7 - Eye & Ear Flashcards by Karlo Sison

Debrox

Dose / Indication / Ingredient + strength

Carbamide Peroxide 6.5%

prepared in anhydrous glycerol

5-10 drops BID

for 3-4 days if needed

>12 y/o

indicated for IMPACTED EARWAX

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Visine

(Tetrahydrozoline HCL / oxymetazoline HCL / naphazoline HCL / pheniramine maleate)

Dose / Indication

Opthalmic DECONGESTANT / ANTIHISTAMINE

1-2 Drops < QID

Third line therapy for Allergic Conjungtivitis

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Systane

(PEG 400 / propylene glycol)

Dose / Indication

Artificial Tears

1-2 Drops

First line therapy for Allergic Conjunctivitis

Also treatment for Dry Eye Syndrome

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NonPharmacologic Treatment

of Water-Clogged Ears

Tilt affected ear DOWNWARD
- manipulate the auricle gently
Blow Dryer
- on LOW HEAT & SPEED
  - (NOT DIRECTLY INTO EAR)
One-Time use of WATER-ABSORBING EAR PLUGS
- remove after 10 min
- for use for patients >16 y/o

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Ocular Irrigants

Cleanse ocular tissues of unwanted debris

while still maintaining MOISTURE

Chemical Burn / Loose Foreign Object

Specifically balanced pH & Osmolality

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EX-ST for self treatment

of OTIC DISORDERS

SUDDEN hearing loss
Signs of infection
Sharp / severe PAIN
Bleeding or signs of trauma
- presence of ruptured tympanic membrane
<12 y/o
Ear surgery within 6 weeks
Tympanostomy tubes present
Hypersensitivity to recommended angents
Incapable of following proper instructions

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Purpose of Earwax

(Cerumen)

Lubricates ear canal

Traps debris

WATERPROOF BARRIER

Antimicrobial properties = Contains lysosimes / ACIDIC pH

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Key Points for

OTIC DISORDERS

Know EX-ST

Limit self-treatment to minor symptoms

Contact PCP if symptoms persist or worsen >4 days

Provide instructions on proper use / effective products

Proper ear hygiene & importance of earwax

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Treatments that we DO NOT RECOMMEND

for Impacted Earwax

Docusate
- conflicting data
Hydrogen Peroxide 3%
- contains WATER –> ear infection possible
Olive Oil
- delay seeking proper treatment
Ear Candles
- INEFFECTIVE –> ear injury / burns
Garlic Oil / Willow Bark / Chamomilla
- lacking data on efficacy / safety

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S/Sx + Goals

Allergic Conjuctivitis

RED eyes + Watery discharge

Remove / Avoid ALLERGEN

Limit or reduce the severity of allergic rxn

symptomatic relief

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S/Sx of

IMPACTED EARWAX

MOST common cause of temporary hear loss

Feeling of fullness/pressure
GRADUAL HEARING LOSS
Dull Pain
Vertigo / Tinnitus
Chronic Cough

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Debrox

Carbamide Peroxide 6.5%

ADR / CI-P / Consult

DNU if h/o of perforation of eardrum or prior ear surgery*
discharge / drainage / SEVERE ear pain*
AIDS / DM*

Mild Tingling + CRACKLING NOISES are normal

DNU for more than <4 days

avoid eye contact

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S/Sx of

WATER-CLOGGED EARS

NOT THE SAME AS SWIMMER’S EAR

Feeling of wetness / fullness
GRADUAL HEARING LOSS
Ear exposed to excessive moisture
- Trappped moisture –>
  - –> itching / pain / inflammation / infection

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Zaditor

KETOTIFEN FUMARATE

Dose / Indication

Opthalmic Antihistamine / Mast Cell Stabilizer

0.035% Ketotifen

1 Drop BID q8-12hrs

2nd line therapy for Allergic Conjunctivitis

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EX-ST for Self-Treatment of

Ocular Disorders

Eye PAIN
Blurred vision, not associated with ointment/drops
Light sensistivity
History of contact lens wear
Blunt trauma to eye
Chemical exposure to eye
HEAT - eye exposure ( excluding sun exposure )
Lack of response to therapy
- in >72hours

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Adult vs Child

Ear Canal

Adult = S-Shaped canal

Eutachian tube lengthens DOWNWARD (towards mouth/nose)

Child = normal

SHORTER / STRAIGHTER*
FLATTER ear canal*

What goes first, Solutions or Suspensions?

And how long do you wait?

Solutions FIRST > suspensions

wait 5 minutes between drops

shake SUSPENSIONS well

ADR / CIs

Opthalmic Antihistamine / Mast Cell Stabilizer

Ketotifen Fumarate (Zaditor)

Can cause Burning / Stinging / Discomfort

can cause Pupil DILATION

esp w/ light-colored irises & contact wearers

CI in ppl w/ risk for angle closure glaucoma

Flowsheet of Impacted Earwax

Complaint of consistant earwax excess / impact
Obtain medical/medication history
1. intended use / previous use / length&history of use
Any EX-ST?
1. yes –> SEE MD
If no, Ask if using IMPROPER removal methods / unapproved meds
1. yes –> S/Sx of infection –> SEE MD
If no, use Carbamide Peroxide
1. if treatment didnt work –> SEE MD
Counsel on proper ear hygiene

Opthalmic DECONGESTANTS

Visine Redness Relief

Treatment for Allergic Conjuctivitis

A-adrenergic agonist -> constriction -> reduced redness
Can cause eye dryness
- and REBOUND CONGESTION, limit use to 72 hours
  - oxymetazoline/PE > naphazoline/tetrahydrozoline
Contraindicated in angle closure glaucoma
Use in caution in:
- HTN / DM
- CVD / Arteriosclerosis
- HYPEthyroidism

Risk factors for Dry Eye Syndrome

Female!

Older Age!

Postmenopausal estrogen therapy

Medications :

Antihistamines / Antidepressants / Decongestants

Diuretics / Beta Blockers

Steps to Instill

Eye OINTMENT

Wash hands
Tilt head back
1. grasp lower outer lid below lashes,
2. pull down form pocket
Place ointment tube over eye, look up
1. place 1/4in to 1/2in of ointment into LOWER EYELID pocket
  1. using a sweeping motion
Close eye for 1-2 minutes
Vision may be temporarily blurred
1. prefer to use ointment at night

Visine - Decongestant/AH

(Tetrahydrozoline HCL / oxymetazoline HCL / naphazoline HCL / pheniramine maleate)

ADR / CI+P / Consult

MILD STINGING

Limit use to <72 hours, Rebound Congestion

>6y/o, remove contact lenses

Contraindicated in angle closure glaucoma
Use in caution in:
- HTN / DM
- CVD / Arteriosclerosis
- HYPERthyroidism

Steps to Instill

EYE DROPS

WASH HANDS
Tilt head back
Grasp lower eyelid below lash line, pull away to make pouch
Place dropper over eye by looking directly at it
Before applying drop, LOOK UP
Release eyelid after drop is applied
Use finger to put pressure over tear duct
Wait 5 min b4 instilling next drop

**Pharmacologic Treatment for** **Dry Eye Syndrome**

**_Artificial Tears_** Stabilize tear film / *reduce tear evaporation* / lubricate occular surface **_Non-Medicated Ointments_** INCREASE retention time in eye / enhance tear film integrity **_Topical Cyclosporine_** RX only, *long term benefit nclear*

**Drops or ointments first** **and how long do you wait?**

**_DROPS FIRST_** \>\> *ointments* wait **10 MINUTES** between products

***Non-pharmacologic Treatment*** for Dry Eye Syndrome

*AVOID- **dry/dusty places** + **prolonged computer use*** Use **humidifiers** + **Eye Protection** outdoors Elmininate offending **medications** Reposition work station away from air vents

**Refresh** (carboxymethhylcellulose sodium, **glycerin**, mineral oil, petrolatum, povidone, polysorb80) **Dose / Indication**

***NON-MEDICATED OINTMENT*** **Use as often as needed** used for **Dry-Eye Treatment**

**Opthalmic Antihistamines**

Treatment for **Allergic Conjunctivitis** **_More effective_** when taken w/ **_Opthalmic Decongestant_** * Histamine1 receptor antagonist * **Pheniramine maleate & Antazoline phosphate**

* **_SUDDEN_ *hearing loss*** * Signs of **infection** * **Sharp / severe PAIN** * **Bleeding** or **signs of trauma** * ****presence of ruptured tympanic membrane * **\<12 y/o** * Ear surgery within 6 weeks * **Tympanostomy tubes** present * **Hypersensitivity** to recommended angents * *Incapable of following proper instructions*

**EX-ST for self treatment** **of OTIC DISORDERS**

* _Eye **PAIN**_ * **Blurred vision**, *not associated with ointment/drops* * **Light** sensistivity * History of **contact lens** wear * **Blunt trauma** to eye * **Chemical exposure** to eye * **HEAT** - eye exposure ( *excluding **sun exposure )*** * *Lack of response to therapy* * *in **\>72hours***

**_EX-ST for Self-Treatment of_** **_Ocular Disorders_**

***Non-pharmacologic* Treatment** **Allergic Conjuctivitis**

*Remove / Avoid offending **ALLERGEN*** Apply **Cold Compress TID/QID** Use **air conditioning** Use / replace **air filters**

**S/Sx of Dry Eye Syndrome**

**White / *mildly*** **Red eye** **Sands / Gritty feeling** **Chronic & Incurable**

**Pharmacologic Treatment for** **WATER-CLOGGED EARS**

* _**Isopropyl Alcohol 95%** in **anhydrous glycerin 5%**_ * _ONLY agent FDA approved_ as ear-drying age * glycerin prevents over drying in ear canal * *may **sting or burn*** * * **50-50 mix of Acetic Acid 5% & Isopropyl Alcohol 95%** * *DO NOT use apple cider vinegar* * *may **sting or burn***

**Steps on how to use an** **EAR DROP**

1. Wash Hands 2. **Warm ear drops** to body temp (hold in PALM of hand) 1. ***shake if indicated*** 3. Tilt head on side or lie down, with ear up 4. Position dropper **tip NEAR the ear canal** 5. To open ear canal: 1. **_pull ear BACK & UPward_** 6. Place proper dose/drops into the ear canal opening 7. You may **gently press flap over ear canal** oepening 1. to force out air bubbbles / push drops down the canal. 8. Stay in **same position ~3 minutes** 1. depends on product 9. Gently **wipe away excess** medication off the outside of ear

**Opthalmic Antihistamine / Mast Cell Stabilizer** **Ketotifen Fumarate (Zaditor)**

Treatment for **Allergic Conjuctivitis** Last up to 12 hours * POTENT Histamine 1 receptor antagonist * *Inhibits* ***mast cell*** degrauluation * --\> *stops release of **inflammatory mediators*** * *Inhibits* ***eosinophils*** * *****--\> stops release of **late-phase mediators*********

**_ORDER OF USE_** ## Footnote **Pharmacologic Treatment options** **for Allergic Conjuctivitis**

FIRST USE: **_Artificial Tears_** Second = Opthalmic **_Antihistamine / Mast cell stabilizer_** THIRD, USE BOTH: Opthalmic **_Decongestant_** Opthalmic **_Antihistamine_**

**Pharmacologic Treatment of** **IMPACTED EARWAX**

**_DEBROX_** **Carbamide Peroxide 6.5%** in anhydrous glycerin * Hydrogen peroxide + moisture * *slow release of **O2*** --\> **_effervescent_** (bubbles) * **Urea debirdes tissue** * **Glycerin softens earway**