CC Nov 2015 Dry eye syndrome

echoecho's version from 2015-11-18 13:44


Question Answer
The normal eye relies on a healthy tear film that results from the proper functioning of the three parts of the eye?1) lacrimal glands 2) eyelids 3) ocular surface
Disruption of the above function can result in what?dry eye syndrome
Medical term for dry eye syndrome is?keratoconjunctivitis sicca
Dry eye syndrome is characterized by disorders of the tear film caused by either 2 things?1) increased evaporation OR 2) reduced tear production
What is the most common cause of evaporative dry eye?posterior blepharitis
Define posterior blepharitis?meibomian gland dysfunction resulting in abnormalities in the lipid layer of the tear film and increased fluid loss
List structural abnormalities of the eyelides that can contribute to dry eye due to increased exposure time of the tear film?1) abormal positioning 2) decreased blinking
Ocular surface irritation, by what 3 causes can result in increased evaporation?1) eye drops 2) contact lenses 3) ocular allergies
Reduced tear production can be divided into 2 categories, what are these?1) Sjogren's 2) non-Sjogrens
Reduced tear production is due to what?inadequate production of one of the three tear layers (oil, water or mucus)
List the 12 consistent risk factors for dry eye?1) older age 2) female gender 3) postemenopausal estrogen therapy 4) low dietary intake of omega-3 fatty acids 5) medications like antihistamines, less strong evidence for antidepressants like TCAs and SSRIs, diuretics, beta-blockers 6) connective tissue disease 7) LASIK and refractive excimer laser surgery 8) radiation therapy 9) hematopoietic stem cell transportation 10) vitamin A deficiency 11) hepatitis C infection 12) androgen deficiency
List the complaints of patients who experience dry eye syndrome?1) eye irritation 2) dry feeling in and about the eye 3) foreign body sensation in the eye
Why is a careful hx (including medication review) and physical exam required to dx dry eye syndrome?because symptoms may represent other eye disorders (ocular allergies, infectious conjunctivitis) and to identify possible underlying causes or associated disorders like Sjogren's, rosacea (meibomian gland dysfunction), sarcoidosis, lymphoma (infiltration of the lacrimal gland)
List the 3 tests that are available to quantify tear production?1) tear break-up time test 2) ocular surface dye staining 3) Schirmer test
List 2 tests available to evaluate tear quality?1) tear break-up test 2) tear osmolarity
Of the above 5 tests, which is adequate of diagnosis?none; no single tests is adequate for dx. The combination of these tests PLUS clinical assessment help to establish the dx
Pts w/ dry eye syndrome may need further evaluation for underlying inflammatory conditions such as SJogren's syndrome b ecause as many as ___% of patients with Sjogren's syndrome develop dry eye syndrome?10
Management of dry eye syndrome is based on what?severity
List the 3 severity categories?1) mild 2) moderate 3) severe
List the treatment for mild dry eye syndrome?1) education and environmental modifications (avoidance of smoke and other irritants, avoidance of air drafts and low-humidity environments, lowering computer screen to decrease lid aperture 2) aqueous artifical tear substitutes, gels/ointments 3) eyelid warm compresses and hygiene
List the treatment for moderate dry eye syndrome?1) in addition to the above treatments for mild dry eye syndrome, use of anti-inflammatory agents (topical cyclosporine (Restasis) and corticosteroids 2) systemic omega-3 fatty acids supplements 3) temporary punctal plugs (collagen) 4) spectacle side shields and moisture chambers
List the treatment for severe dry eye syndrome?1) in addition to the above treatments for mild and moderate dry eye syndrome, use of systemic cholinergic agonists 2) systemic anti-inlammatory agents 3) mucolytic agents 4) autologous serum tears 5) contact lenses 6) permanent punctal occlusion (silicone) 7) tarsorrhaphy
*** Omega fatty acids consisting of what have been showen to improve patient symptoms, as well as resuljts of tear break-up testing and Schirmer results?1) eicosapentaenoic acid (EPA) AND 2) docoszhexaenoic acid (DHA)
*** Omega-3 fatty acids are considered relatively safe, although the FDA recommends that patients not exceed _____ grams/day of omega-3 fatty acids (total for both EPA and DHA), why?1) 3 2) higher levels have been associated with increased bleeding
Is the relationship between omega-3 fatty acids and prostate cancer clear?no
A systematic review and meta-analysis found that the topical immunosuppressant _______ improved subjective and objective outcomes, although improvement may take up to 6 months?cyclosporine (Restasis)
Cyclosporine (Restasis) does not increase tear production in what two patient types?1) those using anti-inflammatory eye drops 2) those with tear duct plugs
How often is Cyclosporine (Restasis) eye drops used daily? Side effect? Cost?1) BID 2) burning and irritation 3) expensive
What eye drops can decrease inflammation? Whys is their use limited to short periods of time?1) low-dose topical steroid eye drops (nonpreserved) 2) due to risks for increased intraocular pressure and cataracts
*** A Cochrane review showed limited evidence that ____ _____ can provide symptomatic relief in severe cases?punctal plugs
Compare the effectiveness of using short-term temporary vs. permanent plugs?equally effective
Patients with dry eye syndrome shoulder be monitored how often to assure they do not develop complications, including what?1) periodically 2) corneal abrasions
List 4 sequelae that would prompt a referral to an Opthalmologist?1) vision loss 2) corneal ulceration 3) moderate to severe eye pain 4) nonresponse to therapy
*** SUMMARY = List the 2 causes of dry eye syndrome?1) increased evaporation 2) reduce tear production
*** SUMMARY = List 2 categories of tests available to diagnose dry eye?1) quantify tear production 2) evaluate tear quality
*** SUMMARY = List 3 tests that can be done listed under quantifying tear production? 1) tear break-up test 2) ocular surface dye staining 3) Schirmer test
*** SUMMARY = List 2 tests that can be done listed under evaluating tear quality?1) tear break-up test 2) tear osmolarity
*** SUMMARY = Which of the above tests is adequate for diagnosis?no single test is adequate
*** SUMMARY = List 4 first line therapies for dry eye syndrome?1) education 2) environmental modifications 3) liquid tears 4) warm compresses
*** SUMMARY = What medication improves subjective and objective outcomes, although improvement may take up to 6 months?Cyclosporine (Restasis) eye drops