Chapter 57: Dry Eye Syndrome

Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A patient experiencing chronically dry eyes reports having a foreign body sensation, burning, and itching. A Schirmer test is abnormal. What is the suspected cause of this patient’s symptoms based on this test finding?

a. Aqueous deficiency b. Corneal abrasion c. Evaporative disorder d. Poor eyelid closure

ANS: A

An abnormal Schirmer test, which assesses aqueous production, indicates aqueous-deficient dry eye. A corneal abrasion usually causes excessive tearing. An evaporative disorder is determined by an evaluation of tear breakup time. Poor eyelid closure causes increased corneal exposure and increased evaporation of tears.

Multiple Response

1. A patient has evaporative dry eye syndrome with eyelid inflammation. What are some pharmacologic and nonpharmacologic measures the provider can recommend? (Select all that apply.)

a. Apply over-the-counter artificial tears as needed.

b. Avoid direct exposure to air conditioning.

NURSINGTB.COM c. Topical steroid eye drops as a maintenance medication. d. Use nontearing baby shampoo to gently scrub the eyelids. e. Use tetrahydrozoline drops for discomfort

ANS: A, B, D

Patients with dry eye are encouraged to use OTC artificial tears to help moisten the eyes. Avoiding exposure to fans, air conditioning, and wind is recommended. Nontearing baby shampoo may be used to cleanse the lids in patients with eyelid inflammation. Topical steroid eye drops should be used sparingly and for short periods of time. Tetrahydozoline drops constrict blood vessels and may dry eyes further.

Chapter 58: Nasolacrimal Duct Obstruction and Dacryocystitis

Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. An adult patient with a history of recurrent sinusitis and allergic rhinitis reports chronic tearing in one eye, ocular discharge, and eyelid crusting. The provider suspects nasolacrimal duct obstruction. Which initial treatment will the provider recommend?

a. Antibiotic eye drops b. Nasolacrimal duct probing c. Systemic antibiotics d. Warm compresses

ANS: D a. Eyelid scrubs with baby shampoo b. Incision and drainage c. Lacrimal bypass surgery d. Topical antibiotic ointment

This is most likely acquired nasolacrimal duct obstruction. Initial treatment should include warm compresses. Antibiotics are only used if infection is present. Nasolacrimal duct probing is not useful for acquired conditions; definitive treatment usually requires surgery.

2. A patient is diagnosed with dacryocystitis. The provider notes a painful lacrimal sac abscess that appears to be coming to a head. Which treatment will be useful initially?

ANS: B

When an abscess is present and coming to a head, incision and drainage may be useful. Definitive treatment with lacrimal bypass surgery will be performed once the acute episode has resolved. Eyelid scrubs and topical ointments are not effective.

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