathophysiology of a pterygium/pinguecula?
Degeneration of collagen fibrils within the conjunctival stroma
116
What are the characteristics of Episcleritis?
Young adults, frequent recurrences, idiopathic, unilateral, SECTORAL injection, can be nodular or simple>>nodule can be moved slightly unlike Scleritis
117
What does "CASA" stand for in KMK when referring to conditions involving pain?
1. Corneal pathology (abrasions, ulcers, etc.)
2. Angle closure
3. Scleritis
4. Anterior Uveitis
118
How can Scleritis be divided into the different types?
1. Non-necrotizing>>Diffuse (most common) and Nodular
2. Necrotizing>>With inflammation (worst form--33% of pts. may die within 1st year b/c of severe autoimmune disease) and Without inflammation (Scleromalacia Perforans)--chronic rheumatoid arthritis
119
What is the hallmark sign for scleritis?
Severe, boring ocular pain that can radiate to the ipsilateral forehead and jaw and even awaken pts. during the night
120
What are Hyaline plaques?
Benign, oval-shaped areas of scleral thinning and allow underlying visibility of the uvea.
121
How to differentiate between Episcleritis and Scleritis?
Scleritis= Diffuse injection, bilateral, severe pain
Episcleritis= Sectoral injection, unilateral, mild ocular pain (if any)
122
What are the 4 main conditions associated w/ HLA-B27 according to KMK?
Chron's disease, Reactive arthritis, Ankylosing spondylitis, and Psoriatic arthritis
123
What is the most common location of uveitis? least common?
Most common: Anterior
| Least common: Intermediate
124
What are the main threats to vision associated with uveitis?
Posterior synechiae, Peripheral anterior synechiae, CME, and cataract formation (PSC most common)
125
In which conditions are Stellate Keratic Precipitates found?
Fuch's Heterochromic Iritis as well as Herpetic Uveitis
126
List as many conditions you can that are associated with Acute, non-granulomatous, anterior uveitis.
1. Inflammatory bowel disease
2. Reactive arthritis
3 Ankylosing Spondylitis
4. Psoriatic Arthritis
5. Bechet's disease
6. Lyme disease
7. Glaucomatocyclitic Crisis (Posner-Schlossman syndrome)
127
What are some of the signs of Behcet's disease?
Acute, recurrent hypopyon iritis and mouth and genital ulcers
128
In Posner-Schlossman syndrome, why the elevated IOP?
elevated IOP due to trabeculitis
| >>fine KP's and open angle on goniosocopy
129
What are the 3 areas that make up the blood aqueous barrier?
1. Tight Junctions of NPCE
2. Schlemm's canal
3. Iris vessels
130
What is the most common cause of Interstitial Keratitis?
Congenital Syphilis (90%)
131
What is Interstitial Keratitis?
acute stromal inflammatory edema and neovascularizaiton
132
What is the TRIAD for Congenital Syphilis?
1. Interstitial Keratitis
2. Hutchinson's teeth
3. Deafness
133
What are 2 conditions associated with Chronic, Non-Granulomatous Arthritis?
1. Juvenile Idiopathic Arthritis
| 2. Fuch's Heterochromic Iridocyclitis
134
What lab testing results are found in a child with JIA?>>what is the classic presentation?
Bilateral uveitis, young girls, (-) RF, (+) ANA
135
What are the signs of Fuchs' Heterochromic Iridocyclitis?
more common in blue eyes, unilateral, mild uveitis with fina stellate KPs, angle neovascularization, and iris heterochromia
136
Which type of Posterior uveitis will result in a vitritis?
Inflammation of the retina>>will cause breakdown of BRB causing WBCs to enter vitreous
>>This WILL NOT occur with inflammation of the choroid
137
What is the most common form of Toxoplasmosis?
Congenital (90%)
138
How is Toxoplasmosis Acquired, if not congenital?
Results from inhalation of parasite in cat feces and/or through eating undercooked meat.
139
What are the common signs for Toxoplasmosis?
Vitritis "headlights in the fog", unilateral redness, photophobia, floaters, recurrences usually accur around age 25
140
Why do patients with Histoplasmosis NOT lead to a Vitritis?
Histoplasmosis causes choroiditis, which does not cause breakdown of BRB--therefore no inflammation in vitreous
141
What is the clinical triad for Histoplasmosis?
1. Punched out lesions
2. PPA
3. Maculopathy
142
What are some characteristic findings when a patient has uveitis and has Sarcoidosis?
"Cotton ball opacities" from retinal vitritis, as well as "candle-wax droppings" from Retinal vasculitis
143
What is an iris coloboma and where does it typically occur?
Incomplete closure of the embryonic fissure typically located inferior nasal quadrant.
144
What are the characteristics of Thygeson's SPK?
2nd-3rd decade, recurrent episodes, FBS, photophobia, blurred vision, BILATERAL
>>small, multiple gray-white clusters of superficial, intraepithelial raised central corneal lesions
>>recurrent over a period of 10-20 years! Treat w/ steroids--only thing that will help!
>>Important, NO RED EYE
145
What are the symptoms and signs of Thermal/UV Keratopathy?
Ocular pain, photophobia, and blurred vision. Occurs 6-12 hours after incident
Happens because of hyperactivation K+ channels, with resulting loss of intracellular K+ and cell death.
Confluent SPK interpalpebral region of cornea
Treat with HEAVY AT's!
146
What is difference between Schirmer 1 & 2 testing?
Schirmer 1--no anesthetic= measures basal, reflex, and emotional tear secretions
Schirmer 1--WITH anesthetic= measures basal secretion only
147
What are the 2 main mechanisms behind dry eye disease?
1. Tear Hyperosmolarity
| 2. Tear Film Instability
148
What are the 2 main categories of Aqueous Deficient Dry Eye?
1. Sjogren's Syndrome (Primary & Secondary)
| 2. Non-Sjogren's Syndrome (Primary lacrimal gland & Secondary lacrimal gland)
149
What type of dry eye is MGD?
Evaporative dry eye
150
What are Intrinsic causes of Evaporative Dry Eye?
1. MGD
2. Posterior Blepharitis
3. Proptosis, lagophthalmocs
4. Low blink rate
151
What are Extrinsic causes of Evaporative Dry Eye?
1. Ocular surface disease--Vit. A deficiency, topical anesthetics, topical preservatives
2. Contact lens wear
152
What is the most common cause of Primary lacrimal gland deficiency?
Age-related
