1.) Cul-de-sac

2.) tear meniscus

3.) tear film

1.) Conjunctival Capillaries

2.) tear film evaporation

3.) puncta

1.) superficial meibomian oils

2.) aqueous liquid phase

3.) innermost mucin layer

4.) microvilli

= Dry eye

Some reserve KCS for people with Sjogren syndrome.

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.

How many office visits are for dry eye complaints?

1.) Schirmer strips

2.) Tear Osmolarity

3.) TBUT

4.) Staining

1.) What tests to use.

2.) Interpretation of the tests.

3.) Diagnostic criteria.

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.

1.) Tear supplements

2.) Tear conservation

3.) Tear stimulation

 What do you call it when Batman skips church?

Christian Bale.

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

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.

Some artificial tears use electrolytes in their formulations.  Name three brands with hypotonic electrolyte formulations:

1.) Hypotears (214mOsm/L)

2.) Theratears (175 mOsm/L)

3.) Retaine MGD

Note that most artificial tears are isotonic.

True or false: 

BAK is a great preservative in artificial tears. You should recommend tears with BAK to your patients.

FALSE.

DO NOTTTT Select artificial tears with BAK. It is irritating and there are better options!!! DON'T. DO. IT.

1.) N-acetylcysteine

2.) tyloxapol (in many rewetting drops)

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

This is a biological grade water mist. 

It claims that artifical tears flush lipids, mucin and actually increases evaporation!

Similasan Dry Eye Relief 

Contains: mercurius sublimatis, belladonna, and euphrasia 

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 **

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 

1. Refresh Liquigel 

2. Refresh Optive

3. Refresh Optive Advanced 

4. Refresh Tears

1. Refresh Celluvisc

2. Refresh Classic

3. Preservative Fresh Refresh Optive

4. Preservative Free Refresh Optive Advanced

5. Refresh Plus 

Refresh Celluvisc. 

The 1% concentration makes the drop very thick, its usually too thick for most patients and causes a lot of blurry vision. 

Patient with allergies to wool (sheep?)

The ointment contains Lanolin 

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**

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. 

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**

1. It treats dry eye via tear stimulation. 

2. It is approved for xerostomia in sjogren syndrome. 

**This is a cholinergic agonist**

1. Salagen

2. Evoxac

3. Gland Transplantation

4. Hormones 

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 

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 **

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