Eye Flashcards
What is the iris?
Color part of eye
-moves to make pupil bigger or smaller so that we can see better
What is the lens?
Helps us focus and see at different distances
What is the pupil?
Tunnel for light to come into the eye
What is the cornea?
-Bends light so we can see, also a protective layer
-Has nerve fibers that let us know if medication gets to the eye (also a downside because it can be irritating)
What is the optic nerve?
Transmits everything from the lens and pupils and sends it to the brain so we can recognize what we are seeing
What is the retina?
Everything we see is processed here and sent to the brain so we can see and comprehend what we see
What is the sclera?
Maintains the shape of the eye
What is the vitreous?
Internal jelly substance of eye that forms the majority of the eyeball
What are the 2 routes of drug delivery to the eye?
Local Delivery: drops, ointments, gels
Systemic Delivery: injections, oral
What are 3 important considerations for eye drops?
-Eye has limited capacity
(eyes can only hold about 1-2 drops)
-Built in defense mechanisms
(sudden increases in tear volume and the corneal protection barrier make eye drop delivery a challenge)
-Residence Time
(drugs need to remain in the eye for about 3-5 mins to work)
What are 3 important considerations with eye ointment?
-Drug Depot
(ointment stays in eye longer and has enhanced/sustained absorption)
-Blurry Vision
(can last up to 30mins)
-Challenge to apply
(difficult to apply the exact dose)
What are the steps for eye drop administration?
- Wash hands
- Remove contacts
- Tilt head back
- Pull down lower eye lid to form a pocket
- Hold dropper close to eye without touching it
- Look up and squeeze until a single drop falls into the pocket
- Remove finger from lower lid
- Close eyes for 2-3 minutes and tip head down towards the floor
- Put finger on tear duct and apply gentle pressure
When using both eye drops and eye ointment, which should you apply first?
Eye drops
If you have to apply two eye ointments, how long should you wait between application?
30 minutes
Can you use eye ointments with contacts?
NO
What are the steps for eye ointment administration?
- Wash hands
- Remove contacts
3.Hold the tube between your thumb and forefinger and put it as near to your eyelid as possible without touching it - Tilt your head back
- Pull down lower lid with finger to form a pocket
- Squeeze a ribbon of ointment into the pocket
- Remove index finger from lower lid
- Blink eye gently and then close for 1 to 2 minutes
- Wipe any excess from eyelid and lashes
- With a clean tissue, wipe the tip of the tube clean
How long should you wait to reinsert contacts after using eye drops?
15 minutes
If you need two separate doses of the same eye drops, how long should you wait in between drops?
5 minutes
If you take two different eye drops, how long should you wait between drops?
5-10 mins
If you take an eye drop and an eye ointment, how long should you wait between doses?
5-10 minutes
In a sig text, which letter indicates “eye” vs “ear”?
Eye: O
Ear: A
In a sig text, what is OS?
Left eye
In a sig text, what is OD?
Right eye
In a sig text, what is OU?
Both eyes
What is conjunctivitis?
Inflammation of the conjunctiva
What are the 3 types of conjunctivitis?
-Bacterial
-Viral
-Allergic
What are the symptoms of bacterial conjunctivitis? (pink eye)
-Redness
-Purulent discharge (yellow, white, or green)
-Eye is “stuck” in morning
-Unilateral (only affects one eye)
Is bacterial conjunctivitis contagious?
Very! Spread through direct contact with patient or through contaminated objects
What is the non-pharmacologic treatment for BOTH bacterial and viral conjunctivitis?
-Avoid sharing tissues, towels, cosmetics, linens, etc.
-Remove contact lenses!
(do not resume wearing until eye is white and no discharge for 24 hours after antibiotics)
What is the pharmacological treatment for bacterial conjunctivitis?
Self-Limiting
-Topical Antibiotics
(shorten the clinical course. Would normally last 5-7 days)
*Antibiotic treatment required in contact wearers!
*Ointment preferred over drops in children to ensure it stays in eyes
How long should you treat bacterial conjunctivitis with antibiotics?
5-7 days
What are the symptoms of viral conjunctivitis?
-Watery eyes
-Burning, sandy, gritty feeling
-“Pus” (morning discharge followed by watery discharge throughout day)
-BOTH eyes involved
-Part of viral upper respiratory infection
If viral conjunctivitis contagious?
VERY
-spread through direct contact with patient or contaminated surfaces
What is the pharmacological treatment for bacterial conjunctivitis?
NONE
-warm or cool compress
-Topical decongestant (zolines)
(but limit duration to avoid rebound congestion)
How long can decongestants be used to treat viral conjunctivitis?
No more than 72 hours
What are the symptoms of allergic conjunctivitis?
-Redness, watery discharge
-ITCHING
-Morning crust
-BOTH eyes involved
-Accompanied by other allergic symptoms
-*Eye rubbing can worsen symptoms
What is the non-pharmacologic treatment for allergic conjunctivitis?
-DO NOT RUB EYES-makes it worse
-Cool compress
-Avoid allergen
What is the pharmacologic treatment for allergic conjunctivitis?
-Antihistamines (ines)
-Mast cell stabilizers
-Multiple Acting Agents
What is uveitis?
Intraocular inflammation
What are the symptoms of uveitis?
-Patterned (Wagon Wheel) redness
-Dilated pupil
-Discomfort and light sensitivity
How do we treat anterior uveitis?
NO OTC TREATMENT
-need to refer
-Topical Glucocorticoids
-Mydriatic/Cycloplegic
What is the most common treatment for uveitis?
Prednisolone acetate 1%
(Pred Forte)
What are some treatment considerations with uveitis?
-Need to refer to an optometrist
-Treat for 4-6 weeks
-Ophthalmic Steroid Toxicity
**increases intraocular pressure
What is a normal intraocular pressure (IOP)?
12-20 mmHg
What is the leading cause of blindness?
Macular degeneration
What are the two top risk factors for macular degeneration?
Smoking and Age
What is macualr degeneration?
Neovascularization (overgrowth of blood vessels) in the eye that can lead to blindness
What are the two types of macular degenration?
Dry
Wet
What are some considerations with DRY macular degeneration?
Common > 50 years old
90% of MD cases
Affects BOTH eyes
Gradual vision loss
What are some considerations with Wet macular degeneration?
**More advanced type
-Rapid vision loss
-Loss of central vision due to abnormal new blood vessel growth
What are the treatment goals for macular degeneration?
-Slow progression
-Prevent severe visual impairment or blindness
What is the difference between AREDS and AREDS 2 vitamin supplement treatment for macular degeneration?
AREDS: does not have beta-carotene
AREDS 2: has beta-carotene
**Beta-carotene causes increased risk of lung cancer in smokers!
In a patient with macular degeneration who smokes, what vitamin supplement should they receive?
AREDS
*this does not contain beta-carotene
What is the pharmacological treatment for macular degeneration?
Vascular Endothelial Growth Factor (VEGF) inhibitors
(prevents blood vessels from forming in the eyes)
*Slows disease progression in age-related macular degeneration
*Injected directly into eye
What are the side effects of VEGF Inhibitors?
-Increased BP
-Retinal detachment
-Increased IOP
-Eye infection
-Vitreous floaters
Who uses VEGF inhibitors and what is an important consideration with them?
Wet Macular Degeneration patients
*VEGF inhibitors are given at intervals!
(injections that last 30 days)
What are the 3 causes of dry eye?
Overall: decreased tear production
-Sjogren’s Syndrome
(autoimmune disease with lymphocytic infiltration of the exocrine glands resulting in xerostomia and dry eyes)
-Non Sjogren’s Syndrome
-Evaporative Loss
What is the pharmacological treatment for dry eyes?
Step 1:
-Tear Supplement
-Warm Compress
-Address environmental factors
-Discontinue medications that may worsen dryness
Step 2:
-Topical treatment
-In office procedures
Step 3:
-Oral drug therapy (antioxidants, omega-3 fatty acids)
-Sclera contact lenses
-Surgery
-Investigation drugs
What tear supplementation is used for dry eye?
Start with aqueous-supplementing
Then use lipid-supplementing
What substance should be avoided with tear supplementation and why?
Avoid benzalkonium chloride
-Is used to keep dry eye products stable, but can be uncomfortable
What nonpharmacologic therapy can be used to treat drug-induced dry eyes?
-Warm compress
-Increased fluid intake
-Humidifier
What pharmacological treatment can be used to treat drug-induced dry eye?
-Artificial tears and ocular lubricants
-Restasis or Xiidra eye drops
What are cataracts and what are some important things to note?
-Cloudiness in specific parts of the lens
*Will not reverse once formed
*May require surgical removal of the lens to restore vision
What is intraoperative floppy iris syndrome?
Seen in cataract surgery and consists of:
-Floppiness of the iris
-Progressive constriction of the pupil
-Prolapse of iris through surgical wounds
**Irreversible!
What causes intraoperative floppy iris syndrome?
Alpha-1 Antagonists
What is optic neuropathy?
Characterized by:
-Bilateral vision loss
-Decreased visual acuity
-Decreased color vision
*reversed when causative agent is stopped
What are some important points about retinopathy?
-Need to perform regular eye exams on patients taking agents that can cause this
-Late stage retinopathy is irreversible
What eye effect does amiodarone cause?
Corneal deposits
What eye effect does digoxin cause?
Yellow tinted visions/halos (toxicity)
What eye effect does anticholinergic agents and antidepressants cause?
Blurred vision
What eye effect does PDE-5 inhibitors cause?
Color changes (blue tint)
What eye effect does bisphosphonates cause?
Inflammation/redness
What eye effect does topiramate cause?
Angle closure glaucoma
What eye effect does SSRIs cause?
Eye tics
