Common Conditions of the Eyes & Ears Flashcards
AD; AS; AU
AD= right ear
AS= left ear
AU- each ear
OD, OS, OU
OD= right eye OS= left eye OU= each eye
1 drop=
0.05 mL
ointments
apply to the conjunctival sac or over lid margins (for blepharitis). Ointments can make vision blurry. Do not use with contact lenses
gels
with caps on, invert and shake once to get the medication into the tip before instilling into the eye
glaucoma is…
a disease of the eye that results in damage to the optic nerve and loss of the visual field
In most cases of glaucoma, the intraocular pressure (IOP) is…
above the normal range of 12-22 mmHg
IP can be increased from…
genetics, age, and medications
Two main forms of glaucoma include…
1) open-angle (most common)
2) closed-angle (sharp, sudden increase in IOP due to a blockage. medical emergency that is treated surgically)
Prostaglandin (PG) analogs are used commonly as initial tx for glaucoma.
Decrease IOP by ~30%. MOA: increase aqueous humor outflow (move fluid out)
Ophthalmic beta-blockers (e.g. timolol)…
decrease IOP by 22%. Preferred if pressure is high in one eye only. MOA: reduce aqueous humor production (make less fluid).
Drugs that can increase IOP include:
- anticholinergics (e.g. oxybutynin, tolterodine, benztropine, trihexyphenidyl, TCAs)
- cough, cold and motion sickness meds (e.g antihistamines, scopolamine)
- chronic steroids, especially eye drops such as prednisolone (Pred Forte)
- topiramate (Topamax)
Prostaglandin analog dosing
1 drop QHS
Prostaglandin analog: warnings & side effects
Warnings- ocular effects: darkening of the iris, eyelid skin, and eyelashes; eyelash length and # can increase; contamination of multiple-dose ophthalmic solution can cause bacterial keratitis.
Side effects- Blurred vision, stinging, increased pigmentation of the iris/eyelashes, eyelash growth/thickening, foreign body sensation
Which prostaglandin analogs do not contain BAK (have a different preservative)?
- travoprost (Travatan Z)
- latanoprost (Xelpros).
- tafluprost (Zioptan)
Comes as 10 single-use, preservative-free containers in a foil pouch; discard each container after use.
Which prostaglandin analogs should be kept in the fridge before opening?
- latanoprost (Xalatan, Xelpros)
- latanoprostene bunod (Vyzulta)
- tafluprost (Zioptan)
bimatoprost
Lumigan
latanoprost
Xalatan, Xepros
latanoprost + netarsudil
Rocklatan
travoprost
Travatan Z
bimatoprost (Latisse)
Indicated for eyelash hypotrichosis (inadequate growth of eyelashes) to increase growth; do not use with prostaglandin analogs indicated for glaucoma
timolol 0.25% and 0.5% (Timoptic, Timoptic-XE, Istalol, Timolol GFS, Betimol, Timoptic Ocudose)
Timolol: 1 drop daily or BID
Timoptic-XE, Timolol GFS (gels): daily. Counsel to shake once before use; wait 10 min after giving other eye drops before inserting gel
timolol + dorzolamide
Cosopt, Cosopt PF (preservative-free)
timolol + brimonidine
Combigan
betaxolol (only selective BB). Less likely to cause pulmonary adverse effects in patients with chronic lung disease (ex. asthma/COPD)
Betoptic S
carteolol
Ocupress
levobunolol
Betagan
BB contraindications & side effects
CIs: Sinus bradycardia, heart block > 1st degree (except in patients with a pacemaker); cardiogenic shock; uncompensated cardiac failure; bronchospastic disease
S/Es: burning, stinging, bradycardia/fatigue, bronchospasm with non-selective agents, itching of the eyes or eyelids, changes in vision, increased light sensitivity
cholinergics (miotics): carbachol and pilocarpine
MOA: increase aqueous humor outflow
S/Es: poor vision at night (due to pupil constriction), corneal clouding, burning (transient), hypotension, bronchospasm, abdominal cramps/GI distress
*Use with caution in patients with a history of retinal detachment or corneal abrasion
carbachol (Miostat)
1-2 drops up to TID
pilocarpine (Isopto Carpine)
Solution: 1-2 drops up to 4 times/day
carbonic anhydrase inhibitors (end in -zolamide)
MOA: reduce aqueous humor production
Warnings: Sulfonamide allergy (caution due to the risk of systemic exposure and dross reactivity (especially with oral formulations)
dorzolamide (Trusopt)
1 drop TID
dorzolamide + timolol (Cospot, Cosopt PF)
Cosopt: 1 drop BID
brinzolamide (Azopt) + brimonidine (Simbrinza)
Azopt: 1 drop TID
acetazolamide (oral). Used infrequently for glaucoma; it is used for the prevention and tx of acute mount (altitude) sickness
S/Es: CNS effects (ataxia, confusion), photosensitivity/skin rash (including the risk of SJS/TEN), anorexia, nausea, risk of hematological toxicities
250 mg PO 1-4 times per day, or 500 mg ER PO BID
adrenergic alpha-2 agonists
increase aqueous humor outflow, reduce humor production
adrenergic alpha-2 agonists (-dine)
MOA: increase aqueous humor outflow, reduce humor production
Warnings: CNA depression: caution with heavy machinery, driving
S/Es: sedation, dry mouth, dry nose
brimonidine (Alphagan P)
Dosed TID
brimonidine + timolol
Combigan
brimonidine + brinzolamide
Simbrinza
apraclonidine (lopidine)
dosed TID
brimonidine (Lumify) is OTC and is…
indicated for ocular redness
rho kinase inhibitors
MOA: increase aqueous humor outflow
Counsel: contains the BAK; remove contact lenses before use. Store in the fridge before opening; once opened, store at room temperature for ≤ 6 weeks
netarsudil (Rhopressa)
Dose: 1 drop daily in the evening
S/Es: burning/eye pain, corneal disease, conjunctival hemorrhage and conjunctival hyperemia (excess blood vessels)
netarsudil + latanoprost (Rocklatan)
Dose: 1 drop daily in the evening
S/Es: burning/eye pain, corneal disease, conjunctival hemorrhage and conjunctival hyperemia (excess blood vessels)
Conjunctivitis, aka “pink eye”, occurs in…
one or both eyes. Can be due to a virus, bacteria, or allergen. Most commonly caused by adenovirus (no tx; infection resolves over several days to 2-3 weeks)
Allergic conjunctivitis can be caused by…
pollen, dust mites, animal dander, molds
Mast cell stabilizers include:
- alcaftadine (Lastacaft)
- cromolyn
- lodoxamide (Alomide)
- nedocromil (Alocril)
Antihistamines include:
- azelastine
- olopatadine (Patanol, Pataday, Pazeo)
- cetirizine (Zerviate)
- epinastine (Elestat)
Antihistamine/mast cell stabilizer
- ketotifen (Alaway, Zaditor), OTC
Blepharitis most commonly involves…
the part of the eyelid where the eyelashes come out of the skin. The primary s/s are inflamed, irritated, and itchy eyelids. The preferred tx includes the application of a warm compress over the eye for a few minutes to loosen the crust, then use of a warm moist washcloth to wipe away the debris.
Eye inflammation can be reduced with a…
cold compress and either an NSAID eye drop (if mild) or a steroid eye drop (if severe). Artificial tears can help with a “gritty” feeling and alleviate dryness
Steroidal eye drops include:
- Prednisolone (Pred Fort, Pred Mild, Omnipred)
- Dexamethasone (Maxidex, Ozurdex)
- Flurometholone (Flarex, FML Forte, FML Liquifilm suspension, ointment)
- Loteprednol (Alrex, Lotemax suspension, ointment, gel)
NSAID eye drops:
- ketorolac (Acular, Acular LS, Acuvail)
- nepafenac (Ilevro, Nevanac)
- bromfenac
- diclofenac
- flurbiprofen
artificial tears (for eye dryness)
- Refresh (OTC)
- Systane (OTC)
- Liquifilm teams (OTC)
- others
chronic dry eye syndrome (keratoconjunctivitis sicca)
- cyclosporine emulsion eye drops (Restasis)
- lifitegrast (Xiidra)
for eye redness and/or allergic conjunctivitis
- naphazoline (Clear Eye Redness Relief), OTC
- naphazoline/pheniramine (Naphcon A, Visine A), OTC
- tetrahydrozoline (Visine), OTC
- brimonidine (Lumify), OTC
drugs causing retinal changes/retinopathy
- chloroquine
- hydroxychloroquine
drugs causing optic neuropathy
- amiodarone (plus corneal deposits)
- ethambutol
- linezolid
drugs causing floppy iris syndrome; causes difficulty in cataract surgery
- alpha-blockers (eg. doxazosin)
drugs causing color discrimination issues
- digoxin (with toxicity)- yellow/green vision
- PDE-5 inhibitors (eg. sildenafil)- greenish tinge around objects
- voriconazole- color vision changes (counsel not to drive at night)
drugs causing vision loss/abnormal vision
- digoxin (with toxicity)- blurriness, halos
- PDE-5 inhibitors- vision loss in one or both eyes (can be permanent)
- isotretinoin- decreased night vision which can be permanent, dry eyes irritation
- vigabatrin- permanent vision loss (high risk)
- voriconazole- abnormal vision, photophobia
Antibiotic eye drops can be used for outer ear infections. During tx, patients should stay out of the water, avoid flying due to pressure changes and avoid the use of headphones and earplugs. These drops include:
- ciprofloxacin and dexamethasone (Ciprodex)
- ciprofloxacin and hydrocortisone (Cipro HC)
- neomycin, colistin, hydrocortisone and thonzonium (Coly-Mycin S)
Ear wax removal med can be bought OTC:
carbamide peroxide (Debrox), triehtanolamine. Can be used every 4-8 weeks as a preventive measure. Instill 5-10 drops BID for up to 4 days.
Eye drops counseling:
- can cause stinging/burning (except for preservative-free)
- Wait 5 minutes in between 2 drops of the same medication.
- Wait 5-10 minutes in between drops of 2 different medications.
- Apply gels last. Wait 10 minutes after the last eye drop before use.
- Remove contact lenses before using drops. Wait 15 minutes to reinsert.
Prostaglandin analog counseling
- Darkening of the iris and an increase in eyelash grown can occur.
- Do not use with bimatoprost (Latisse). Latisse can reduce the effectiveness of other prostaglandins.
