Ocular Surface Disease Treatment Options Pharmacology II Quiz
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Questions and Answers

Which medication shows improvement in conjunctival staining and subjective measures of dry eye?

  • Lifitegrast (Xiidra)
  • Cyclosporine 0.09% (CEQUA)
  • Cyclosporine 0.05% (Restasis) (correct)
  • Artificial tears

    • What is the most common adverse effect of Cyclosporine 0.05% (Restasis)?

  • Ocular burning (correct)
  • Mild ocular hyperemia
  • Epiphora
  • Blur

    • What is the indication for Cyclosporine 0.09% (CEQUA)?

  • To relieve eye pain
  • To treat allergic conjunctivitis
  • To reduce ocular hyperemia
  • To increase tear production in keratoconjunctivitis sicca (correct)

    • Which medication has the highest FDA-approved concentration of cyclosporine A for Dry Eye?

    <p>Cyclosporine 0.09% (CEQUA)</p> Signup and view all the answers

    What is the reported adverse effect of CEQUA (cyclosporine ophthalmic solution) 0.09%?

    <p>Pain on instillation</p> Signup and view all the answers

    Which medication is known for its improvement in SPK and subjective measures of dry eye?

    <p>Cyclosporine 0.09% (CEQUA)</p> Signup and view all the answers

    What is the global dry eye definition according to TFOS DEWS II?

    <p>Dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, accompanied by ocular symptoms, and involving tear film instability, hyperosmolarity, ocular surface inflammation, damage, and neurosensory abnormalities.</p> Signup and view all the answers

    What is the core mechanism of Dry Eye Disease according to the Pathophysiology Report?

    <p>Tear hyperosmolarity</p> Signup and view all the answers

    Which factor damages the ocular surface directly and by initiating inflammation in Dry Eye Disease?

    <p>Tear hyperosmolarity</p> Signup and view all the answers

    According to TFOS DEWS II, what plays etiological roles in dry eye disease?

    <p>Tear film instability and hyperosmolarity</p> Signup and view all the answers

    What characterizes dry eye as per the TFOS DEWS II definition?

    <p>Loss of homeostasis of the tear film accompanied by ocular symptoms</p> Signup and view all the answers

    What is the role of neurosensory abnormalities in dry eye disease according to TFOS DEWS II?

    <p>They play etiological roles in initiating inflammation.</p> Signup and view all the answers

    Which of the following is a potential side effect of using Lacrisert?

    <p>Blurred vision</p> Signup and view all the answers

    What is the approximate duration for Lacrisert to dissolve once inserted in the eye?

    <p>14-18 hours</p> Signup and view all the answers

    What are the potential candidates for lacrimal occlusion therapy?

    <p>Patients with inflammatory etiology to dry eye</p> Signup and view all the answers

    Which type of plugs may result in retention of pro-inflammatory proteins?

    <p>Permanent silicone plugs</p> Signup and view all the answers

    What is the potential duration for the extended dissolvable synthetic absorbable plug Oasis?

    <p>5-6 months</p> Signup and view all the answers

    Which procedure involves the use of collagen rods that dissolve over 4-7 days?

    <p>Temporary synthetic plugs</p> Signup and view all the answers

    What type of plugs can be removed and have a contraindication of chronic dacryocystitis?

    <p>Intracanalicular silicone plugs</p> Signup and view all the answers

    What is the primary function of tear conservation ointments?

    <p>To retard evaporation</p> Signup and view all the answers

    What is the recommended frequency for using Lacrisert?

    <p>Once daily</p> Signup and view all the answers

    'Freeman plug' and 'Smart Plugs' are associated with which procedure?

    <p>Punctal occlusion</p> Signup and view all the answers

    What is the approximate diameter of collagen rods used in lacrimal occlusive devices?

    <p>0.2-0.6 mm</p> Signup and view all the answers

    What is the duration of use for Oasis, an extended duration absorbable plug?

    <p>4-6 months</p> Signup and view all the answers

    What is the most common complication associated with plug loss?

    <p>Canaliculitis</p> Signup and view all the answers

    Which device stimulates the external branch of the anterior ethmoidal nerve to increase tear production?

    <p>iTear100 device</p> Signup and view all the answers

    What is the main adverse event associated with the use of the iTear100 device?

    <p>Dizziness and light headedness</p> Signup and view all the answers

    What is the exact mechanism of action of TYRVAYA (varenicline solution) nasal spray?

    <p>Stimulates trigeminal parasympathetic pathway via the nose</p> Signup and view all the answers

    How should TYRVAYA nasal spray be administered to avoid complications?

    <p>Mist inside of nostril gently</p> Signup and view all the answers

    What is the purpose of TYRVAYA nasal spray?

    <p>Treatment of dry eye disease</p> Signup and view all the answers

    Which drug is a selective nicotinic acetylcholine agonist used in nasal spray form for dry eye disease?

    <p>Varenicline (TYRVAYA)</p> Signup and view all the answers

    According to the author, what is the overall certainty of evidence regarding the use of topical steroids for dry eye disease?

    <p>Moderate to very low certainty</p> Signup and view all the answers

    Which treatment option avoids painful drop instillation and offers ease of administration?

    <p>TYRVAYA nasal spray</p> Signup and view all the answers

    What is the main side effect associated with the use of TYRVAYA nasal spray?

    <p>Sneezing</p> Signup and view all the answers

    What is the purpose of the iTear100 device?

    <p>Increased basal tear film production</p> Signup and view all the answers

    Which drug stimulates tear secretion from meibomian glands, lacrimal glands, and goblet cells?

    <p>Varenicline (TYRVAYA)</p> Signup and view all the answers

    Artificial tear formulations preserved in bottle break down to nontoxic substances when exposed to light or ocular surface. Which substance breaks down to sodium chloride and water?

    <p>Stabilized Oxychloro Complex</p> Signup and view all the answers

    Which preservative in artificial tear formulations may cause epithelial toxicity and tear disruption?

    <p>Quaternary ammonium compounds (BAK)</p> Signup and view all the answers

    Which nutrient is essential for the differentiation and maintenance of mucosal epithelium, and its absence may lead to the loss of goblet cells?

    <p>Vitamin A</p> Signup and view all the answers

    Which of the following artificial tear formulations is a hypotonic solution that decreases osmolarity and is preserved with sodium perborate?

    <p>Thera Tears (ATF)</p> Signup and view all the answers

    Which artificial tear formulation is known for its nano-droplet technology, which helps retain lubricant on the ocular surface?

    <p>Systane COMPLETE</p> Signup and view all the answers

    What is the active ingredient in Eyesol® (perfluorohexyloctane based solution) that prevents evaporation of the aqueous layer in tears?

    <p>Perfluorohexyloctane</p> Signup and view all the answers

    Which ophthalmic solution is 100% perfluorohexyloctane drop, with no water, no preservative, and no other ingredients?

    <p>Miebo</p> Signup and view all the answers

    Which preservative free ophthalmic drop is also known as NOV03 and has a dual mode of action that affects abnormalities in the lipid layer and meibomian glands?

    <p>Miebo</p> Signup and view all the answers

    Which artificial tear formulation interacts with the lipophilic layer of tears to prevent evaporation and has low surface tension for rapid spread over the ocular surface?

    <p>Miebo</p> Signup and view all the answers

    In the SEECASE study, which ophthalmic solution showed benefits for signs and symptoms favoring QID application?

    <p>NOV03 (Miebo)</p> Signup and view all the answers

    Which artificial tear formulation is known for its proprietary polymer HP-Guar that chemically combines with borate in the pH environment of the eye to create a meshwork gel retaining active lubricants on the ocular surface?

    <p>Systane COMPLETE</p> Signup and view all the answers

    Which of the following is a result of tear hyperosmolarity in dry eye disease?

    <p>Release of inflammatory mediators and proteases</p> Signup and view all the answers

    In which form of dry eye disease does tear hyperosmolarity result from reduced lacrimal secretion?

    <p>Aqueous Deficient Dry Eye (ADDE)</p> Signup and view all the answers

    What is the main purpose of tear supplementation in dry eye treatment?

    <p>To reduce tear film instability</p> Signup and view all the answers

    What function do polysaccharides serve in artificial tear formulation?

    <p>Enhance viscosity and lubrication</p> Signup and view all the answers

    Which substance is an example of a viscoelastic polysaccharide used in artificial tear formulation?

    <p>Polyvinyl Alcohol (PVA)</p> Signup and view all the answers

    What do buffers in artificial tear formulation resist?

    <p>Change in pH</p> Signup and view all the answers

    What is the primary function of tonicity and pH regulators in artificial tear formulation?

    <p>To maintain effective osmolarity and pH</p> Signup and view all the answers

    What is the role of electrolytes in artificial tear formulation?

    <p>Maintain or lower osmolarity</p> Signup and view all the answers

    Which type of polymer serves to decrease blink friction and minimize surface tension in artificial tear formulation?

    <p>Mucilages</p> Signup and view all the answers

    Corticosteroids for dry eye are likely to provide what level of improvement in symptoms compared with artificial tears?

    <p>Small to moderate improvement (moderate certainty evidence)</p> Signup and view all the answers

    What is the FDA approval status of Cyclosporine 0.09%?

    <p>FDA approved in 2018</p> Signup and view all the answers

    What is the main mechanism of action of Cyclosporine in the eye?

    <p>Reduces apoptosis of conjunctival epithelial cells</p> Signup and view all the answers

    Which adverse reaction is NOT commonly associated with systemic Cyclosporine therapy?

    <p>Ocular pemphigoid</p> Signup and view all the answers

    What is the main effect of topical Cyclosporine on T cells?

    <p>Prevents T cells from releasing cytokines</p> Signup and view all the answers

    Which statement about the penetration of Cyclosporine into the eye is true?

    <p>It is limited due to the hydrophilic nature of the corneal stroma</p> Signup and view all the answers

    What is the primary indication for using Cyclosporine 0.05% (Restasis) in patients?

    <p>To increase tear production in patients with suppressed tear production due to ocular inflammation</p> Signup and view all the answers

    In conjunctival biopsies, how does Cyclosporine reduce dry eye symptoms?

    <p>By reducing apoptotic cells</p> Signup and view all the answers

    At what time period can significant improvement be expected after using Cyclosporine 0.05% (Restasis)?

    <p>6 months after starting treatment</p> Signup and view all the answers

    What is the primary function of tear supplementation in dry eye treatment?

    <p>To provide relief by replacing or augmenting natural tears</p> Signup and view all the answers

    Which artificial tear formulation interacts with the lipophilic layer of tears to prevent evaporation and has low surface tension for rapid spread over the ocular surface?

    <p>Miebo (Perfluorohexyloctane Ophthalmic Solution)</p> Signup and view all the answers

    What characterizes dry eye as per the TFOS DEWS II definition?

    <p>Instability of the tear film</p> Signup and view all the answers

    What is the purpose of the iTear100 device?

    <p>To avoid painful drop instillation and offer ease of administration</p> Signup and view all the answers

    Which medication has the highest FDA-approved concentration of cyclosporine A for Dry Eye?

    <p>Cyclosporine 0.09%</p> Signup and view all the answers

    What is the approximate duration for Lacrisert to dissolve once inserted in the eye?

    <p>3 to 7 days</p> Signup and view all the answers

    What preservative free ophthalmic drop is also known as NOV03 and has a dual mode of action that affects abnormalities in the lipid layer and meibomian glands?

    <p>Eyesol® (perfluorohexyloctane based solution)</p> Signup and view all the answers

    'MEIBO' is a perfluorohexyloctane drop that spreads uniformly over the ocular surface, preventing evaporation and sensitizing osmolarity changes. What type of liquid is perfluorohexyloctane?

    <p>Semifluorinated alkane liquid</p> Signup and view all the answers

    What is the main adverse event associated with the use of the iTear100 device?

    <p>Epithelial toxicity</p> Signup and view all the answers

    What is the main effect of topical Cyclosporine on T cells?

    <p>Inhibition of T cell proliferation</p> Signup and view all the answers

    What preservative in artificial tear formulations may cause epithelial toxicity and tear disruption?

    <p>BAK (Benzalkonium chloride)</p> Signup and view all the answers

    What is the core mechanism of Dry Eye Disease according to the Pathophysiology Report?

    <p>Tear film instability and hyperosmolarity</p> Signup and view all the answers

    What does TFOS DEWS II define dry eye as?

    <p>A disease of the tear film</p> Signup and view all the answers

    What is the main mechanism of action of Cyclosporine in the eye?

    <p>Reduction of ocular surface inflammation</p> Signup and view all the answers

    What role do neurosensory abnormalities play in dry eye disease according to TFOS DEWS II?

    <p>They contribute to tear film instability</p> Signup and view all the answers

    What is the global dry eye definition according to TFOS DEWS II?

    <p>A multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film</p> Signup and view all the answers

    What plays etiological roles in dry eye disease according to TFOS DEWS II?

    <p>Tear film instability and hyperosmolarity</p> Signup and view all the answers

    What damages the ocular surface directly and by initiating inflammation in Dry Eye Disease?

    <p>Tear hyperosmolarity</p> Signup and view all the answers

    What is the approximate duration for Lacrisert to dissolve once inserted in the eye?

    <p>~48 hours</p> Signup and view all the answers

    What are potential candidates for lacrimal occlusion therapy?

    <p>Punctal plugs or cautery</p> Signup and view all the answers

    Which medication shows improvement in conjunctival staining and subjective measures of dry eye?

    <p>Cyclosporine 0.09% (CEQUA)</p> Signup and view all the answers

    What is the FDA approval status of Cyclosporine 0.09%?

    <p>Approved for use in dry eye treatment</p> Signup and view all the answers

    What is the main consequence of tear hyperosmolarity in Dry Eye Disease?

    <p>Goblet cell and epithelial cell loss</p> Signup and view all the answers

    Which form of Dry Eye Disease is characterized by tear hyperosmolarity caused by excessive evaporation from the exposed tear film?

    <p>Evaporative Dry Eye (EDE)</p> Signup and view all the answers

    What is the primary function of tear supplementation in dry eye treatment?

    <p>To decrease tear hyperosmolarity</p> Signup and view all the answers

    Which substance functions to enhance viscosity, lubrication, retention time, and tear stability in artificial tear formulation?

    <p>Polysaccharides</p> Signup and view all the answers

    What are examples of viscoelastic substances used as polysaccharides in artificial tear formulation?

    <p>Sodium hyaluronate, chondroitin sulfate</p> Signup and view all the answers

    What do buffers in artificial tear formulation primarily resist?

    <p>Change in pH</p> Signup and view all the answers

    What is the purpose of tonicity and pH regulators in artificial tear formulation?

    <p>To maintain or lower osmolarity</p> Signup and view all the answers

    What do electrolytes in artificial tear formulation primarily maintain or lower?

    <p>Osmolarity</p> Signup and view all the answers

    You are designing an ideal artificial tear. What is the main characteristic of the polymer it should contain?

    <p>Enhanced viscosity and lubrication properties</p> Signup and view all the answers

    What is the primary role of polysaccharides in artificial tear formulation?

    <p>To decrease blink friction</p> Signup and view all the answers

    What is the primary function of sodium chloride and boric acid in artificial tear formulation?

    <p>To maintain tonicity and pH</p> Signup and view all the answers

    What effect does sodium hyaluronate (500,000 x viscosity saline) have in artificial tear formulation?

    <p>Increase viscosity</p> Signup and view all the answers

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