Chapter 11 and 12: Eye, ENT Flashcards
When two different eye drop preparations are used at the same time of the day, what time interval should be left between administration of the two eye preparations?
With what preparations would a longer interval be required?
5 minutes between the two
The interval should be extended when eye drops with a prolonged contact time, such as gels and suspensions, are used
If a patient needs eye drops and eye ointment at the same time of the day, what should be applied first?
Eye drops then eye ointments
When a patient is applying eye drops, what can be done after to reduce naslacrimal drainage (and therefore systemic absorption)?
Pressure on the lacrimal punctum for at least a minute
What is a rare side effect of using phosphate-containing eye drops in patients with damaged corneas?
Corneal calcification
What is the expiry date for multiple application eye drops after opening at home?
4 weeks
Are preservative or preservative free eye drops preferred in soft contact lens patients?
Preservative free
Some drugs and preservatives in eye preparations can accumulate in hydrogel soft lenses and may induce toxic and adverse reactions.
Ideally, patients should not wear contact lenses during treatment period
Can eye drops be used in patients wearing rigid corneal contact lenses?
Yes
Can eye ointments be applied at the same time as contact lenses?
No
Patient should not use contact lenses if being treated via eye ointment
How does aspirin interact with contact lenses?
Salicylic acid appears in tears and can be absorbed by contact lenses—leading to irritation
What eye side effect can be caused by isotretinoin?
Conjunctival inflammation
What are the 3 main dangers associated with corticosteroid eye drops?
- A red eye- corticosteroids may aggrevate herpes simplex virus leading to corneal ulceration
- Steroid glaucoma
- Steroid cataract
When are combination corticosteroid + anti-infective drug eye drops used?
Sometimes used after ocular surgery to reduce inflammation and prevent infection
Only under specialist supervision, not routinely used
Does atropine eye drops result in pupil constriction or pupil dilation?
Pupil dilation, otherwise known as mydriasis
Are lighter or darker pigmented eyes more resistant to pupil dilation with atropine?
Darker pigmented eyes are more resistant
What is Sjögren’s syndrome?
Disorder of your immune system identified by its two most common symptoms — dry eyes and a dry mouth
Usually accompanies lupus, rheumatoid arthritis, and other immune system disorders
What is the traditional choice of treatment for tear deficiency?
How often can you apply this?
Hypromellose
Can apply frequently e.g. hourly
If a patient is finding it troublesome applying hypromellose eye drops hourly for dry eyes, what can be an alternative that requires reduced application frequency?
Carbomers cling to the eye surface may help reduce frequency of application to 4 times daily.
What is a side effect of chloramphenicol eye drops in babies?
Grey baby syndrome
What is the MHRA advice regarding the use of latanoprost eye drops Xalatan?
Increased reporting of eye irritation e.g. excessive watering since reformulation
What is the patient advice regarding prostaglandin analogue eye drops e.g. latanoprost?
Patients should be warned of a possible change in eye colour as an increase in the brown pigment in the iris can occur, which may be permanent
Changes in eyelashes can also occur, and patients should also be advised to avoid repeated contact of the eye drop solution with skin as this can lead to hair growth or skin pigmentation
Acetazolamide is a sulfonamide derivative - what is a main side effect with this group of medicines?
Blood disorders, rashes, and other sulfonamide-related side-effects occur occasionally—patients should be told to report any unusual skin rash.
What antibiotic eye drops are used for treating bacterial conjuctivitis?
Chloramphenicol
What antibiotic eye drops are used for corneal ulcers?
Ciprofloxacin
How often are antibacterial eye drops usually administered?
Apply 1 drop at least every 2 hours then reduce frequency as infection is controlled and continue for 48 hours after healing.
How often is antibacterial eye ointment usually applied?
Either at night if eye drops are applied throughout the day
Or if used alone, 3-4 times daily
What are the two types of glaucoma?
Chronic open angle glaucoma
Acute angle-closure glaucom-
People with occular hypertension are at an increased risk of developing chronic open-angle glaucoma. What intra-ocular pressure is this?
> 21mmgHg
What is the difference in the onset of symptoms in chronic vs acute glaucoma?
Chronic is asymptomatic at first and then vision loss presents
Acute - abrupt onset of symptoms
What is 1st line for occular hypertension >24 mmHg and for chronic open-angle glaucoma?
What is second line?
What is 3rd line?
What is 4th line?
- Prostaglandin analogue e.g. latanoprost
- Try an alternative prostaglandin analogue for occular hypertension
- Beta blocker e.g. timolol
- Carbonic anhydrase inhibitors such as brinzolamide or dorzolamide, a topical sympathomimetic such as apraclonidine. Combination therapy can be offered at this point
In what situations would you opt for preservative free eye drops in occular hypertension?
- Allergic to preservatives
- Clinical significant occur disease and at high risk of conversion to chronic open-angle glaucoma
At what age is it recommended that children start fluoride supplement?
6 months
Does acute sinusitis require antibacterial treatment straight away?
Symptoms usually improve within 2 to 3 weeks without requiring treatment.
Antibacterial therapy is indicated if serious condition or showing signs that the patient is systemically unwell
For symptoms around 10 days and less - paracetamol or ibuprofen
For symptoms 10 days or more -high dose nasal corticosteroid
What is xerostomia?
Dry mouth
What mouthwash causes reversible brown staining of teeth and tongue?
Chlorhexidine
If there are systemic signs of infection in gingivitis, what antibiotics are used?
Metronidazole
Alternative = amoxicillin
What antibiotics can you use for a tooth abscess?
Amoxicillin or metronidazole
How is mild rhinitis treated?
Antihistamine or topical nasal corticosteroids
In seasonal allergic rhinitis, when is it recommended the patient starts treatment?
2-3 weeks before the season commences
Should corticosteroid nasal preparations be used in nasal infections?
No- should be avoided until after healing has occurred
Is the risk of systemic effects greater with nasal drops or nasal sprays?
Why?
Drops as they are administered incorrectly more often than sprays
How do you manage nasal polyps?
Corticosteroid nasal drops to help shrink them
(Oral corticosteroids can be used if the polyps are large)
Corticosteroid nasal spray can be used for maintenance
Are preparations containing ephedrine or xylometazoline more likely to cause a rebound effect?
Xylometazoline
Ephedrine is the safest sympathomimetic preparation to use
What is the initial treatment for oral thrush?
If this does not work, what can then be used?
Nystatin or miconazole (local treatment)
Fluconazole - this is especially needed in immunocompromised patients
What is stomatitis?
Inflammation of the mouth and lips
What are used in the prevention of oral candidiasis in immunocompromised patients?
Antiseptic mouthwashes
Intravitreal is administration into where?
The eye
Blepharitis management usually consists of good eyelid hygiene. What can you use if staphylococcal infection is suspected?
Fusidic acid
What medicine for glaucoma is taken orally?
Acetazolamide
