2 - Ocular Flashcards
T/F Cornea has nerve fibers
T–you have feeling there!
T/F cataracts develop on your eyes
F – in your eye. clouding of the lens of the eye.
Which dosage form of eye drops are best?
suspension. best d/t surface. area. remind to shake gently. don’t refrigerate generally.
susp>soln>ung
Describe S/Sx of allergic conjunctivitis and treatment.
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
Describe S/Sx of bacterial conjunctivitis.
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.
What percentage of the pop devos allergy to neomycin?
11%
Describe the S/Sx of iritis.
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.
Describe S/Sx and Tx of angle closure glaucoma.
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)
Describe S/Sx and Tx of a stye.
bulging swollen upper eyelid Warm compress. Don't recommend ung. Topical antimicrobial might be useful. If doesn't resolve might need to be drained.
Describe S/Sx and Tx of pseudomonas eye.
bacteria growth in cornea.
d/t wetting contacts w saliva.
clamp oopen eye and do contnuous abx drip
What are key questions to ask if someone has splashed something into their eye?
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?
Would you rather slash acid or base in your eye?
acid burns are less damaging.
bases cause greater protein denaturation.
How should chemical exposure of the eye be treated?
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
What is normal IOP?
10-20 mmHg
How would you treat a pt w high IOP?
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
What is the difference between ocular HTN and glaucoma?
decr in field of vision in glaucoma
What are treatment options for ocular HTN and glaucoma
beta-blockers prostaglandin analogues carbonic anhydrase inhibiors cholinergics sympathomimetics
Which type of glaucoma is a medical emergency?
angle-closure
What is the goal of treating ocular HTN or glaucoma?
prevent blindness
What are contraindications to use of beta-blockers?
asthma, COPD, CHF
Which beta-blocker is beta1 specific?
betaxolol
What is the frst-line beta blocker?
timolol 0.25%
What are the primary ocular SEs of beta blockers?
stinging
punctate keratitis
corneal anesthesia
if experience last two, find another product
What are the prostaglandin analogues?
bimatoprost (Lumigan) 0.03%
latanoprost (Xalatan) 0.005%
travoprost (Travatan, TravantanZ) 0.04%
Tafluprost (Zioptan) 0.0015%
What are important counsel point for prostaglandin analogues?
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
What are the carbonic anhydrase inhibitors?
dorzolamide 2%
brinzolamide 1%
acetazolamide
methazolamide
What is an important contraindiciation to carbonic anhydrase inhibitors?
sulfa allergy
What are important counselling points for CAIs?
SEs: metalic taste (candy), drwosy, malaise, paresthesias
Can use in pts with low CrCl
Cap thebottle to minimize crystallization
What cholinergic products are used to Tx ocular HTN and glaucoma?
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
What are the hyperosmotic agents? What are they used to treat? Tips?
mannitol
glycerin
isosorbide
glycerin cheap–add flavor
don’t drink
only isosorbide in DM
What are the sympathomimetic agents used to lower IOP?
dipiverfin
aproclonidine
brimonidine
Describe use of brimonidine in reducing IOP.
sympathomimetic.
0. 1 or 0.15% bid-tid
SSE: fatigue, conjunctival blanching, lid restraction
Alphagan-P contains Purite (pool chemical, penetration)
What are the most common ocular corticosteroids?
prednisolone acetate 1% (pred forte)
flurometholone acetate 0.1% (Flarex)
What is the primary mydriatic cyclopegic prscribed for inflammation?
Atropine 1% up to 1 wk
What are Tx options for allergic conjunctivitis?
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.
Describe dry eyes and tx.
oft have incr secretion
bothersome, gritty
tx: decr contact wearing
decr time in front of screen
artificial tears
if these don’t work–> refer
What would be the first line treatment for ocular hyperten in a pt with COPD?
prostaglandin analgoues and CAIs.
sympathomimetics typ not first line.
not betablockers unless insist cheaper–punctal occulsion. bid.
