Home' Australian Pharmacist : Australian Pharmacist March 2015 Contents Australian Pharmacist March 2015 I ©Pharmaceutical Society of Australia Ltd.
1. Why must ocular irritation be
considered a complex clinical
a) The eye is the province of eye care
practitioners and is beyond the scope of
b) The ocular surface is a finely balanced
and complex environment that may
be subject to numerous physiological
responses and imbalances.
c) The variety of demulcent eye drops
on the market makes it hard to give
d) Ocular irritation may be an indicator of
an underlying systemic condition.
2. Why are abnormalities in the lipid
layer important in multiple ocular
a) Abnormalities in lipid layer chemistry
reflect imbalances in systemic lipid
b) The lipid layer facilitates the
immune reaction that decreases the
physiological response in allergic
c) Visible changes in the lipid layer to the
naked eye allow for a rapid diagnosis of
different ocular surface conditions.
d) The lipid layer is essential for the
stabilisation of the tear film and
qualitative or quantitative changes in
the lipid layer result in symptoms of
3. What is the MOST APPROPRIATE
order to manage mixed ocular
a) Treat the irritation resulting from dry
b) Treat the dry eye, allergies and
meibomian gland dysfunction
simultaneously with multiple eye drops.
c) Manage any allergies or inflammation
first to see if the dry eye symptoms
resolve and then separately determine
a protocol to treat residual evaporative
dry eye symptoms.
d) Advise the patient to completely
change their lifestyle and/or work
environment to minimise exposure
to environmental factors that may be
affecting their condition.
4. What are the advantages of
phospholipid eye sprays in
evaporative dry eye?
a) Phospholipid eye sprays are more cost
effective than demulcent eye drops.
b) Phospholipid eye sprays also rejuvenate
the perio-ocular skin.
c) Phospholipid eye sprays increase the
tear film volume rapidly.
d) Phospholipid eye sprays work to
stabilise the existing tear film without
increasing tear volume, providing
increased comfort, improved vision and
long duration of effect.
is the relatively large amount of
phospholipids in the eye drops and
increase in tear film volume, which
often negatively impact clarity of vision
for some time after the eye drops
An alternative way to amplify the
tear film phospholipids is to use a
topical spray containing soy-derived
phosphytidylcholine. This substance is
sprayed onto the closed eye enabling
the eyelashes to retain a small quantity
in the manner similar to that in which
the bristles on a paint brush retain
paint. The phosphytidylcholine is
then transferred across the lid margin
onto the tear film with the blink
action. As a result there is usually a
visible improvement in tear break
up time within a few minutes, and
studies suggest there is an on-eye
duration of action of 90 minutes or
more. The absence of an increased
tear film volume means there are no
adverse effects on clarity of vision post
instillation; in fact, some studies show
an improvement in clarity of vision
post-instillation. The rapid application
mechanism is useful for time poor
patients or those who are unable to
instil eye drops into their open eye due
to aversion. This alternative delivery
system of the polar phospholipid
phosphytidylcholine is both useful as a
first line treatment, and as an adjunct to
existing demulcent preparations.5,6
Identifying and managing the ‘walking
wounded’ of ocular surface disease can
be a rewarding clinical challenge that
results in many grateful patients. It pays
to be aware of the ocular surface when
consulting with patients regarding their
ocular symptoms, as well as being aware
of all the available treatment modalities
that may be used to restore the ocular
surface and tear film to homeostasis.
1. Gipson IK, Aregüeso P, Beuerman R, et al. Research in dry eye:
report of the research sBsubcommitteee of the international
dry eye workshop. Ocul Surf 2007;5(2):179–193.
2. Behrens A, Doyle JJ, Stern L, et al. Dysfunctional
tear syndrome – A Delphi approach to treatment
recommendations. Cornea 2006;25(8):900–908 .
3. Schaumberg DA, Nicholls JJ, Papas EB, et al. The
International Workshop on meibomian gland dysfunction:
report of the subcommittee on the epidemiology of, and
associated risk factors for MGD. Invest Opthalmol Vis Sci
4. Campbell D, Griffiths G, Tighe BJ. Tear analysis and
lens-tear interactions: part 2 ocular lipids – nature
and fate of meibomian gland phospholipids. Cornea
5. Lee S, Dausch S, Maierhofer G, et al. A new therapy
concept with a liposome eye spray for the treatment of
“dry eye”. Klin Monbl Augenheilkd 2004;221:1–12.
6. Dieter D, Suwan L, Dausch S, et al. Comparative study of
treatment of the dry eye syndrome due to disturbances
of the tear film lipid layer with lipid-containing tear
substitutes – efficacy of lipid-containing tear substitutes.
Klin Monbl Augenheilkd 2006;223:974–83 .
7. Craig JP, Purslow C, Murphy PJ, et al. Effect of a liposomal
spray on the preocular tear film. Cont Lens Anterior Eye
8. Ehlers WH, Donshik PC. Allergic ocular disorders: a
spectrum of diseases. CLAO J 1992;18(2):117–24.
9. Suzuki S, Goto E, Dogru M, et al. Tear film lipid
layer alterations in allergic conjunctivitis. Cornea
10. Lemp MA, Crews LA, Bron AJ, et al. Distribution of aqueous
deficient and evaporative dry eye in a clinic based patient
cohort: a retrospective study. Cornea 2012;31(5):472–8 .
11. McCulley JP, Uchiyama E, Aronowicz JD, et al. Impact of
evaporation on aqueous tear loss. Trans Am Ophthalmol
Soc 2006;104:121–8 .
12. Lemp MA, Baudouin C, Baum J, et al. The definition and
classification of dry eye disease. Ocul Surf 2007;5(2):75–92.
13. Gothwal VK, Pseudovs K, Wright TA, et al. McMonnies
questionnaire: enhancing screening for dry eye
syndromes with Rasch analysis. Invest Opthalmol Vis Sci
14. Tomlinson A, Bron AJ, Korbut DR et al. The International
Workshop on meibomian gland dysfunction: report of
the diagnosis subcommittee. Invest Opthalmol Vis Sci
15. Geerling G, Tauber J, Baudoin C, et al. The International
Workshop on meibomian gland dysfunction: report of
the subcommittee on management and treatment of
meibomian gland gysfunction. Invest Opthalmol Vis Sci
16. Plugfelder SC, Geerling G, Kinoshita S, et al. Management
and therapy of dry eye disease: report of the management
and therapy subcomittee of the international dry eye
workshop. . Ocul Surf 2007;5(2):163–78.
Answer online at www.psa.org.au
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