Chapter 11: Eye Flashcards
Counsel a patient on administering eye drops.
Form a pocket by pulling down your lower eyelid, instil the eyedrop, keep eye closed for 5-10secs or long as possible to allow absorption.
wash hands before and after
Counsel a patient on administering eye ointment
Pull down your lower eyelid, line against your lashline and blink to help spread the ointment
wash hand before and after
A patient has newly been prescribed eye ointment and eye drops they ask you which to use first. What do you say?
Drops first, then ointment
If two eye drops are co-prescribed how long should a patient wait between using them and why?
5mins due to dilution and overflow
Which eye formulation can cause transient blurred vision?
Ointments (thicker and greasier so 10-15m) especially at night so caution with driving
Drops - few minutes
Eye medication that have phosphate as an ingredient demonstrate a risk of ___________
Corneal damage (v. rare)
Expiry dates for eye drops.
At home: discard after 4 weeks or 28 days
Hospital: do not use after 7 or 14 days dep on trust
Outpatient or surgical: single application
Using contact lenses for prolonged periods of time increases the risk of _________
infectious and non-infectious keratitis/ conjunctivitis
Why do people prefer preservative free eye drops?
Preservative e.g. benzalkonium can cause stinging and irritation
If someone wears contact lenses which formulations will be more suitable?
Hard lenses: Eye drops oK
Soft lenses e.g. silicone: Remove lenses prior to using eye drops (even if using PF eye drops the preservatives can accumulate)
Ointments/oily eye drops: never wear lenses during use
Give examples of some drugs that can stain contact lenses and what colour?
Rifampicin - red bodily secretions and lenses
Sulfasalazine - Orange stain
Give examples of drugs that reduce blink rate?
Anxiolytics
Hypnotics
Anti histamines
Muscle relaxants e.g. baclofen, quinine
Give examples of drugs that reduce lacrimation?
Antihistamines Antimuscuranics Phenothiazines B-blockers Diuretics TCS: amitryp, nortrip
A drug used for severe acne can cause corneal inflammation due to its drying SE. What drug is this?
isotretinoin
Which drug can cause lens irritation due to its absorption via lens?
Aspirin (salicylic acid in it)
Risks associated with prolonged topical corticosteroid use in eyes?
1) steroid cataracts
2) red eye = corneal ulceration and potential damage to the eye
3) steroid glaucoma
What is the intravitreal implant oxurdex licensed for?
High cost drug - needs funding
Macular oedema
What is allergic conjunctivitis
Result of allergens e.g. hayfever/pollen
What OTC products can be used for allergic conjunctitivitis?
sodium cromglicate - mast cell stabiliser
Available OTC - 10ml, apply QDS
SE: stinging
Anti histamine eye drops: antazoline
Vasoconstricors: reduce redness e.g. xylometazoline
Signs of allergic conjunctivitis?
Both eyes, clear watery eyes, redness, itchy
Dry eyes options?
Hypromellose hourly PRN
Carmellose QDS - thicker and more moisturising so longer relief
3 types of eye infections?
Conjunctivitis - bacterial (treat with chloramphenicol 5x a day for 5days every 2hrs first 2 days then every 4 hrs next three days - 2yrs+ - FRIDGE) or viral (self limiting but if associated with herpes then use aciclovir 5x a day and 3 days after healing)
Blepharitis - eye lid infection (use fuscidic acid if pus-y and staphylococci infection) + daily hygiene eg eye lid wipes and cleansers)
Indications for topical corticosteroids?
Steroid glaucoma and cataracts
If corticosteroids are used in infections e.g. HSV what is the risk?
Aggravates infection and leads to corneal ulcers that can cause blindness (if occurs use ciproflox eye drops every 15 mins for 1st 6hrs)
