2. Fatemeh Dashti Optometrist . BSc - MSc

4. Lacrimal system

17. Dry eye clasification

18. Tear deficient dry eye

19. Evaporative dry eye

20. Dry eye classification

21. Classification scheme for dry eye proposed by NEI/industry workshop

27. Symptoms of Ocular Surface Disease Current Triggers of Dry Eye Disease Environment Medications Contact Lens Surgery Rheumatoid Arthritis Lupus Sjögren’s Graft vs Host Postmenopause Meibomian Gland Disease Inflammation Tear Deficiency/ Instability Irritation

31. symptoms

38. Propose mechanism of ocular surface inflammation in dry eye

42. Dry eye diagnostic tests Type of evaluation Test Tear secretion Schirmer I,John”s test, cotton thred test, Dye clearance test, Fluorophotometery Tear stability Invasive BUT- NoninvasiveBUT Tear film integrity Epithelial integrity Rose bengal staining Physical feature Osmolality , PH, Ferning evaporation rate Chemistry Electrolytes, Protein(lysozyme, lactoferin) Histology Imperssion cytology, lacrimal gland biopsy, minor salivary gland biopsy

44. Tear break up- time test

47. NITBUT

48. NITBUT

51. Fluorescein clearance test (FCT)

53. Tear film osmolarity Lacrimal gland disease Decreased corneal sensation Increased palpebral fissure Meibomian gland dysfunction Decreasde sensation Increased evaporation Increased tear osmolarity

55. Normal osmolarity : 300-310 mosm/l

56. Tear film osmolarity Condition Expected range of value Normal < 312 mosm/l Borderline dry eye 312- 323 mosm/l Moderate/severe dry eye > 323 mosm/l

58. Schirmer test

63. Phenol red test

73. Meibomian gland evaluation-NORMAL

74. Meibomian gland evaluation-MGD

78. Corneal esthesiometry

81. VALUES IN NORMAL TEAR AND DRY EYE

82. INTERFEROMETRY OF THE LIPID LAYER

83. Tearscope –plus lipid layer thickness(LLT)

87. Ferning test

88. Levels of severity of dry eye disease

89. Treatment

99. Preservative – free artificial tears

104. Emollients : simple Eye pomades

107. artificial tear spray Less chance of contamination . Tears Again Liposome spray (10cc) ($15) ( occusoft) Natures Tears Eye Mist (10cc) ($7) (all scripts)

112. collagen discs & plugs

117. Transplantation of secretory glands

118. Dry eye treatment recommendations by severity level

119. Dry eye treatment recommendations by severity level

120. Dry eye treatment recommendations by severity level

121. Dry eye treatment recommendations by severity level

122. Never walk on the traveled path, because it only leads you where the others have been. Graham Bell