38. Common Conditions of the Eyes and Ears Flashcards
Med abbreviation: AD
Right ear
Med abbreviation: AS
Left ear
Med abbreviation: AU
Each ear
Med abbreviation: OD
Right eye
Med abbreviation: OS
Left eye
Med abbreviation: OU
Each eye
Eye/ear Solutions: 1 drop = ___ mL
0.05mL
What is a counseling point for eye/ear ointments?
Apply to conjunctival sac or over lid margins (for blepharitis)
Can make vision blurry, do not use with contacts
What is a counseling point for ewye gels?
With cap on, invert and shake once to get med into tip before instilling into eye
Glaucoma is a disease of the eye that results in ____
damage to optic nerve and loss of visual field (i.e., the vision straight ahead and peripheral vision, measured by visual field test)
In most cases, intraocular pressure (IOP) is above the normal range of ____ in glaucoma
12-22 mmHg
Goal of treatment for glaucoma is ___
to reduce IOP
What are the 2 different types of glaucoma?
Open-angle glaucoma (most common) - without symptoms and treated with eye drops or surgery
Closed-angle glaucoma - sharp sudden increase in IOP d/t blockage, presents with eye pain, HA, and decreased vision. Considered med emergency that is treated surgically
Drugs that can increase IOP
anticholinergics (e.g. antihistamines, oxybutynin, tolterodine, benztropine, scopolamine, trihexyphenidyl, TCA)
Decongestant (e.g. pseudoephedrine)
Chronic steroids , esp eye drops such as prednisolone (Pred Forte)
Topiramate (Topamax)
Glaucoma treatments decrease IOP by targeting ____ in 2 main ways: ____, ___, or both
the aqueous humor (fluid in the eye)
Reduce aqueous humor production (make less fluid) - beta-blockers (timolol), carbonic anhydrase inhibitors (drozolamide)
Increase aqueous humor outflow (move fluid out) - prostaglandin analogs (lantaoprost)
Both - often with add-on, alpha-2 agonists (brimonidine)
What glaucoma med is most effective at decreasing IOP (~30%)?
Prostaglandin analogs (used 1 drop once daily)
Which glaucoma med is preferred if the pressure is high in only one eye?
Beta-blockers (b/c darkening of iris and eyelash thickening seen with prostaglandin analogs is not desirable in only one eye (uneven))
How do prostaglandin analogs work for glaucoma?
Increase aqueous humor outflow
Examples of prostaglandin analogs used in glaucoma
Bimatoprost (Lumigan)
Latanoprost (Xalatan, Xelpros)
travoprost (Travatan Z)
Note: Bimatoprost (Latisse) inidcated for eyelash hypotrichosis (inadequate growth of eyelashes), do NOT use with prostaglandin analogs indicated for glaucoma
Warnings with prostaglandin analogs used in glaucoma
Darkening of iris, eyelid skin, and eyelashes
Eyelash growth/thickening
Side effects with prostaglandin analogs used in glaucoma
Blurred vision, stinging, increased pigmentation or iris/eyelashes, eyelash growth/thickening
Lantanoprost, latanoprostene bunod, tafluprost storage notes
Refrigerator BEFORE opening, store at room temp after opening
How do beta-blockers work for glaucoma?
Reduce aqueous humor production
Timolol 0.25%, 0.5% (Timoptic, Timoptic-XE, Istalol) dosing and administration notes
1 drop daily or BID
Timoptic-XE, Timolol GFS (gels): daily
Gels: shake once before use; wait 10 min after administering other eye drops before inserting gel
Side effects of timolol
Burning, stinging, bradycardia/fatigue, bronchospasm with non-selective agents, itching or eyes/eyelids, changes in vision, increased light sensitivity
Beta-blockers used in glaucoma are all non-selective except ____ which is less likely to cause pulmonary adverse effects in pts with asthma/COPD
betaxolol
In timolol/dorzolamide (Cosopt PF), what does PF stand for?
Preservative free
How do cholinergics (Carbachol (Miostat), piloarpine (Isopto Carpine)) work for glaucoma?
Increase aqueous humor outflow
Side effects of cholinergics (Carbachol (Miostat), piloarpine (Isopto Carpine)) used in glaucoma
Poor vision at night d/t pupil constriction
Others: corneal clouding, burning (transient), hypotension, bronchospasm, abd cramps/GI upset
How do carbonic anhydrase inhibitors work for glaucoma?
Reduce aqueous humor production
-zolamide (carbonic anhydrase inhibitors used for glaucoma) = caution with ____ allergy
sulfonamide
Which carbonic anhydrase inhibitor is used infrequently for glaucoma; it is used for prevention and treatment of acute mountain (altitude) sickness?
Acetazolamide
Examples of carbonic anhydrase inhibitors
Dorzolamide (Trusopt)
Brinzolamide (Azopt)
Acetazolamide - oral, injection
Methazolamide - oral
How do Adrenergic Alpha-2 agonist work for glaucoma?
increase aqueous humor outflow, reduce aqeuous humor production
Examples of Adrenergic Alpha-2 agonist
Brimonidine (Alphagan P)
Apraclonidine (Iopidine)
counseling points to prevent spread of conjunctivitis (“pink eye”)
Avoid touching eyes
Use proper hand hygiene and wash hands thoroughly and frequently
Change towels and washcloths daily - do not share wit others
Discard eye cosmetics esp mascara
Conjunctivitis (“pink eye”) can be d/t ___
virus, bacteria, allergen, or some type of ocular irritant such as chemical or contact lenses
Viral conjunctivits causes and treatment
Adenovirus (most common)
No topical treatment, will last days to 3 weeks
Bacterial conjunctivitis causes and treatment
S. aureus (others: strep pneumoniae, H. influenzae, Moraxella catarrhalis)
Most severe cases caused by Neisseria gonorrhoeae or Chlamydia - requires systemic treatment
Moxifloxacin (Vigamox)
Neomycin/Polymyxin B/Dexmethasone (Maxitrol)
Ofloxacin (Ocuflox)
Trimethorpim/Polymyxin B (Polytrim)
Azithromcyin (AzaSite) - store in fridge, stable for 14 days at room temp
Others: besifloxacin (Besivance), ciprofloxacin (Ciloxan), erythromycin, gentamicin (Gentak), neomycin/bacitracin/polymyxin B (Neo-Polycin), tobramycin (Tobrex), tobramycin/bdexamethasone (TobraDex), Sulfacetamide (Bleph-10)
Allergic conjunctivitis causes and treatment
Common allergens - pollen, dust mites, animal dander, molds
Mast cell stabilizers: cromolyn, lodoxamide (Alomide), nedocromil (Alocril)
Antihistamines: azelastine, olopatadine (Pataday) OTC, cetirizine (Zerviate), epinastine
Antihistamine/Mast Cell Stabilizer: Ketotifen (Alaway, Zaditor) OTC, alcaftadine (Lastacaft)
Note: prednisolone/steroid eye drops often used acutely for severe reaction but not long term d/t risk of increased IOP
What is blepharitis?
eyelid inflammation, most commonly involves eyelid margins (Where eyelashes come out of skin)
How to treat blepharitis?
warm moist washcloth for compress
Symptom-based ophthalmic treatments: inflammation of the eye
cold compress and either an NSAID eye drop (if mild, ketorolac (Acular)) or steroid eye drop (if severe, Predniosolone (Pred Forte, Pred Mild))
Why do most eye drops burn?
Preservatives (common one is benzalkonum chloride BAK) or actual drug in the eyedrops
Contact lenses trap drug and preservatives against the surface of the eye, making irritation worse - lenses should be removed before using eye drops and wait 15min after admin before reinserting (esp with drops containing preservative BAK, can damage eyes when used with contacts)
PF formulations for pts who cannot tolerate side effects
Symptom-based ophthalmic treatments: Dryness
Refresh (OTC)
Systane (OTC)
aka artificial tears
Symptom-based ophthalmic treatments: Chronic Dry Eye disease
Cyclosporine Emulsion eye drops (Restasis) - indicated for keratoconjunctivitis sicca (severe, chronic dry eye syndrome)
Others: lifitegrast (Xiidra), loteprednol (Eysuvis), Varencicline nasal spray (Tyrvaya)
Symptom-based ophthalmic treatments: Redness
Naphazoline (Clear Eyes Redness Relief) (OTC)
Naphazoline/Pheniramine (Naphcon A, Visine A) (OTC)
Tetrahydrozoline (Visine) (OTC)
Brimonidine (Lumify) (OTC)
Common drugs known to cause retinal changes/retinopathy
Chloroquine, hydroxychloroquine
Common drugs known to cause optic neuropathy
Amiodarone (plus corneal deposits)
Ethambutol
Linezolid
Common drugs known to cause intraoperative floppy iris syndrome (IFIS); causes difficulty in cataract surgery
Alpha-blockers (e.g. tamsulosin)
Common drugs known to cause color discrimination
Digoxin (with tox) = yellow/green vision
PDE-5i (e.g. sildenafil) - greenish tinge around objects
Voriconazole - color vision changes
What can be used for ear wax (cerumen) blockage?
Irrigation with carbamide peroxide (Debrox)
Others: water, saline solution, mineral oil, hydrogen peroxide
Use should be limited to 3-5 days with f/u after this time
Common drugs known to cause vision loss/abnormal vision
Digoxin (with tox) - blurriness, halos
PDE-5i - vision loss (one or both eyes; can be permanent
Isotretinoin - decrease night vision (can be permanent), dryness, irritation
Topiramate - visual field defects
Vigabatrin - permanent vision loss (high risk)
Voriconazole - abnormal vision, photophobia
Mild cases of otitis externa (swimmer’s ear) can be treated with ear drops containing ____
acetic acid and glucocorticoid (VoSol HC)
Mod-severe cases of otitis externa (swimmer’s ear) can be treated with abx such as ___
ciprofloxacin and dexamethasone (Ciprodex)
Others: ciprofloxacin and hydrocortisone (Cipro HC), noemycin, colistin, hydrocortisone, and thonzonium (Cortisporin-TC)
