Common Conditions of the Eyes & Ears Flashcards
T/F: Eye drops can be used in the ear but never use ear drops in the eyes.
TRUE
- AD: __
- AS: __
- AU: __
- OD: __
- OS: __
- OU: __
Fill in the blanks
Eyes and ears abbreviations
1) EAR
* AD: Right ear
- AS: Left ear
- AU: Each ear
2) EYE
* OD: Right eye
- OS: Left eye
- OU: Each eye
Solutions: 1 drop = __ mL
Suspensions: __
Ointments: apply to the conjunctival sac or over lid margins. ointments can make vision __.
Gels: with cap on, invert and __ once to get the medication into the tip before instilling into the eye.
Fill in the blanks
Solutions: 1 drop = 0.05 mL
Suspensions: Shake well
Ointments: apply to the conjunctival sac or over lid margins. Ointments can make vision blurry.
Gels: with cap on, invert and shake once to get the medication into the tip before instilling into the eye
What is glaucoma and how it’s diagnosed?
- Glaucoma is a disease of the eye that results in damage to the optic nerve and loss of the visual field.
- The vision straight and the peripheral vision measured by the visual field test.
- In most cases, intraocular pressure (IOP) is above the normal range of 12 -22 mmHg. The goal of treatment is to reduce IOP.
List the drugs that can increase IOP
- Anticholinergics ( e.g., oxybutynin, tolterodine, benztropine, trihexyphenidyl, TCAs)
- Cough, cold and motion sickness medications (e.g., antihistamines, scopolamine)
- Chronic steroids, especially eye drops such as prednisolone (Pred Forte)
- Topiramate (Topamax)
What are two main forms of galucoma?
Open-angle glaucoma
* Most common type
- Often presents without symptoms
- Treatment: eye drops or surgery
Closed-angle glaucoma
* Sharp, sudden increase in IOP due to blockage
- Usually presents with eye pain, headaches and decreased vision
- Treatment: medical emergency that is treated surgically
Drug treatments for glaucoma
Treatments decrease IOP by targetting the aqueous humor (fluid in the eye) in two main ways:
- Prostaglandin (PG) analogs - intitial Tx, most effective at decreasing IOP (30%), used once daily.
- Opthalmic BBs (e.g., timolol) - preferable if the pressure is high in one eye only.
What are glaucoma treatment goals?
Decrease IOP:
1. Reduce aqueous humor production (make less fluid)
* BBs, like timolol
3. Increase aqueous humor outflow (move fluid out)
* Protaglandin analogs, like latanoprost
- Or, do both: often achieved with add-on treatment
* Alpha-2 agonists, like brimonidine
Prostaglandin analogs - MOA, brand/generic, admistration, warnings, SEs, storage
MOA: increase aqueous humor outflow
Brand/generic: apply 1 drop QHS
* Bimaprost (Lumigan)
- Latanoprost (Xalatan, Xelpros) + netarsudil (Rocklatan)
- Travoprost (Travatan Z)
- Tafluprost (Zioptan)
- Latanoprostene bunod (Vyzulta)
- Bimaprost (Latisse) - indicated for eyelash hypotrichosis to increase eyelash growth; do not use with prostaglandin analogs indicated for glaucoma
Warnings:
* Ocular effects - darkening of the iris, eyelashes; eyelash length and number can increase
Side Effects:
* Blurred vision
- Stinging
- Increased pigmentation of the iris/eyelashes
- Eyelash growth
Storage:
* Latanoprost, latanoprostene and tafluprost should be stored in the refrigerator before opening
- Once opened, store at room temperature
BBs - MOA, administration, brand/generic, SEs
MOA: reduce aqueous humor production
Administration:
* Timolol - apply 1 drop daily or BID
- Timoptic-XE Timollol GFS (gels) - daily
- Gels: shake once before use; wait 10 minutes after administering other eye drops before inserting gel
Brand/generic:
* Timolol 0.25% and 0.5% (Timoptic, Timoptic-XE, Istalol, Timolol GFS, Betimol, Timoptic Ocudose); + dorzolamide (Cosopt, Cosopt PF), + brimonidine (Combigan)
- Betaxolol (Betoptic S)
- Carteolol
- Levobunolol (Betagan)
Side Effects:
* Burning
- Stinging
- Bradycardia/fatigue
- Bronchospasm
All are non-slective BBs except betaxolol; Betaxolol is less like to cause pulmonary adverse effects in patients with chronic lung disease (asthma/COPD)
Cholinergics (Miotics)
Carbonic Anhydrase Inhibitors
Adrenergic Alpha-2 Agonists
Rho Kinase Inhibitors
Cholinergics (Miotics): increase aqueous humor outflow
* Carbachol (Miostat), Pilocarpine (Isopto Carpine)
- SEs: pupil constriction
Carbonic Anhydrase Inhibitors: reduce aqueous humor production
* Dorzolamide (Trusopt) + timolol (Cosopt, Cosopt PF), Brinzolamide (Azopt) + brimonidine (Simbrinza), Acetazolamide (oral, injection), Methazolamide (oral, injection)
- Warnings: sulfonamide allergy
- Acetazolamide - Tx of acute mountain (altitude) sickness
Adrenergic Alpha-2 Agonists: increase aqueous humor outflow, reduce aqueous humor production
- Brimonidine (Alphagan P); + timolol (Combigan), + brinzolamide (Simbrinxa), Apraclonidine (lopidine)
- Brimonidine (Lumify) (OTC) is indicated for ocular redness
Rho Kinase Inhibitors: increase aqueous humor outflow
- Netarsudil (Rhopressa) + latanoprost (Rocklatan)
Conjunctivitis, AKA __ can be due to a __, __, __ or ocular irritant. Mostly occur in __ __ and are highly contagious.
Fill in the blanks
- Pink eye
- Virus
- Bacteria
- Allergen
- Young children
How do you prevent the spread of conjunctivits?
- Avoid touching eyes
- Use proper hand hygiene and wash hands thoroughly and frequently
- Change towels and washcloths daily
- Discard eye cosmetics, particularly mascara
Treatment of conjunctivitis by type
Viral, bacterial and allergic
Viral - Adenovirus
* No topical Tx; infection runs its course over several days to three weeks
Bacterial - Staphyloccoccus aureus, Neisseria gonorrhoeae (most severe cases) or Chlamydia (most severe cases)
- Moxifloxacin (Vigamox)
- Neomycin/Polymixin B/ Dexamethasone (Maxitrol)
- Ofloxacin (Ocuflox)
- Trimethoprim/Polymyxin B (Polytrim)
- Azithromycin (AzaSite) - store in the refrigerator, stable for 14 days at room temperature
Allergic - Common allergens
* Mast cell stabilizers: Cromolyn, lodoxamide (Alomide), nedocromil (Alocril)
- Antihistamines: Azelastine, olopatadine (Pataday), cetirizine (Zerviate), Epinastine (Elestat)
- Antihistamine/Mast cell stabilizer: Ketoifen (Alaway, Zatidor), alcaftadine (Lastacaft)
What is blepharitis and its treatment?
- Belpharitis is an eyelid inflammation most commonly involves the eyelid margins
- Apply a warm compress over the eye for a few minutes to loosen the crusty deposits, then use a warm, moist washcloth (water + a few drops of baby shampoo) to wipe away the debris
Inflammation of eyes can be reduced with a __ compress and either an __ eye drop (if mild) or a __ eye drop (if severe)
Other ocular conditions - symptom-based opthalmic Tx
- Cold
- NSAID
- Steroid
Why do most eye drops burn?
Benzalkonium chloride (BAK) is a preservative added to eye drop bottles to prevent the growth of microorganisms and contamination;
* Preservatives are toxic to bacteria and are irritating to sensitive tissues in the eyes, which leads to burning/stinging after administration
* Some drugs found in eye drops can also cause irritation * Contact lenses trap the drug and preservatives against the surface of the eye, making irritation worse * Lenses should be removed before using eye drops and wait 15 minutes after administration before reinserting * This is especially important with drops containing BAK as these can damage the eyes when used with contacts * Some eye drops have preservative-free formulations for those unable to tolerate the side effects * Example: Cosopt PF (the PF stands for preservative-free)
Examples of treatments for symptom-based opthalmic conditions
Inflammation, dryness, chronic dry eye disease, redness
Inflammation
* Steroids - Prednisolone (Pred Forte, Pred Mild)
- NSAIDS - Ketorolac (Acular)
- Steroids should be used short-term due to risk of increased IOP
Dryness
* Refresh (OTC)
- Systane (OTC)
- Often referred to as Artificial tears
Chronic Dry Eye Disease
* Cyclosporine Emulsion Eye Drops (Restasis)
Redness
* Naphazoline (Clear Eyes Redness Relief) (OTC)
- Naphazoline/Pheniramine (Naphcon A, Visine A) (OTC)
- Tetrahydrozoline (Visine) (OTC)
List the common drugs known to cause vision changes or damage
- Retinal changes/retinopathy
- Optic neuropathy
- Intraoperative floppy iris syndrome (IFIS)
- Color discrimination
- Vision loss/abnormal vision
Retinal changes/retinopathy
* Chloroquine
- Hydroxychloroquine
Optic neuropathy
* Amiodarone (+corneal deposits)
- Ethambutol
- Linezolid
Intraoperative floppy iris syndrome (IFIS); causes difficulty in cataract surgery
- Alpha-blockers (e.g., tamsulosin)
Color discrimination
* Digoxin (with toxicity) - yellow/green vision
- PDE-5 inhibitors (e.g., sildenafil) - greenish tinge around objects
- Voriconazole - color vision changes
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 (can be permanent), dry eyes, irritation
- Topiramate - visusal field defects
- Vigabatrin - permanent vision loss (high risk)
- Voricinazole - abnormal vision, photophobia
Tinnitus causes ringing, roaring or __ sounds and is caused by drug __ (e.g., __ ).
Fill in the blanks
- Buzzing
- Toxicity
- Salicylates
Which antibiotic ear drops are used for treatment of otitis externa?
- Ciprofloxcin and dexamethasone (Ciprodex)
How does ear wax (cerumen) blockage occurs and how is it treated?
- It occurs when wax (cerumen) accumulates in the ear or becomes too hard to wash away naturally
- It is removed in a medical office
- If the condition is chronic, ear wax removal medication [carbamide peroxide (Debrox), triethanolamine] can be used every 4-8 weeks as a preventive measure
What are key counseling points for all eye drops?
- Can cause stinging/burning (except for preservative-free)
- Wait 5 minutes in between two drops of the same medication
- Apply gels last. Wait 10 minutes after the last eye drop before use
- Wait 5-10 minutes in between drops of two different medications
- Remove contact lenses prior to using eye drops. Wit 15 minutes to reinsert
What are key counseling points for prostaglandin analogs?
- Darkening of the iris and an increase in eyelash growth can accur
- Do not use with bimaprost (Latisse). Latisse can reduce the effectiveness of other prostaglandins
