1. Eye *complete*

Question 1

Eye preparations application

Answer 1

Leave 5 min gap between eye preparations to prevent drug dilution and the eye overflowing.
Longer intervals will be needed for gels as they are more viscous and willl take longer to be absorbed.
Ointments should be applied last as they take the longest

Question 2

Eye prepations counselling

Answer 2

Transient blurred vision common with eye preparations. More with eye ointements for up to 10-15 minutes. So are applied at bedtime for this reason.

Question 3

Eye preparations expiry dates

Answer 3

Home use - 28 days
Hospital/ward - 1 week
Outpatients/surgery - single application

Question 4

Preservatives in eye drops

Answer 4

Benzalkonium chloride commonly used. Can cause stinging and irritation especially at first application.

Question 5

Eye drops and contact lenses

Answer 5

• Hard lenses - can still use eye drops whilst wearing the lenses
• Soft lenses - must remove lenses before using eye drops OR can use preservative-free eye drops as preservatives accumulate in soft lenses
• Lenses should NEVER be worn when applying eye ointments/oily eye drops.

Question 6

Drugs and contact lenses considerations

Answer 6

Rifampicin and sulfasalazine stain bodily fluids such as tears, this stains contact lenses orange

Question 7

Allergic conjuctivitis

Answer 7

Caused by allergies

Question 8

Allergic conjuctivitis treatment

Answer 8

1. Sodium cromoglicate (mast stell stabiliser)
2. Antazoline, Azelastine (antihistamine)
3. Xylometazoline, Naphazoline (vasoconstrictors reduce redness)

Question 9

Dry eyes

Answer 9

Treated with tear replacement

Hypromellose - applied hourly
Carmellose - applied QDS

Thicker formulations such as carbomer gels are more moisturising and reduce frequency of application

Question 10

Bacterial conjunctivitis

Answer 10

Chloramphenicol eye drops/ointment

Question 11

Viral conjunctivitis associated with herpes simplex virus

Answer 11

Viral conjuctivitis usually caused by cold/flu which is self limiting. However if it is associated with herpes simplex virus can use….

Aciclovir: 5 times daily and until 3 days after healing

Question 12

Blepharitis

Answer 12

Chloramphenicol can be applied to the lid margins to help.
If pus is present it may be a stapphylococcal infection - fuscidic acid would treat it

Question 13

Eye inflammation and topical steroids

Answer 13

Topical corticosteroids are used to reduce inflammation BUT have following side effects:
* glaucoma and cataracts
* increase susceptibility to infections and aggravating existing infections

Can lead to corneal ulcers and red eye if used improperly, when the cause of the eye inflammation is not treated

Corneal ulcers = DANGEROUS, as they can lead to blindness.

Question 14

Corneal ulcers treatment

Answer 14

Intensive antibiotic course with ciprofloxacin administered every 15 minutes for the first 6 hours

Question 15

Eye examinations/procedures

Answer 15

Cycloplegics/Mydriatics are used to dilate the pupils for eye examinations

• Antimuscarinics such as atropine
• Phenylephrine

Phenylephrine interacts with MAOI antidipressants. Should not be used in patients taking this due to risk of hypertensive crisis.

Patients should not drive until visiion is clear

Question 16

Glaucoma

Answer 16

Characterised by raised intra-ocular pressure

Question 17

Glaucoma treatment

Answer 17

First line:
1. Beta blockers, e.g betaxolol
Contraindicated in asthma

2. Prostaglandin analogues e.g latanoprost
   Side effects: long lashes, darkens iris colour

Second line
1. Sympathomimetic eye drops, e.g brimonidine

2. Carbonic anhydrase inhibitors eye drops, e.g brinzolamide, dorzolamide

-lamide

Question 18

Closed-angle glaucoma

what are the signs

Answer 18

MEDICAL EMERGENCY

• cloudy eye,
• nausea and vomiting
• headache
• intense eye pain
• blurred hazy vision
• rainbow-coloured rings around lights
• sight loss