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Ocular Physiology > Tear Film Assessment > Flashcards

Tear Film Assessment Flashcards

1
Q

Dry eye is a sign of

A

Inflammation

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2
Q

Gold standard in dry eye diagnosis

A

None , but testing options have recently grown

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3
Q

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

A

Have dry eye

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4
Q

Dry eye can be triggered by

A

Patient taking Antihistamines because cholinergic said dry everything up

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5
Q

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

A

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

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6
Q

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

A

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

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7
Q

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

A

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

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8
Q

Determine severity of dry eye by

A

Labeling from Level 1-4

Level 4 including severe corneal staining, erosions, conjunctival scarring

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9
Q

Symptoms of dry eye

A

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

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10
Q

In dry eye sometimes the irritation so high they will feel

A

Like something is on their eye

Not enough tears will become scratchy

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11
Q

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

A
  • most common sign of dry eye

- late manifestation of dry eye tests

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12
Q

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

A

Has made clinical diagnosis difficult

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13
Q

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

A

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

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14
Q

Most accurate testing for dry eye

A

History and questionnaires

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15
Q

Questionnaires used widely to diagnose DED

A

OSDI and DEQ-5

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16
Q

Most used questionnaire for DED? What does it measure

A

OSDI

Measures frequency of symptoms, environmental triggers, vision quality

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17
Q

DEQ-5

A

Dry eye questionnaire has 4 questions related ti visual disturbance

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18
Q

SPEED

A

Dry eye questionnaire with 8 items

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19
Q

Tear meniscus height

A

Tells how much tear volume

Normally 0.2mm

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20
Q

Lissamine green

A

Vital dye that stains devitalized cells of the conjunctiva

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21
Q

NaFl

A

Viatl dye stains corneal breaks and devitalized cells of the cornea

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22
Q

Epithelial damage during dry eye

A

Could develop an ulcer

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23
Q

Autoimmune diseases usually cause what type of dry eye

A

Aqueous deficiency

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24
Q

Typical dry eye is

A

Lipid deficiency (evaporative)

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25
Q

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

A

Lipid deficiency

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26
Q

Schirmer test sensitivity and specificity

A

25% sensitivity
90% specificity
Best for aqueous deficiency

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27
Q

Wetting of the Schirmers strip is measured after

A

5 minutes

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28
Q

Schirmer test is good at detecting

A

Sjorgens patient because they wont even get 1mm

29
Q

Advantage of phenol red thread test for dry eye

A

Reading is taken after 15 seconds

30
Q

Neither schirmer nor phenol red testing

A

Agrees with symptoms

31
Q

Normal for phenol red thread

A

9-18mm

32
Q

Normal for schirmer test

A

> 10mm

33
Q

Phenol red sensitivity and specificity

A

Dame as schirmers

34
Q

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

A

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

35
Q

Most common used testing for tear film stability

A

TBUT because of quick assessment and readily available flourescein

36
Q

Normal TBUT

A

10 seconds

37
Q

Non invasive NITBUT involves

A

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

38
Q

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

A

Abnormal

39
Q

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

A

Meibomian gland problems but not for tear deficiency

40
Q

When TBUT is less than the blink rate

A

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

41
Q

Lid structure and function can be affected by

A

Eyelash extension, makeup , démodex, blepharitis, laxity

42
Q

Diagnostic tool images integrity of the meibomian glands using infrared cameras

A

Meibography

43
Q

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

A

Correlated with meibomian grade but not meibomian gland loss

44
Q

Lipiview

A

Imaging tool used to detect level of dry eye

45
Q

Non invasive tear break up time mires

A

Are projected onto the cornea, look for image distortion

46
Q

Tearscope pattern can tell you if

A

Lipid layer is in good condition

47
Q

Rose bengal isn’t used much because

A

It it’s painful

48
Q

Osmolarity state in dry eye

A

Hyperosmolar results could be thrown off if reflex tears are used

49
Q

Sjorgens syndrome

A

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

50
Q

All steroid hormones come from

A

Cholesterol

51
Q

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

A

Demodex

52
Q

Demodex mites can carry bacteria that will contribute to ocular

A

Surface inflammation

53
Q

Demodex infestation os associated with

A

Floppy eye syndrome (sleep apnea)

54
Q

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

A

Tea tree oil

  • its messy, smelly and stings
  • can come back if you dont stay in top of it
55
Q

Following agents will not kill demodex

A

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

56
Q

Cliradex

A

A derivative of tea tree oil (transient stinging)

57
Q

Inflamma Dry MMP 9

A

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

58
Q

Matrix metalloproteinases

A

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

59
Q

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

A

308mOsm/L

60
Q

Osmolarity of a person with dry eye

A

Will increase

61
Q

Korb blackie lid leak test

A

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

62
Q

Snap back test

A

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

63
Q

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

A

Poor orbicularis muscle tone

64
Q

Tear film ferning

A

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

65
Q

Thermography

A

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

66
Q

Impression cytology collection

A

Cell sample of the ocular surface

67
Q

risk factors for conjunctival chalasis

A

Age, dry eye history and previous ocular surgery

Wearing CL

68
Q

Conjunctival chalasis can masquerade as

A

Dry eye

69
Q

Conjunctival chalasis

A

Painful eye condition that mimics dry eye

Extra conjunctival tissue

Ocular Physiology (7 decks)

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