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Eye Disease > Dry Eye Preparations > Flashcards

Dry Eye Preparations Flashcards

1
Q

What percentage of agents recommended by optometrists involved in MECS were ocular lubricants?

A

30%

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2
Q

What forms do ocular lubricants come in?

A

Eye drops, gels and ointments

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3
Q

Why should ocular lubricants not be called artificial tears?

A

They do not mimic the electrolyte composition of human tears

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4
Q

What exactly does ocular lubricants treat?

A

Discomfort associated with a reduced or unstable tear film and also with recurrent corneal erosion

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5
Q

Are ocular lubricants a P medicine?

A

No, it is a CE-marked medicine products and therefore can be sold and supplied by optometrists

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6
Q

Are ocular lubricants regulated by the Medicines Act?

A

No, it is a medical device

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7
Q

What is the main Management for step 1 dry eye?

A

Ocular lubricants

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8
Q

What are two main dry eye managements for step 2 of dry eye?

A

Non-preserved lubricants and non-medicated ointment at night

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9
Q

What is the main objective of ocular lubricants?

A

Improve patient’s ocular comfort and quality of life

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10
Q

What are five example of aqueous substitutions?

A
  • Cellulose esters
  • Carbomers
  • Polyvinyl alcohol
  • Sodium hyaluronate
  • Hydroxypropl Guar
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11
Q

What are some issues with more adhesive ocular lubricants?

A

Although they have a longer contact time with the ocular surface, they can cause blurry vision and for the eye lids to stick together

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12
Q

The tear has non-newtonian behaviour, what does this mean?

A

Tears change viscosity when under stress (does not follow newton’s viscosity law)- when the sheer rate is low then the viscosity increases

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13
Q

What is the sheer rate?

A

the rate of change of velocity at which one layer of fluid passes over an adjacent layer

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14
Q

What are pros & cons of cellulose esters?

A
  • Good retention time
  • Blurred vision
  • Crusting of eyelids
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15
Q

What are the two formulations of carbomers?

A

Carbomer 980 and carbomer 940
(Can come in a tube called GelTears)

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16
Q

What is a carbomer?

A

Synthetic polymer with a good retention time and good viscosity by displaying non-newtonian shear thinning

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17
Q

What are some features of Polyvinyl Alcohol?

A
  • Synthetic polymer
  • LOW viscosity
  • Good for mucin and lipid deficiency
  • Shorter retention time
18
Q

Is sodium hyaluronate a synthetic polymer or naturally occurring polymer?

A

Naturally occuring (Muccopolysaccharide)

19
Q

What are some properties of sodium hyaluronate?

A

-Viscous formulation
- Good retention time
- Exhibits non-newtonian shear thinning properties
- Blurs vision
- Avilable as single and multidose

20
Q

What is different about hydroxypropyl-guar?

A

It incraeses its viscosity after contact with the ocular surface due to a difference in the pH which cuases the chemical reaction to take place

21
Q

Why are preservative added into ocular lubricants?

A

Exposure to the atmosphere leads to increased risk of microbial contamination

22
Q

What is an issue with ocular lubricants with preservatives?

A

Increased risk of corneal toxicity and damage to the cornea

23
Q

Which patients in particular would you recommend preservative free eye drops to?

A

If they use the drops more than 6 times a day and if they are using multiple preserved formulations

24
Q

Why are preservative ocular lubricants NOT compatible with contact lenses?

A

Benyzlkonium chloride is taken in by the CLs and slowly released and then released slowly and artificially increased the preservative contact time with the ocular surface which is more so true with high water content lenses

25
Q

What is Benyzlkonium chloride?

A

Eye drop preservative

26
Q

What are four examples of newer preservatives to reduced ocular toxicity which is replacing Benyzlkonium chloride?

A
  • Purite
  • Sodium perborate (converts water into oxygen)
  • SofZia
  • Polyquaternium
27
Q

How does a multidose preservative free eye drop work like a single dose minim?

A

A valve system is incorporated to prevent air from getting into the bottle to reduce risk of microbial contimination

28
Q

Why is a multi dose more preferable than single dose?

A

It is more cost effective

29
Q

Why are lubricating eye ointments mainly used during the night?

A

They have a high viscosity and a long retention time and causes blurred vision

30
Q

What are some key features of lubricating eye ointments?

A
  • High viscosity
  • long retention time
  • Rebuild the lipid layer
  • Melt at temperature of ocular tissues
31
Q

Give an example of a lubricating eye ointment?

A

Lacri-lube

32
Q

What is filamentary keratitis?

A

Mucus filaments which are firmly attached to the surface of the eye

33
Q

How can filamentary keratitis be resolved?

A

Using Acetylcysteine 5-10% (Ilube), it breaks the bonds of these disulphide bonds

34
Q

What is a liposomal spray?

A

An aqueous suspension of phospholipids- containing lipsomes and works by spraying the eyelids and eventually it gets on the lid margins and works as a lipid layer replacement so especially useful in evaporative dry eye

35
Q

What can Ikervis (ciclosporin) treat?

A

An immunosuppressive anti-T cell drug for severe keratitis to regulate cell-mediated immunity on ocular surface which have not been helped with severe substitutes

36
Q

What is the name of an ocular lubricant made from the patient’s own serum?

A

Autologus serum

37
Q

How does an autologus serum work?

A

Blood sample is taken and a centrifuging process separates the blood into the serum which is then placed in dropper bottles with saline to dilute it - NEEDS TO BE refrigerated

38
Q

How do tear stimulation approaches work?

A

Either stimulate the lacrimal gland to produce more aqueous, mucin secretions from goblet cells or lipid secretion from meibomian glands

39
Q

Name the three formulations for mild dry eye and their dosages

A

Hypromellose 0.3% eye drops
Carbomer 980 0.2% gel
Carmellose 0.5% eye drops

40
Q

Name the three formulations for moderate dry eye and their dosages

A

Carbomer 980 0.2%
Carmellose 0.5% SDU
Multidose preservative free

41
Q

How would you handle severe dry eye?

A

Multidose preservative free drops during the day and eye ointment during the night; you may need to refer

42
Q

What must you factor in, in terms of the capability of the px, when deciding what ocular lubricant to give to your px?

A

If they have a high level of dexterity especially with the single dose units

Eye Disease (48 decks)

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