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OPTM 737 > Test 1: Ocular Surface Disease > Flashcards

Test 1: Ocular Surface Disease Flashcards

1
Q

anterior blepharitis types

A

staphylococcal blepharitis - staph epidermis, staph aureus
seborrheic blepharitis - dermatologic condition
demodex - mite

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2
Q

staphylococcal blepharitis signs and symptoms

A

the classic appearance of staph bleph is yellowish debris or collates with complaints of matter or discharge and erythema and hyperemia of the eyelid margins

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3
Q

staphylococcal blepharitis treatment

A

warm compresses, eyelid hygiene (consider commercial lid cleansers)
add topical antibiotics for short term (7-10 days) to decrease the bacterial load

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4
Q

staphylococcal blepharitis pt edu

A

chronic nature of disease and that there is no known cure

long term maintenance is needed

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5
Q

seborrheic blepharitis signs and symptoms

A

oily or greasy matter in ashes, can have mild conjunctival injection and inferior punctate epithelial erosions
patient with complaint center on the eyelids themselves, including irritation, redness and itching

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6
Q

seborrheic blepharitis patient edu

A

chronic nature of the disease and that it will likely return
daily commercial lid scrubs may help to keep condition under control

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7
Q

demodex signs and symptoms

A

critical sign is cylindrical dandruff, with disorders of eyelashes, lid margin inflammation, meibomian gland dysfunction, blepharoconjunctivitis and blepharokeratitis
pt complaints including itching, burning, FBS, crusting and redness of the lid margin

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8
Q

demodex treatment

A

tea tree oil (cliradex wipes 4-Terpineol) a minimum 60 days of treatment is recommended to ensure eradication of the mite in all life cycles (approx. 30 day incubation)
meticulous hygiene of body and home is needed to fully eradicate the mites

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9
Q

allergic conjunctivitis

A

SAC
PAC
VKC
AKC

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10
Q

allergic conjunctivitis signs and symptoms

A

bilateral itching, hyperemia, lid edema

can be seasonal and occur with other allergic symptoms

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11
Q

allergic conjunctivitis treatment

A

drug of choice topical dual mechanism anti-allergy medications (combined H-1 receptor antagonist and mast cell stabilizers such as olopatadine) along with art tears to dilute allergens, cool compresses, and avoiding known allergens
severe allergies can be treated with topical steroids or oral antihistamines to control symptoms completely

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12
Q

other causes of non-lid related disease

A

chronic keratoconjunctivitis
chronic conjunctivitis
refractive surgery

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13
Q

aqueous deficient dry eye syndrome

A

sjogren syndrome dry eye

non-sjogren dry eye

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14
Q

primary sjogren’s syndrome dry eye

A

SS but no other autoimmune disease

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15
Q

secondary sjogren’s syndrome dry eye

A

SS and another autoimmune disease usually rheumatoid arthritis

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16
Q

non-sjogren dry eye

A

lacrimal deficiency, age related dry eye

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17
Q

reflex hypo secretion

A

a reduction in sensory feedback from the ocular surface causes dry eye in two ways: by decreasing reflex-induced lacrimal secretion and by reducing blink rate which increases evaporation

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18
Q

potential causes of reflex hypo secretion

A

herpes simplex keratitis, herpes zoster ophthalmicus, corneal surgery, limbal incision (extra-capsular cataract extraction), keratoplasty, refractive surgery, topical anesthesia, chronic contact lens wear, diabetes mellitus

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19
Q

lacrimal gland duct obstruction

A

normal aging changes, specific (rare)

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20
Q

intrinsic causes of evaporative dry eye

A

meibomian gland deficiency

disorders of the lid aperture, low blink rate, drug action (accutane)

21
Q

meibomian gland deficiency

A

defined as chronic diffuse abnormality of meibomian glands
characterized by terminal duct obstruction and/or qualitative/quantitative changes in glandular secretion
these changes result in alteration of tear film, symptoms of eye irritation, clinically apparent inflammation and ocular surface disease

22
Q

meibomian gland deficiency prevalence

A

the most common cause of evaporative DED 85% of evaporative DED

23
Q

meibomian gland deficiency diagnosis

A

may be diagnosed by meibomian gland expression ONLY
any altered quality of expressed secretion, and/or by a loss of gland functionality (decreased or absent expressibility) is evidence of disease
as MGD progresses, patient symptoms develop and lid margin signs may become visible with biomicroscopy

24
Q

meibomian gland deficiency treatment

A

warm compresses with lid massage, nutritional supplements (fish oil or omega-3)
in office MG expression has been shown beneficial
some success with off-label topical azithromycin on lashes
more significant disease might need oral doxycycline

25
Q

extrinsic causes of evaporative DED

A 
vitamin A deficiency 
topical drugs (preservatives) 
contact lens wear
other types of ocular surface disease (allergic conjunctivitis)
26
Q

vitamin A deficiency

A

vitamin A deficiency is a common cause of blindness in third world countries
the increasing popularity of gastric bypass surgery has caused an increase in cases of vitamin A deficiency resulting in severe dry eye including corneal scarring, corneal ulcers/perforation, and conjunctival dryness

27
Q

screening for dry eye disease

A

patient symptoms and clinical signs don’t usually match

every patient should be screened for dry eye symptoms

28
Q

screening exam

A

ask specific questions
evaluate DED risk factors - health history, meds, etc.
evaluate dis lashes, blink, lid closure, conj
evaluate tear film TBUT
evaluate cornea for fluorescein staining - immediately after TBUT evaluate the cornea for staining including severity, location and pattern

29
Q

elements of a comprehensive dry eye work-up

A

case history with dry eye questionnaire - symptoms surveys, ocular surface disease (normal 1-12, mild 13-22, moderate 23-32, severe 33-100), standard patient evaluation of eye dryness
assess tear osmolarity - tear lab
assess tear quantity and volume - schirmer 1 test, phenol red thread test
anterior seg evaluation with white light
tear stability - TBUT
evaluate ocular surface integrity with dyes
meibomian gland expression and assessment

30
Q

tear osmolarity

A

measured within 10 sec in TearLab

readings higher than 308 mOsmol/l are considered diagnostic of DED

31
Q

schirmer 1 test

A 
sensitivity 85% and specificity 83%
no anesthetic - place strip in lower fornix and patient closes eyes for 5 min
normal - greater than 10 mm
borderline - 5-10 mm
abnormal - less than 5 mm
32
Q

phenol red thread test

A

phenol red impregnated cotton thread inserted in lower fornix of lid for 15 sec
color change of wetted thread is easy to observe and measure directly with scale on package
a value >9 mm is normal
sensitivity 86% and specificity 83%

33
Q

evaluating ocular surface integrity with dyes

A

fluorescein is best for assessing cornea
lissamine green is better for conj
documentation of staining should include pattern, position, depth, and grade

34
Q

location of corneal staining

A

superior quadrant - superior limbic keratoconjunctivitis
diffuse punctate staining - toxicity
staining near lid margin - indicative of blepharitis
interpalpebral staining - incomplete blink or nocturnal lagophthalmos
sectoral staining - FB or localized irritant like GPC, concretions, loose lash or debris

35
Q

location of conjunctival staining

A

staining occurs more frequently on the nasal conjunctiva in patients with DED, whereas temporal staining is more indicative of SS

36
Q

meibomian gland expression and assessment

A

express Megs and evaluate composition of secretions
record findings - clear, cloudy, cloudy with debris, thick or paste like, or non-expressive
multiple ways to express - the mastrota paddle, the MG evaluator, or simply by a finger or cotton swab

37
Q

treatment and management goals

A

primary goal is to reduce symptoms and return tear film and ocular surface to as close as possible to normal state of health
frequency and severity of symptoms and how do they affect patient’s ADLs
what portion of ocular dysfunction is attributable to evaporative causes (evaluate MG) or aqueous deficiency (evaluate quantity and volume)
is the integrity of ocular surface compromised

38
Q

episodic

A

symptoms and signs are not consistently present but occur under certain environmental conditions or during specific visual tasks

39
Q

chronic

A

assumed to be caused by inflammation
the treatment goal in chronic DED is to control inflammatory mediators, to reduce signs and symptoms, and to minimize disease progression

40
Q

recalcitrant

A

progressive DED despite maximal conventional therapies

uncommon strategies may be required

41
Q

episodic treatment protocol

A

art tears
warm compresses
lid hygiene
environmental modifications

42
Q

chronic treatment protocol

A 
short term steroids 
topical cyclosporine 
omega 3s
doxycycline 
MG expression 
lid taping 
restasis
43
Q

recalcitrant treatment protocol

A

scleral lenses
amniotic membranes
tarsorrhaphy

44
Q

art tears

A

type of AT used does matter
remember to consider preservative, lipid content, osmolarity, viscosity
if prescribed more than 4 times/day, it should be PF

45
Q

warm compress

A

should be used at least 2 times/day for 2 weeks

compress should be warm and held on lids for at least 4 min

46
Q

lid hygiene

A

commercially available lid scrubs better for various forms of anterior blepharitis and MGD if the patient can tolerate

47
Q

environmental modifications

A

avoid air from any source blowing directly into the eye, use a humidifier

48
Q

medications

A

are there any medications that can be stopped or changed?
anti-inflammatories
topical steroids - use to calm allergies, or inflammation, particularly helpful before starting topical cyclosporine
cyclosporine
Restasis
Xiidra

49
Q

MG expression

A

cotton swab, mastroda paddle, BlephEx, LipiFlow

OPTM 737 (6 decks)

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