Chapter 11: Eye Flashcards

1
Q

Counsel a patient on administering eye drops.

A

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

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2
Q

Counsel a patient on administering eye ointment

A

Pull down your lower eyelid, line against your lashline and blink to help spread the ointment

wash hand before and after

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3
Q

A patient has newly been prescribed eye ointment and eye drops they ask you which to use first. What do you say?

A

Drops first, then ointment

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4
Q

If two eye drops are co-prescribed how long should a patient wait between using them and why?

A

5mins due to dilution and overflow

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5
Q

Which eye formulation can cause transient blurred vision?

A

Ointments (thicker and greasier so 10-15m) especially at night so caution with driving

Drops - few minutes

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6
Q

Eye medication that have phosphate as an ingredient demonstrate a risk of ___________

A

Corneal damage (v. rare)

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7
Q

Expiry dates for eye drops.

A

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

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8
Q

Using contact lenses for prolonged periods of time increases the risk of _________

A

infectious and non-infectious keratitis/ conjunctivitis

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9
Q

Why do people prefer preservative free eye drops?

A

Preservative e.g. benzalkonium can cause stinging and irritation

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10
Q

If someone wears contact lenses which formulations will be more suitable?

A

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

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11
Q

Give examples of some drugs that can stain contact lenses and what colour?

A

Rifampicin - red bodily secretions and lenses

Sulfasalazine - Orange stain

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12
Q

Give examples of drugs that reduce blink rate?

A

Anxiolytics
Hypnotics
Anti histamines
Muscle relaxants e.g. baclofen, quinine

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13
Q

Give examples of drugs that reduce lacrimation?

A
Antihistamines
Antimuscuranics
Phenothiazines
B-blockers
Diuretics
TCS: amitryp, nortrip
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14
Q

A drug used for severe acne can cause corneal inflammation due to its drying SE. What drug is this?

A

isotretinoin

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15
Q

Which drug can cause lens irritation due to its absorption via lens?

A

Aspirin (salicylic acid in it)

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16
Q

Risks associated with prolonged topical corticosteroid use in eyes?

A

1) steroid cataracts
2) red eye = corneal ulceration and potential damage to the eye
3) steroid glaucoma

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17
Q

What is the intravitreal implant oxurdex licensed for?

A

High cost drug - needs funding

Macular oedema

18
Q

What is allergic conjunctivitis

A

Result of allergens e.g. hayfever/pollen

19
Q

What OTC products can be used for allergic conjunctitivitis?

A

sodium cromglicate - mast cell stabiliser
Available OTC - 10ml, apply QDS
SE: stinging

Anti histamine eye drops: antazoline
Vasoconstricors: reduce redness e.g. xylometazoline

20
Q

Signs of allergic conjunctivitis?

A

Both eyes, clear watery eyes, redness, itchy

21
Q

Dry eyes options?

A

Hypromellose hourly PRN

Carmellose QDS - thicker and more moisturising so longer relief

22
Q

3 types of eye infections?

A

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)

23
Q

Indications for topical corticosteroids?

A

Steroid glaucoma and cataracts

24
Q

If corticosteroids are used in infections e.g. HSV what is the risk?

A

Aggravates infection and leads to corneal ulcers that can cause blindness (if occurs use ciproflox eye drops every 15 mins for 1st 6hrs)

25
When eye examinations occur, your pupils are dilated via drugs. Give examples of the drugs used.
Phenylephrine and atropine
26
Phenylephrine must not be used with _____ due to the risk of
MAOIs due to the risk of hypertensive crisis
27
What is glaucoma? Can you think of a systemic medication that causes glaucoma as a SE?
Raised intraocular pressure | Prednisolone / steroids
28
1st line for glaucoma? What is the contra-indication?
B-blockers e.g. Timolol, betaxolol Contra indicated in asthma - bronchospasm even though they are eye drops OR Prostaglandins generic as more cost effective (brands are 3rd line option) e.g. bimatoprost, latanoprost (report eye irritation within a week)
29
Side-effects of prostaglandins e.e.g bimatoprost?
Darker iris colour - brown longer eye lashes Avoid repeated contact with solution
30
2nd line for glaucoma?
Sympathomimetics e.g. brimonidine Carbonic anhydrase inhibitors e.g. brinzolamide (acetazolamide is taken orally)
31
Which eye condition is a medical emergency?
Closed angle glaucoma - RISK OF BLINDNESS ``` Cloudy eyes N/V Headache Intense eye pain blurred hazy vision sight loss Rainbow rings around lights ```
32
Licensed age for steroid e.g. dexamethasone eye drops (maxidex)?
2yrs +
33
Symptoms of dry eye?
Soreness and inflammation at the ocular surface - use tear replacement therapy
34
Medication used to treat dry eye?
hypromellose | carbomer - less frequent application
35
An eye infection with pseudomonas can be treated with?
Gentamicin Quinolones (except moxifloxacin) Tobramycin
36
Chloramphenicol licensing OTC?
2yrs+ and max 5 days use (4g pack size)
37
Side-effects of chloramphenicol?
``` Angio-oedema Bone marrow disorders Stinging Fever Skin rx ```
38
Which eye drops used in herpetic keratitis requires contraception for both men and women for atleast 90 days of treatment?
Ganciclovir
39
Risk factors for glaucoma (inc intraocular pressure)?
``` T2DM Corticosteroid use Age Family hx Ethnicity CVS disease Hypertension ```
40
which medication for glaucoma can be given orally?
Acetazolamide
41
Common SE of acetazolamide?
haemorrhage so ask patients to report rashes due to blood disorders
42
Which eye drop has an MHRA warning to report eye irritaion within a week?
Latanoprost