wk4: AED Dry eye Mx Flashcards
How can you classify dysfunctional tear syndrome patients? (3)
With lid margin disease
Tear distribution problems
Without lid margin disease
How can you classify dysfunctional tear syndrome patients with lid margin disease? (2)
anterior lid margin
posterior lid margin
How can you classify dysfunctional tear syndrome patients with tear distribution problems? (5)
conjunctivochalasis
lid + lash malposition
elevated surface lesions
reduced or incomplete blinking
other
How can you classify dysfunctional tear syndrome patients without lid margin disease? (4)
severity level 1-4
How can we treat dysfunctional tear syndrome patients with anterior lid disease? (2)
lid hygeine
topical antibiotic
How can we treat dysfunctional tear syndrome patients with posterior lid disease? (3)
Hot compresses and massage, and, it that doesn’t work:
tetracyclines or
topical steroids
How do we treat the following tear distribution problems:
A: reduced/incomplete blinking (2)
B: elevated surface lesions (2)
C: lid and lash malposition (2)
D: conjunctivochalasis (2)
What if these tx don’t work? (1)
A: lubrication/contact lenses
B: lubrication/steroids
C: lubrication/contact lenses
D: lubrication/steroids
And if none of these works, surgery
How do we grade level 1 dysfunctional tear syndrome? (2)
1 or more of:
mild/moderate symptoms + no signs
mild/moderate conjunctival signs
How can we manage level 1 dysfunctional tear syndrome? (4)
education/counselling
environmental modifications
control of systemic modifications
perserved tears/allergy control
How do we grade level 2 dysfunctional tear syndrome? (5)
moderate/severe symptoms
tear film signs
mild PEE
conj. staining
visual signs
How can we manage level 2 dysfunctional tear syndrome with no inflammation present? (3)
If no inflammation: unpreserved tears/gels/ointment
How can we manage level 2 dysfunctional tear syndrome with inflammation? (4)
If inflammation: steroids/cyclosprine/nutritional supplements/secretagogues
How do we grade level 3 dysfunctional tear syndrome? (4)
severe symptoms
marked SPK
central corneal stain
filamentary keratitis
How can we manage level 3 dysfunctional tear syndrome? (3)
tetracyclines
autologous serum
punctal plugs (after inflammatory control)
How do we grade level 4 dysfunctional tear syndrome? (3)
severe symptoms
severe corneal staining/erosion
conjunctival scarring
How can we manage level 4 dysfunctional tear syndrome? (5)
topical vitamin A
contact lenses
acetylcysteine
moisture goggles
surgery
List examples of dry eye treatment options for the following categories:
A: Palliative/protective treatment (2)
Supplements
Soidum Hyaluronate
Autologous serum eye drops (also is anti-inflamm)
List examples of dry eye treatment options for the following categories:
B: Anti-inflammatory (4)
Flaxseed oil/fish oil
Topical corticosteroids
Oral tetracycline (MMP9)
Autologous serum eye drops
List examples of dry eye treatment options for the following categories:
C: immunomodulation (1)
Topical cyclosporine
Other than palliative, anti-inflammatory and immunomodulation, what other type of treatment option exists for dry eye? (1)
Biomechanical tx
What differences are there between commercial eye drops?
No real differences. Any differences stated by companies are from in vitro studies and don’t represent what happens in humans
What is the role of tear supplements? (3)
used to hydrate ocular surface, counteract dehydration, and reduce lid friction
What is the major problem we face with tear supplements? (2)
Not instilled frequently enough or
necessity of long term use not understood by patient (education important)
How can liquid tear supplements vary? (4)
can vary in:
viscosity
contact time
friction
wetting properties
How do the mechanisms of action for liquid tear supplements vary? (2)
some improve adherence to glycocalyx
others absorb water and improve tear distribution
How do gel tear supplements differ from liquids (1) and ointments? (1)
Increased contact time across cornea than liquid
Less profound effect on vision than ointments
Between liquids, gels and ointments, which has the better contact time?
ointments (however they severely disrupt visual performance)
When is ointment best used? (2)
at night before bed (due to the poor vision), or
in an eye with already poor vision