Tear Film Assessment

Question 1

Dry eye is a sign of

Answer 1

Inflammation

Question 2

Gold standard in dry eye diagnosis

Answer 2

None , but testing options have recently grown

Question 3

A high proportion of patients who present with complaints of ocular irritation

Answer 3

Have dry eye

Question 4

Dry eye can be triggered by

Answer 4

Patient taking Antihistamines because cholinergic said dry everything up

Question 5

Many doctors perform one or two test to try to establish a probable dry eye diagnosis

Answer 5

Since there is no single, simple, reproducible diagnostic test for dry rye

Question 6

Most patients with mild to moderate dry eye do not present with

Answer 6

Ocular staining, and their schirmer test results can be quite variable (hard to diagnose when mild to moderate range)

Question 7

Diagnosis of dry eye is further complicated by the fact that many patients with mild dry eye have only

Answer 7

Intermittent symptoms. Some patients become symptomatic when exposed to the atmosphere/ dry climate/ long use of video. Ask patient for symptoms/severity + frequency.

Question 8

Determine severity of dry eye by

Answer 8

Labeling from Level 1-4

Level 4 including severe corneal staining, erosions, conjunctival scarring

Question 9

Symptoms of dry eye

Answer 9

Burning + itching (blepharitis)
Dryness
Grittiness
Something in my eye

Question 10

In dry eye sometimes the irritation so high they will feel

Answer 10

Like something is on their eye

Not enough tears will become scratchy

Question 11

Ocular surface staining with flourescein, rose bengalor Lisa mine green during dry eye

Answer 11

• most common sign of dry eye

- late manifestation of dry eye tests

Question 12

Patients often have symptoms way before staining occurs. This lack of relationship between the objective and subjective_

Answer 12

Has made clinical diagnosis difficult

Question 13

Dry eye is a multifactorial disease. Results in ____. Accompanied by ____.

Answer 13

Results in discomfort + visual disturbance and tear film instability
Accompanied by increased osmolarity of the tear film and inflammation of the ocular surface

Question 14

Most accurate testing for dry eye

Answer 14

History and questionnaires

Question 15

Questionnaires used widely to diagnose DED

Answer 15

OSDI and DEQ-5

Question 16

Most used questionnaire for DED? What does it measure

Answer 16

OSDI

Measures frequency of symptoms, environmental triggers, vision quality

Question 17

DEQ-5

Answer 17

Dry eye questionnaire has 4 questions related ti visual disturbance

Question 18

SPEED

Answer 18

Dry eye questionnaire with 8 items

Question 19

Tear meniscus height

Answer 19

Tells how much tear volume

Normally 0.2mm

Question 20

Lissamine green

Answer 20

Vital dye that stains devitalized cells of the conjunctiva

Question 21

NaFl

Answer 21

Viatl dye stains corneal breaks and devitalized cells of the cornea

Question 22

Epithelial damage during dry eye

Answer 22

Could develop an ulcer

Question 23

Autoimmune diseases usually cause what type of dry eye

Answer 23

Aqueous deficiency

Question 24

Typical dry eye is

Answer 24

Lipid deficiency (evaporative)

Question 25

Which dry eye is more common between aqueous deficiency and lipid deficiency?

Answer 25

Lipid deficiency

Question 26

Schirmer test sensitivity and specificity

Answer 26

25% sensitivity 90% specificity Best for aqueous deficiency

Question 27

Wetting of the Schirmers strip is measured after

Answer 27

5 minutes

Question 28

Schirmer test is good at detecting

Answer 28

Sjorgens patient because they wont even get 1mm

Question 29

Advantage of phenol red thread test for dry eye

Answer 29

Reading is taken after 15 seconds

Question 30

Neither schirmer nor phenol red testing

Answer 30

Agrees with symptoms

Question 31

Normal for phenol red thread

Answer 31

9-18mm

Question 32

Normal for schirmer test

Answer 32

>10mm

Question 33

Phenol red sensitivity and specificity

Answer 33

Dame as schirmers

Question 34

Testing for dry eye where you put in fluorescein in the eye to see how fast it disappears.

Answer 34

Flourescein clearance test Not commonly used Schirmer strip is used to measure

Question 35

Most common used testing for tear film stability

Answer 35

TBUT because of quick assessment and readily available flourescein

Question 36

Normal TBUT

Answer 36

10 seconds

Question 37

Non invasive NITBUT involves

Answer 37

Observation of an illuminated grip patter reflected from the anterior tear surface

Question 38

In TBUT dry spots appearing in less than 10 seconds is considered

Answer 38

Abnormal

Question 39

TBUT works well with picking up ___ problems but not ___.

Answer 39

Meibomian gland problems but not for tear deficiency

Question 40

When TBUT is less than the blink rate

Answer 40

The ocular surface becomes unprotected and the signs and symptoms of dry eye are exacerbated

Question 41

Lid structure and function can be affected by

Answer 41

Eyelash extension, makeup , démodex, blepharitis, laxity

Question 42

Diagnostic tool images integrity of the meibomian glands using infrared cameras

Answer 42

Meibography

Question 43

TBUT and corneal staining scores are significantly correlated with ____ but not ___.

Answer 43

Correlated with meibomian grade but not meibomian gland loss

Question 44

Lipiview

Answer 44

Imaging tool used to detect level of dry eye

Question 45

Non invasive tear break up time mires

Answer 45

Are projected onto the cornea, look for image distortion

Question 46

Tearscope pattern can tell you if

Answer 46

Lipid layer is in good condition

Question 47

Rose bengal isn’t used much because

Answer 47

It it’s painful

Question 48

Osmolarity state in dry eye

Answer 48

Hyperosmolar results could be thrown off if reflex tears are used

Question 49

Sjorgens syndrome

Answer 49

90% female Progressive Autoimmune disease Dry eyes and dry mouth (tooth decay) Arthritis Second most common rheumatologic disorder Lupus like feautures of vasculitis and immune complex

Question 50

All steroid hormones come from

Answer 50

Cholesterol

Question 51

Characterized by cylindrical dandruff around the base of the eyelashes (pathognomic)

Answer 51

Demodex

Question 52

Demodex mites can carry bacteria that will contribute to ocular

Answer 52

Surface inflammation

Question 53

Demodex infestation os associated with

Answer 53

Floppy eye syndrome (sleep apnea)

Question 54

Demodex is resistant to many conventional treatments but can be killed with

Answer 54

Tea tree oil - its messy, smelly and stings - can come back if you dont stay in top of it

Question 55

Following agents will not kill demodex

Answer 55

Baby shampoo, 10% propidone iodine, 75% alcohol, macrolides such as erythromycin, metronidazole, 4% policarpine

Question 56

Cliradex

Answer 56

A derivative of tea tree oil (transient stinging)

Question 57

Inflamma Dry MMP 9

Answer 57

A more sensitive diagnostic marker for dry eye than clinical signs alone (works) Marker for inflammation of eye

Question 58

Matrix metalloproteinases

Answer 58

(MMP) proteolytic enzymes that are produced by stressed epithelial cells on the ocular surface -levels go up in a dry eye

Question 59

Widely accepted, more sensitive, threshold (osmolarity) for use in routine practice to help diagnose mild to moderate dry eye subjects

Answer 59

308mOsm/L

Question 60

Osmolarity of a person with dry eye

Answer 60

Will increase

Question 61

Korb blackie lid leak test

Answer 61

Simple and effective way to indents dry eye and MGD patients with insufficient lid seal -see if red lid goes through lower lid or not

Question 62

Snap back test

Answer 62

Best way to find out if you have an eyelid skin laxity | -pull eyelid and asses how quickly and easily it returns to normal position

Question 63

Bad snap back test: slowly goes back into normal lid position means

Answer 63

Poor orbicularis muscle tone

Question 64

Tear film ferning

Answer 64

Separation of normal from dry eyes on the basis of ferning patterns of tear crystallization

Question 65

Thermography

Answer 65

Cooling rate is faster in DED because of greater rate of tear fil evaporation

Question 66

Impression cytology collection

Answer 66

Cell sample of the ocular surface

Question 67

risk factors for conjunctival chalasis

Answer 67

Age, dry eye history and previous ocular surgery | Wearing CL

Question 68

Conjunctival chalasis can masquerade as

Answer 68

Dry eye

Question 69

Conjunctival chalasis

Answer 69

Painful eye condition that mimics dry eye | Extra conjunctival tissue