Week 4 Flashcards
non modifiable risk factors of dry eye
age
female
asianrace
MGD
Connective tissue disease
sjogren’s syndrome
modifiable risk factors of dry eye
CL wear
computers
adverse environments
some meds
HRT
The main effects of Cl on tear film
disrupts tear film
increases tear film evaporation rate
alters mucus production
induces hypertonic tear film
more lipid deposits of CL’s ?
makes MGD worse
effects of wearing soft CL
increases tear evaporation rate
decreases tear thinning time
decreases pre lens tear stability
lipid layer becomes thinner
dryness symptoms ↑
HOW TO ASNWER DRY EYE CASE STUDY Q
Consider treating any underling condition (e.g. blepharitis)
before fitting CLs?
* Carefully consider lens wearing modality and material
* Consider reducing daily wear time (DWT)
* Consider using rewetting eye drops/ocular lubricants
(preservative free)
* Frequent aftercare required
* Risk of drop out!
DRY EYE DIAGNOSIS OSDI
It has 12 questions.
It assess DED symptoms and the effects of DED on daily activities
assess the symptoms over the last week
DED diagnostic value:
* Scores >13
DRY EYE DIAGNOSIS deq-5
5 questions
assesses if severity increases at the
end of the day
DEQ-5 assess the symptoms over the
last month
DED diagnostic value:
* Scores >6
DRY EYE DIAGNOSIS
SPEED
It evaluates the frequency of DED symptoms over the past 3 months
DED diagnostic values:
* Scores >6
DRY EYE DIAGNOSIS
CLDEQ
CLDEQ-8 score of ≥12 points is proposed to identify soft CL wearers who could benefit from clinical management of their
CL-related symptoms
Dry eye diagnosis: signs/ TEAR STABILITY
1.Non-invasive tear film break-up time (NIBUT)
2.Fluorescein break up time (FBUT)
DED diagnostic value: Score <10s
3.Tearscope
* It allows both the measurement of the NIBUT and the assessment of the tear film lipid layer of the tear film
4.Oculus Keratograph 5M
* It is an advanced corneal topographer with a built-in real keratometer. It also evaluates:
* NIBUT (Objective evaluation)
* Tear film lipid layer
* Meibomian glands
* Tear meniscus height
Dry eye diagnosis: signs/TEAR VOLUME
1.Schirmer test
DED diagnostic value: <5mm/5min
2.Phenol Red Thread test (PRT)
DED diagnostic value <10mm/15 seconds
3.Tear Meniscus Height (TMH)
DED diagnostic value <0.2 mm
Dry eye diagnosis: signs/ TEAR COMPOSITION
Tear osmolarity (Tear Lab)
Objective measurement
Dry eye diagnostic values:
* Osmolarity value of ≥ 308 mOsm/L
or
* Inter-eye difference > 8 mOsm/L
Dry eye diagnosis: signs/OCULAR SURFACE DAMAGE
1.Meibomian gland assessment
Oculus Keratograph 5M
2.Ocular surface staining-NAFi
3.Ocular surface staining
* Lissamine green stains epithelial cells only if the cell
membrane is damaged
Dry eye diagnostic values:
* Corneal punctate spots >5 in number
* Conjunctival spots >9 in number
* Lid margin >2 mm length & 25% margin width
4.Lid wiper epitheliopathy (LWE)
* When Lissamine green dye is applied to the eyelid margin, a
line called Marx line can be observed running along the
inner eyelid
Patients with increased LWE grades are likely to suffer
from DED
5.Lid Parallel Conjunctival Folds
(LIPCOF)
Patients with increased LIPCOF grades are likely to suffer
from DED
5.Ocular surface sensitivity
* Cochet-Bonnet or non-contact air-jet aesthesiometers can be
used to assess ocular surface sensitivity.
Dry eye diagnosis: signs/OCULAR SURAFCE INFLAMMATION
Ocular/conjunctival redness
Conjunctival redness is the most common clinical sign that is suggestive of ocular surface inflammation
