Ocular Disease Final - Lacrimal

Front 1

Name the reflex secretors

Back 1

Main lacrimal and palpebral lacrimal glands

Front 2

What produces the oily layer?

Back 2

Meibomian, sebaceous glands of zeiss, sweat glands of moll

Front 3

What produces the aqueous layer?

Back 3

Accessory glands of wolfring and krause.

Front 4

What produces the mucin layer?

Back 4

Goblet cells, crypts of henle, glands of manz

Front 5

T/F - Omega-3 FAs and flaxseed takes months before results in helping dry eye.

Back 5

True

Front 6

If the eye is inflamed, inflammatory mediators (decrease/increase) lacrimal activity.

Back 6

Decrease - probably to prevent flushing mediators out

Front 7

Lacrimal gland secretion = sympathetic or parasymp?

Back 7

Parasymp

Front 8

Where does reflex tearing originate from?

Back 8

1. Trigeminal nerve stimulation assoc w/ corneal irritation
2. Optic nerve stimulation from bright light
3. CNS stimulation from emotional trauma

Front 9

T/F - The nasolacrimal duct is part of the upper excretory lacrimal system.

Back 9

False - lower

Front 10

Each caniliculus divided into shorter __mm (vertical/horz) portion and __mm (vertical/horz) portion.

Back 10

2, vertical, 8, horz

Front 11

Diameter of puncta?

Back 11

0.5 mm

Front 12

Lacrimal sac dimensions?

Back 12

12x5 mm

Front 13

Nasolacrimal duct extends ___ mm to drain into ___.

Back 13

12-20, inferior meatus

Front 14

Tear fluid is drawn into the caniliculus by:
1. Osmotic force
2. Capillary force
3. Suction

Back 14

2. Capillary force

Front 15

Caniliculi shift (medial/lateral) and become (dilated/compressed) and (elongated/shortened) during blink.

Back 15

Medial, compressed, shortened

Front 16

T/F - Avitaminosis A is related to aqueous deficiency.

Back 16

False - mucin deficiency

Front 17

T/F - Ocular pemphigoid is related to aqueous deficiency.

Back 17

False - mucin deficiency

Front 18

How can HSV can result in dry eye?

Back 18

Decreased corneal sensitivity results in decreased blink rate and poor corneal wetting.

Front 19

Can a patient that has epiphora still have dry eye symptoms?

Back 19

Yes, because can have poor tear film quality.

Front 20

T/F - Parasympathomimetics can cause dry eye.

Back 20

False - ParasympathoLYTICS

Front 21

According to Dr. S, what is the "lipstick sign"?

Back 21

When lipstick sticks onto the teeth since the mouth is very dry - associated with Sjogren's syndrome.

Front 22

How soon should you evaluate TBUT after instilling NaFl?

Back 22

3 minutes after, because the saline added to the strip creates an artificial environment for the tear film

Front 23

What is OPI?

Back 23

Ocular protection index = TBUT/Blink rate. Under 1.0 = bad?

Front 24

Average tear meniscus is ___mm.

Back 24

0.2-1.0 mm

Front 25

What is Teargard?

Back 25

Artificial tears with lipid component

Front 26

Is it appropriate to Rx artificial tears PRN?

Back 26

No, must give patient a regimen e.g. 1 gtt at breakfast, lunch, dinner, QHS

Front 27

What kind of drops are appropriate for mucin deficiencies?

Back 27

Mucomimetic drops, topical vitamin A (Vit-A-drops), retinyl palmitate

Front 28

What is retinyl palmitate used for?

Back 28

Mucin deficiency

Front 29

What is Ultrabase?

Back 29

Lipopheric (lipid bearing) agent used in dry eye Tx

Front 30

What is lacrisert?

Back 30

Hydroxypropylcellulose rod inserted into inferior cul-de-sac QDay.

Front 31

What is the first choice for punctal occlusion?

Back 31

Collagen plugs

Front 32

Is it appropriate to use collagen plugs as first line Tx?

Back 32

No, must optimize ocular surface first (analogy = plugging up a dirty sink)

Front 33

Out of the procedures below, what would you recommend for dry eye: electrocautery or YAG laser occlusion?

Back 33

Electrocautery; YAG has poor tissue sealing

Front 34

Is it possible to get wet eye from dry eye?

Back 34

Yes - response to corneal irritation

Front 35

T/F - Congenital glaucoma is associated with dry eye.

Back 35

True (rare)

Front 36

T/F - At birth, if you see a blocked valve of Hasner, you should expect it to resolve on its own.

Back 36

True - 90% resolve spontaneously.

Front 37

Name the meds that cause a blocked/stenosed punctum.

Back 37

Idoxuridine, Phospholine iodide, Eserine, Epinephrine

Front 38

What is the causative agent of canaliculitis?

Back 38

Actinomyces israelii, causing sulfur granules that block the canaliculus

Front 39

Dacrycystitis = blocked canaliculus or lacrimal sac?

Back 39

blocked lacrimal sac

Front 40

How do you Tx congenital nasolacrimal obstruction?

Back 40

Topical ABs (sulfacetamide); if less than 6 mos, use massage and nasal decongest.

Front 41

How do you Tx bacterial canaliculitis?

Back 41

Warm compress, Penicillin G, Augmentin, curettage with canaliculotomy to remove liths

Front 42

What is a dacryocystorhinostomy?

Back 42

Rebuild nasolacrimal system, for chronic obstruction of the lacrimal drainage system

Front 43

Dacryoadenitis = lacrimal gland or sac?

Back 43

Lacrimal GLAND

Front 44

Dacryocystitis = lacrimal gland or sac?

Back 44

Lacrimal SAC

Front 45

T/F - Dacryoadenitis is more commonly chronic.

Back 45

True

Front 46

T/F - Dacryoadenitis = secondary acute more common than primary

Back 46

True

Front 47

Dacryoadenitis more common in (men/women) at around what age?

Back 47

Women (3rd to 4th decade)

Front 48

T/F - Dacryadenitis is infectious or inflammatory in etiology

Back 48

True

Front 49

Which type of Dacryoadenitis involves pain - acute or chronic?

Back 49

Acute

Front 50

Primary acute Dacryoadenitis = unilateral or bilateral?

Back 50

Unilateral; secondary = bilateral due to systemic condition

Front 51

T/F - Chronic Dacryoadenitis is usually infectious in nature.

Back 51

False - usually inflammatory

Front 52

How do you Tx acute and chronic Dacryoadenitis?

Back 52

Acute = ID causative agent, Augmentin

Chronic = r/o lacrimal gland tumor, Tx underlying cause, Tx dry eye

Front 53

What are the causative agents of acute Dacryocystitis?

Back 53

Staph aureus, strep; can see H. flu in children

Front 54

T/F - Dacryocystitis can be either congenital or acquired.

Back 54

True

Front 55

T/F - Acquired Dacryocystitis is usually unilateral.

Back 55

True

Front 56

T/F - Chronic Dacryocystitis involves pain.

Back 56

False - only Acute involves pain

Front 57

T/F - Acute Dacryocystitis can be associated with preseptal cellulitis

Back 57

True

Front 58

T/F - Acute Dacryocystitis involves only local pain.

Back 58

False - pain may radiate to teeth or ear

Front 59

What is the difference in discharge in acute vs chronic Dacryocystitis?

Back 59

Acute = purulent
Chronic = intermittent milky

Front 60

How long can congenital Dacryocystitis persist in children?

Back 60

9-12 months

Front 61

What is the Tx for acquired Dacryocystitis in children?

Back 61

Augmentin, Cefclor

Front 62

T/F - It is appropriate to dilate and irrigate an inflamed Dacryocystitis.

Back 62

False - NEVER dilate and irrigate if inflamed

Front 63

What is the Tx for acquired Dacryocystitis in adults?

Back 63

R/O tumor, never dilate/irrigate if inflamed, topical ABs if infected, oral ABs if tear sac is infected (Dicloxacillin, Cloxacillin, Keflex, Augmentin), analgesics, warm compress

Front 64

Is it appropriate to use antibiotics in chronic Dacryocystitis?

Back 64

ABs not indicated; Use lacrimal cilation and irrigation, warm compress; Can get surgery (Dacryocystorhinostomy)