Term
Name the three places tears exist in the eye: |
|
Definition
1.) Cul-de-sac
2.) tear meniscus
3.) tear film |
|
|
Term
How do tears exit the eye? |
|
Definition
1.) Conjunctival Capillaries
2.) tear film evaporation
3.) puncta |
|
|
Term
What are the four layers of the traditional tear film model? |
|
Definition
1.) superficial meibomian oils
2.) aqueous liquid phase
3.) innermost mucin layer
4.) microvilli |
|
|
Term
|
Definition
A multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by an increased osmolarity of the tear film and inflammation of the ocular surface. |
|
|
Term
Keratoconjunctivitis sicca (KCS) |
|
Definition
= Dry eye
Some reserve KCS for people with Sjogren syndrome. |
|
|
Term
What is Sjögren Syndrome? |
|
Definition
A chronic autoimmune disease affecting moisture- producing glands. |
|
|
Term
What are the symptoms of sjogren syndrome and who is most likely to experience this disease? |
|
Definition
1.) dry eyes
2.) dry mouth
3.) kidney, GI, blood vessel, lungs, pancrease, CNS dysfunction.
1.) 9/10 people with sjogren syndrome are women.
2.) 50% of it occurs alone.
3.) 50% of it accompanies another autoimmune disorder of the connective tissue. (In this case it's called secondary sjogren.
|
|
|
Term
How many office visits are for dry eye complaints? |
|
Definition
|
|
Term
What percentage of the population experiences dry eye? |
|
Definition
|
|
Term
Are dry eye sufferers usually male or female? |
|
Definition
|
|
Term
How many people use artificial tears? |
|
Definition
|
|
Term
How do you test for dry eye? Give four examples: |
|
Definition
1.) Schirmer strips
2.) Tear Osmolarity
3.) TBUT
4.) Staining |
|
|
Term
In tests for dry eye, there is a lack of consensus on ... |
|
Definition
1.) What tests to use.
2.) Interpretation of the tests.
3.) Diagnostic criteria. |
|
|
Term
Dryness of the ocular surface results in excess ______ which may lead to neurogenic _______. |
|
Definition
Dryness of the ocular surface results in excess nervous stimulation which may lead to neurogenic inflammation. |
|
|
Term
The release of _____ causes the dysfunction and destruction of the lacrimal glands, tear film, and conjunctiva in dry eye disease. |
|
Definition
The release of inflammatory cytokines causes the dysfunction and destruction of the lacrimal glands, tear film, and conjunctiva in dry eye disease. |
|
|
Term
In dry eye, what is the key mechanism of ocular surface injury? |
|
Definition
|
|
Term
What are the two main categories of dry eye? |
|
Definition
1.) Aqueous deficient (not enough tears)
2.) Evaporative (lipid layer is fucked-up)
Note: You can have both of these problems at the same time. |
|
|
Term
Refer to table at the bottom of page 2 of your CH 14 notes. |
|
Definition
|
|
Term
List 3 treatments for aqueous deficient dry eye: |
|
Definition
1.) Tear supplements
2.) Tear conservation
3.) Tear stimulation |
|
|
Term
Is there active drug in artificial tears? |
|
Definition
Nope! The vehicle polymer gives relief. |
|
|
Term
What do you call it when Batman skips church? |
|
Definition
|
|
Term
Name the 11 polymers used in artificial tears: |
|
Definition
1.) MC
2.) HPMC 3.) CMC
4.) HPC
Above are all cellulose ethers
5.) Polyvinyl alcohol (PVA)
6.) Polyvinylpyrrolidone (PVP)
7.) Dextran
8.) Propylene glycol
9.) glycerin
10.) sodium hyaluronate
11.) HP-Guar
|
|
|
Term
What type of tears do dry eye patients usually have? Isotonic, hypotonic, or hypertonic? |
|
Definition
|
|
Term
What are the 7 possible components of artificial tears? |
|
Definition
1.) Polymers
2.) Electrolytes
3.) Buffers
4.) Preservatives
5.) Nutrients
6.) Mucolytic agents
7.) Disappearing Tears
You can remember this list by using:
BAD MEN P.
|
|
|
Term
What is the tonicity of normal tears? |
|
Definition
|
|
Term
Some artificial tears use electrolytes in their formulations. Name three brands with hypotonic electrolyte formulations: |
|
Definition
1.) Hypotears (214mOsm/L)
2.) Theratears (175 mOsm/L)
3.) Retaine MGD
Note that most artificial tears are isotonic. |
|
|
Term
The buffers in artificial tears are usually: acidic, basic, or neutral? |
|
Definition
Artificial tears have slightly basic buffers. |
|
|
Term
True or false:
BAK is a great preservative in artificial tears. You should recommend tears with BAK to your patients. |
|
Definition
FALSE.
DO NOTTTT Select artificial tears with BAK. It is irritating and there are better options!!! DON'T. DO. IT. |
|
|
Term
What types of nutrients are added to artificial tears? |
|
Definition
|
|
Term
Which artificial tear uses vitamin A as a nutrient? |
|
Definition
|
|
Term
Most artificial tears don't have mucolytic agents. However, they are sometimes used. What are the two mucolytic agents that could be present in artificial tears? |
|
Definition
1.) N-acetylcysteine
2.) tyloxapol (in many rewetting drops) |
|
|
Term
Name the brands of artificial tears that use disappearing preservatives, and name the preservative that each uses, and tell how that preservative works. |
|
Definition
1.) Genteal (Novartis)
GenAqua
Sodium perborate --> H2O2 --> H2O + O2
2.) Refresh Products (Allergan)
Purerite
Sodium chlorate --> NaCl + H2O
3.) Blink Tears and Blink Gel Tears (AMO)
OcuPure
Sodium Chlorate --> NaCl + H2O
|
|
|
Term
Do single use artificial tear vials contain preservative? How long are they safe to use? |
|
Definition
No. They should be thrown away after 12 hours. |
|
|
Term
What is Goniosol used for? What polymer does it contain? Preservative? |
|
Definition
NOT FOR DRY EYE PATIENTS Used as a contact medium between the eye and gonioscope. Let us you look at the angle very well. *Has 2.5% HPMC as polymer-->very thick *Preserved with BAK *It is very harsh on the cornea |
|
|
Term
What is wrong with giving a 10mL bottle of viva drops to your patient? |
|
Definition
That's 200 drops of a preservative free artificial tear! That's 2 months of drops sans preservative! Ew. |
|
|
Term
|
Definition
*It treats all 3 layers of tears. i. Lipid layer-->Amisol clear ii. Aqueous layer--> lacrophilic aqueous solution iii. Mucin layer--> mucomimetic polymer Has a Unique polymer= Polixetonium *Indicated for moderate to severe dry eye *Used 3-4x/day |
|
|
Term
What is Nature's Tears EyeMist? What does it claim about artificial tears? |
|
Definition
This is a biological grade water mist.
It claims that artifical tears flush lipids, mucin and actually increases evaporation! |
|
|
Term
What dry eye medication is homeopathic? |
|
Definition
Similasan Dry Eye Relief
Contains: mercurius sublimatis, belladonna, and euphrasia |
|
|
Term
What is the method of action of Retaine MGD? What type of dry eye disfunction is it treating? |
|
Definition
It delivers ingredients through electrostatic attraction between the positively charged droplets (cationic droplets) and the negatively charged ocular surface.
This is used to treat meibomian gland disfunction.
**This is an emulsion, it is HYPOtonic and preservative free ** |
|
|
Term
What preservative does Alcon Products contain? |
|
Definition
|
|
Term
What Alcon products contain a preservative? Which ones are preservative free? |
|
Definition
Contain preservative (polyquad):
i. Systane
ii. Systane Ultra
iii. Systane Gel Drops
iv. Systane Balance
Preservative Free:
i. Systane PF
ii. Systane Ultra PF
iii. Systane Nighttime Ointment |
|
|
Term
What is the vehicle found in the Alcon drops? |
|
Definition
|
|
Term
What is the preservative found in Allergan drops? |
|
Definition
|
|
Term
What Allergan lubricants contain a preservative? |
|
Definition
1. Refresh Liquigel
2. Refresh Optive
3. Refresh Optive Advanced
4. Refresh Tears |
|
|
Term
What Allergan lubricants are preservative free? |
|
Definition
1. Refresh Celluvisc
2. Refresh Classic
3. Preservative Fresh Refresh Optive
4. Preservative Free Refresh Optive Advanced
5. Refresh Plus |
|
|
Term
What vehicle is found in most Allergan Artificial Tear Products? |
|
Definition
|
|
Term
Which of the Allergan lubricants has the highest Carboxymethylcellulose concentration? And what does this mean for the patient? |
|
Definition
Refresh Celluvisc.
The 1% concentration makes the drop very thick, its usually too thick for most patients and causes a lot of blurry vision. |
|
|
Term
Systane Nighttime ointment is contraindicated for what patients? |
|
Definition
Patient with allergies to wool (sheep?)
The ointment contains Lanolin |
|
|
Term
List the Tear Gels that we have. |
|
Definition
1. Genteal Gel
2. Refresh LiquiGel
3. Tears Again Night and Day
4. Systane Gel Drops
5. Etc.
**With these usually can get away with patients using BID since they are so thick instead of the usual 4x/day** |
|
|
Term
What is the method of action of Liposome spray? How is it deliverd? What does the spray contain? |
|
Definition
1. It helps seal in naturally-occuring lipids which are transferred to tear film.
2. It is dilerved through closed lids.
3. It contains tiny microspheres (liposomes) that contain phopholipids. It is all natural, also contains Vitamins A, C and E. |
|
|
Term
How do Artifical Tear inserts (Lacrisert) work? |
|
Definition
They are water soluble rods that are placed in the inferior cul-de-sac. They contain 5mg HPC and dissolves in about 6-8 hours. It is used to treat moderate to severe dry eye! |
|
|
Term
What is the method of action of Salagen (oral pilocarpine)? What is it approved for? |
|
Definition
1. It treats dry eye via tear stimulation.
2. It is approved for xerostomia after radiation and Sjogren sydrome.
**off label use for severe, recalcitrant dry eye** |
|
|
Term
What is the method of action of Evoxac? What is it approved for? |
|
Definition
1. It treats dry eye via tear stimulation.
2. It is approved for xerostomia in sjogren syndrome.
**This is a cholinergic agonist** |
|
|
Term
What are the methods/medications we use for Tear Stimulation? |
|
Definition
1. Salagen
2. Evoxac
3. Gland Transplantation
4. Hormones |
|
|
Term
What are our methods for Tear Conservation? |
|
Definition
1. Decrease evaporation
i. Goggles
ii. Moisture chambers
iii. humidifiers
iv. minimizing aggravating factors
v. ointments
2. Obstruct Tear Outflow
i. Punctal plugs
a. temporary-collagen
b. extended duration
c. silicone- perminant
ii. electrocautery
iii. argon laser puntal occlusion |
|
|
Term
How does Restasis (cyclosporin A 0.05%) work? What FDA Pregnancy Category is it? |
|
Definition
1. This is a anti-inflammatory medication. It is a T-cell Modulator that inhibits T-lymphocytes. It take a minimum of 3months to see results.
2. Category C
**This is a emulsion, Rx only, Single use Vials PF, BID use, and need to presecribe 2 trays for 30 day use ** |
|
|
Term
List the different methods we have to treat underlying causes of dry eye. (7 total) |
|
Definition
1. Restasis
2. Supplements
i. Fatty acids- flax seed, fish oil, etc.
3. topical corticosteroids
4. systemic tetracylines
i. if meibomian gland dysfunction
5. Sex hormones
6. Autologous Serum 20%
i. this uses blood serum, contains vit A, epidermal growth facto, TGF-beta
7. Botulinum Toxin
i. increased tearing/decreased lacrimal drainage
8. amniotic membrane
i. prokera |
|
|