Week 2.02 Dry Eye Flashcards
Dry eye disease
- multifactorial
- loss of homeostasis
- tear film instability
What is reduced in DED
CS and VA
What are some non modifiable risk factors for DED
- female
- Asian
- MGD
- Sjögren’s syndrome
- connective tissue diseases
What are some modifiable risk factors
- computer use
- contact lens
- environment
- medications
What are the two types of DED px
Asymptomatic
Symptomatic
Asymptomatic but signs of ocular surface disease
Signs without symptoms - predeiposition - preventative treatment
Neurotrophic condition - signs indicating treatment as DED
What is aqueous deficient dry eyee
Reduced tear quantity where tear production is not enough to counteract drainage and evaporation
What is evaporative dry eye
Reduced tear quality where there is normal aqueous production but excessive tear evaporation. Often due to lipid layer insufficiency.
Which questionnaires do we have for dry eye and what does each score correspond to
OSDI - 12 questions - >13 suggests dry eye
DEQ-5 - 5 questions - >6 suggests dry eye
Non invasive tear break up time
specular reflection of an illuminated grid pattern, and you check if there’s any distortion of the rings
- Tear film stability can be affected by fluorescein therefore TBUT measurements using non-invasive techniques are often longer than those made using fluorescein
- Often not available in practice
- NIBUT <10s suggests dry eye
Schirmer test
- Sterile strip of filter paper in lower fornix
- Measure length moistened in 5 mins >10mm = normal
- Reliable if less moistened
- Reflex tear secretion due to irritation
- Still used to diagnose Sjögren’s syndrome
Phenol red
- Thin cotton thread soaked with phenol red a pH sensitive dye, when dry its yellow when soaked in tears turns red
- 16-20mm in 15 secs normal
- No longer available
Lid wiper epitheliopathy
Lid wiper – portion of the marginal conjunctiva of the upper and lower lid which spreads the tear film over the ocular surface
Rich in goblet cells
LWE is when the lid wiper stains with dyes such as fluorescein and lissamine green
What kid of questions might u ask DED px
How severe is discomfort
Mouth dryness? - may suggest sjoregens
Vision clear on blinking?
Any redness?
Itching?
Contact lens wearer?
Any health conditions/medication?
What is stage 1 of management
- education
- modification of environment - air con
- diet modification
- elimination of systemic and topical meds
- Ocular lubricants
- lid hygiene and warm compresses
Stage 2 of management
- non preserved lubricants
- Tea tree oil for demodex
- punctal plugs
- overnight treatments
- physical heating and expression of MG
- drugs to manage DED
Topical antibiotic, corticosteroids for ant Blepharitis
Stages 3 & 4
- theraputic cl options such as soft bandage lenses, rigid scleral
- corticosteroid for longer
