2 - Ocular

Question 1

T/F Cornea has nerve fibers

Answer 1

T–you have feeling there!

Question 2

T/F cataracts develop on your eyes

Answer 2

F – in your eye. clouding of the lens of the eye.

Question 3

Which dosage form of eye drops are best?

Answer 3

suspension. best d/t surface. area. remind to shake gently. don’t refrigerate generally.

susp>soln>ung

Question 4

Describe S/Sx of allergic conjunctivitis and treatment.

Answer 4

diffuse, non-patterned redness.
scratchy, sandy gritty discomfort
vision may be blurry.
clear discharge and other symptoms such as runy nose, sneezing
topical decongestant–naphazoline, tetrahydrozoline qid for up to 72 hrs.

If the patient’s eyelid is bumpy but eye doesn’t hurt, likely a new allergen coming into contact with the eye. soap, make-up, detergents, **contact lens soln (preservative). May use ketotifen q12h

Question 5

Describe S/Sx of bacterial conjunctivitis.

Answer 5

yellow or purulent discharge.
not much discomfort but scratchy/gritty.
eyes being stuck shut in the morning–> use warm compress.
use OTC neosporin rubbed on junctin of the eyelids when eye is closed qid.

Question 6

What percentage of the pop devos allergy to neomycin?

Answer 6

11%

Question 7

Describe the S/Sx of iritis.

Answer 7

redness radiated out fromt he retina.
pupil will not constrict
discomfort, esp insunlight

–> inflamm of muscle internal to the eye

REFER. topical corticosteroid (prednisolone acetate 1% qid) and a mydriatic/cycloplegia (atropine 1% bid-qid). if on steroid for >2 wk must test IOP.

Question 8

Describe S/Sx and Tx of angle closure glaucoma.

Answer 8

pupil mid-dilated and redness raidates away from iris. **cloudiness of cornea. sig pain, bulging of eye.

oft d/t working in low light or new med that dilates pupil

**REFER IMMEDIATELY TO ER.

Tx: pilocarpine (myosis) or timolol(incr outflow) or hyperosmotic (isosorbide, counsel don’t drink)

Question 9

Describe S/Sx and Tx of a stye.

Answer 9

bulging swollen upper eyelid
Warm compress. 
Don't recommend ung. 
Topical antimicrobial might be useful. 
If doesn't resolve might need to be drained.

Question 10

Describe S/Sx and Tx of pseudomonas eye.

Answer 10

bacteria growth in cornea.
d/t wetting contacts w saliva.

clamp oopen eye and do contnuous abx drip

Question 11

What are key questions to ask if someone has splashed something into their eye?

Answer 11

What were you doing? 
Were you using any chemicla or cleaning products?
How much did you get into you eye?
How long ago? 
What did you do since the exposure?

Question 12

Would you rather slash acid or base in your eye?

Answer 12

acid burns are less damaging.

bases cause greater protein denaturation.

Question 13

How should chemical exposure of the eye be treated?

Answer 13

irrigate the eye
don’t alow pts to use contact soln or saline in bottle.

place head over sink and flood hand/eye w water

don’t ringe w strong stream that hits the cornea

refer to ER immediately

Question 14

What is normal IOP?

Answer 14

10-20 mmHg

Question 15

How would you treat a pt w high IOP?

Answer 15

timolol 0.25% bid (start low and go slow) 
prostaglandin analogues (lumigan 1%) q hs as IOP ften spikes in AM. 
alpha agonist (brimonidine 0.2%) tid

Question 16

What is the difference between ocular HTN and glaucoma?

Answer 16

decr in field of vision in glaucoma

Question 17

What are treatment options for ocular HTN and glaucoma

Answer 17

beta-blockers
prostaglandin analogues
carbonic anhydrase inhibiors
cholinergics
sympathomimetics

Question 18

Which type of glaucoma is a medical emergency?

Answer 18

angle-closure

Question 19

What is the goal of treating ocular HTN or glaucoma?

Answer 19

prevent blindness

Question 20

What are contraindications to use of beta-blockers?

Answer 20

asthma, COPD, CHF

Question 21

Which beta-blocker is beta1 specific?

Answer 21

betaxolol

Question 22

What is the frst-line beta blocker?

Answer 22

timolol 0.25%

Question 23

What are the primary ocular SEs of beta blockers?

Answer 23

stinging
punctate keratitis
corneal anesthesia

if experience last two, find another product

Question 24

What are the prostaglandin analogues?

Answer 24

bimatoprost (Lumigan) 0.03%
latanoprost (Xalatan) 0.005%
travoprost (Travatan, TravantanZ) 0.04%
Tafluprost (Zioptan) 0.0015%

Question 25

What are important counsel point for prostaglandin analogues?

Answer 25

admin hs***

SE: 
HA
**iris pigmentation
superficial punctate keratitis
**Latisse is for growing eyelashes; Lumigan is for tx of open angle glaucoma. 
stinging 
hyperema=redness

Question 26

What are the carbonic anhydrase inhibitors?

Answer 26

dorzolamide 2%
brinzolamide 1%
acetazolamide
methazolamide

Question 27

What is an important contraindiciation to carbonic anhydrase inhibitors?

Answer 27

sulfa allergy

Question 28

What are important counselling points for CAIs?

Answer 28

SEs: metalic taste (candy), drwosy, malaise, paresthesias
Can use in pts with low CrCl
Cap thebottle to minimize crystallization

Question 29

What cholinergic products are used to Tx ocular HTN and glaucoma?

Answer 29

pilocarpine 0.25%-10%
carbachol 0.75%-3%
echothiophate iodide 0.03%-0.25%

these products constict the pupil and move iri forward

not going to be on exam

Question 30

What are the hyperosmotic agents? What are they used to treat? Tips?

Answer 30

mannitol
glycerin
isosorbide

glycerin cheap–add flavor
don’t drink
only isosorbide in DM

Question 31

What are the sympathomimetic agents used to lower IOP?

Answer 31

dipiverfin
aproclonidine
brimonidine

Question 32

Describe use of brimonidine in reducing IOP.

Answer 32

sympathomimetic.
0. 1 or 0.15% bid-tid

SSE: fatigue, conjunctival blanching, lid restraction

Alphagan-P contains Purite (pool chemical, penetration)

Question 33

What are the most common ocular corticosteroids?

Answer 33

prednisolone acetate 1% (pred forte)

flurometholone acetate 0.1% (Flarex)

Question 34

What is the primary mydriatic cyclopegic prscribed for inflammation?

Answer 34

Atropine 1% up to 1 wk

Question 35

What are Tx options for allergic conjunctivitis?

Answer 35

ocular vasoconstrictors
naphazoline (Naphcon) 6-8 x d
oxymetazoline (Visine LR) 2-4 x d
tetrahydrozoline (Visine ) 3-4 x d

max 3 d

start w a simple decongetant. keottifen.

Question 36

Describe dry eyes and tx.

Answer 36

oft have incr secretion
bothersome, gritty

tx: decr contact wearing
decr time in front of screen
artificial tears
if these don’t work–> refer

Question 37

What would be the first line treatment for ocular hyperten in a pt with COPD?

Answer 37

prostaglandin analgoues and CAIs.
sympathomimetics typ not first line.
not betablockers unless insist cheaper–punctal occulsion. bid.