Dry Eye That s Not Dry Eye
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- Evelyn Horn
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1 Dry Eye That s Not Dry Eye All burning, irritated eyes aren t dry eye. This course will present several anterior segment cases that were initially misdiagnosed as Dry Eye Disease. Attendees will be offered case history, exam data and diagnostics testing results to interactively arrive at the proper conclusion. The course takes a deep dive into potential differential diagnoses that mimic Dry Eye Disease. Each case reviewed are conditions commonly seen in optometric practice and offer clinical application. Objectives: To accurately identify signs and symptoms of Dry Eye Disease To demonstrate the clinical applications and benefits of diagnostic testing in ocular surface disease To inform attendees about anterior segment conditions that mimic Dry Eye Disease To educate primary care optometrists about sign and symptoms and potential differential diagnoses in Dry Eye Disease To provide clinical cases to illustrate principles outlined in the course. Outline I. Dry Eye Disease a. Demographics
2 i. Females>Males ii. Changing demographics b. Causes i. Anatomical ii. Physiological iii. Autoimmune 1. Sjögren s syndrome 2. Lupus a. Primary b. Secondary 3. Rheumatoid arthritis iv. Modern risk factors 1. Surgical a. Cataract b. Refractive c. Oculo-plastic v. Medications vi. Hormone changes 1. Menopause 2. Birth control pills 3. Pregnancy vii. Diseases 1. Diabetes 2. Thyroid conditions c. Sign and symptoms
3 II. i. Hyperemia ii. Epiphora iii. Irritation iv. Visual fluctuations 1. Blur 2. Contrast sensitivity Case #1 Conjunctivochalsis 1. Oculus keratograph Tear Prism Height a. May present as artifact ii. Allergic Conjunctivitis 1. No true chemosis 2. No response to allergy medications iii. Conjunctivochalsis
4 III. d. Treatment options i. Pinch-Paste technique 1. Pre- and Post-operative considerations 2. Conjunctival buttonhole created 3. Fibrin glue injected (hold 30 seconds) 4. Excise excess conjunctiva 5. Pre- and Post- photos provided ii. Conjunctival revision with amnio-graft iii. Risks and benefits Case #2 Punctal Stenosis 1. Oculus keratograph Tear Prism Height 2. Phenol red thread (PRT) testing results ii. Nasal lacrimal duct obstruction
5 IV. 1. Discussion about dilation and irrigation a. Appropriate to time perform b. Technique c. Risks and benefits iii. Puntal stenosis 1. Causes a. Aging b. Medications Case #3 Allergic Conjunctivitis ii. Blepharitis iii. Allergic conjunctivitis 1. Anterior segment findings a. Papillae at palpebral conjunctiva
6 b. Edematous puncta resulting in epiphora 2. Treatment options a. Ophthalmic allergy medications b. Oral allergy medications c. Allergy injections d. Avoidance of allergen V. Case #4 Post-Operative inflammation s/p Cataract extraction with intraocular lens 1. Chronic photophobia OD only 2. 6 months s/p CE/IOL a. Anterior chamber reaction ii. Foreign Body iii. Uveitis s/p CE/IOL
7 VI. 1. Treatment options a. Topical steroids b. Steroid injection c. Surgery Case #5 Decompensated Phoria 1. Constant lateral diplopia 1. 6 months iv. Refractive data 1. Phorias ii. Decompensated phoria 1. Diagnostic considerations a. Imaging
8 2. Treatment options a. Occulsion b. Prismatic correction
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