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Pharmacotherapy > Eye > Flashcards

Eye Flashcards

1
Q

What eye services is covered by AB Health Care?

A
  • annual complete eye exams for children 18 and younger and seniors 65 and older
  • Medically necessary or urgent care eye visits are also covered for everyone regardless of age
    • Examples
      • Sudden changes in vision
      • Annual exams for diabetics
      • Removing foreign objects from the eye
      • pre/post op care for cataract pts
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2
Q

How do other individuals pay for eye care?

A
  • indiv. b/w 19 and 64 may qualify for full or partial coverage if they have private insurance such as through an employer
  • ABC, Manulife, Assure
  • pt may hesitate to have their eyes looked at as it may be costly. optometrists have ability to triage pts and then treat or refer them to a specialist if needed
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3
Q

define red flags

A

signs and symptoms that found in pt’s history or clinical exam that are alarming and can indicate something more serious and may warrant immediate referral

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4
Q

What are the red flags for eye problems? (9)

A
  • pain - assess pain on a scale
  • severe headache
  • excessive tearing - tearing can be indication of a viral infection
  • Vision disturbance, spotted, blurry
  • Contact lens - greater long-term consequences or severity
  • Photophobia - light sensitivity
  • Exposure to heat or chemicals (workplace)
  • Blunt trauma/imbedded foreign body/protrusion
  • No improvement with recommended self care can signify other issues
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5
Q

What questions should you ask for self-care assessment?

A
  • SCHOLAR-E, onset, freq, duration of symptoms
  • What area is involved
  • One or both eyes, eye, eyelid or both?
  • Is there discharge
    • A little or a lot? Can you describe it
  • Redness or inflammation?
  • Aggravating, remitting
  • Recurrence of symptoms
  • Any attempted treatments?
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6
Q

What is dry eye disease?

A
  • one of the most common eye problems
  • multifactorial disease of ocular surface, loss of homeostasis of tear film and with symptoms of tear film instability, hyperosmolarity, ocular surface inflammation and damage, neurosensory abnormalities
  • tear composition off balance
  • may lead to discomfort, eye surface damage, visual disturbances, neg impact on quality of life and psychological health
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7
Q

DED symptoms?
- what happens in severe cases?
-

A
  • burning
  • stinging
  • gritiness
  • scratchiness
  • foreign-body sensation
  • transient changes in vision
  • severe: blurred vision, photophobia, excess tear production
  • usually bilateral
  • can develop over days, months, years
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8
Q

DED pathophys

What are the parts of Lacrimal Functional Unit

A
  • cornea, conjunctiva, accessory lacrimal glands, meibomian glands, nervous system - connected to endocrine system and NS and control tear production
    • If a component is not working properly inflammation cascade
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9
Q

Name and describe 3 tear components

A
  • Innermost mucus (mucin layer): coats eye and allows aqueous layer to stick to the cornea which is water repellent and helps remove waste from eyes
  • Aqueous later: supplies oxygen and electrolytes to the eye
  • Lipid layer: acts as a lubricant b/w eyelid and eyeball creating a smooth surface
  • Tear quality can lead to DED (not quantity if tears are present)
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10
Q

DED Classification - what are the 2 types?

A

Aqueous Deficient Dry Eye (2 types): aq or mucus layers are deficient
Evaporative Dry Eye (2 types)

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11
Q

what are the 2 types of aqueous deficient dry eye?

difference in characteristics?

A

Sjogren-type (autoimmune) - pt may have dry eye and mouth

  • primary ~10% of pt w/ aq deficient dry eye have Sjorgen syndrome which affects exocrine glands
  • secondarily - rest are due to other autoimmune diseases

Non-Sjogren-type (nonautoimmune)

  • Lacrimal gland deficiency (age-related hepatitis)
  • Lacrimal duct obstruction (injury, infections, scarring conditions)
  • Reflex hyposecretion: sensation on cornea reduced so tear production is compromised (refractive surgery, diabetes, contact lenses)
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12
Q

2 types of Sjogren-type

3 types of Non-Sjogren

A

primary and secondary

  • Lacrimal gland deficiency (age-related hepatitis)
  • Lacrimal duct obstruction (injury, infections, scarring conditions)
  • Reflex hyposecretion: sensation on cornea reduced so tear production is compromised (refractive surgery, diabetes, contact lenses)
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13
Q

Evaporative Dry Eye (2 types)

what are the factors of each one?

A

external factors

  • low humidity
  • high temp
  • exposure to sun, dust, wind

internal factors
- Meibomian gland dysfunction (chronic inflamm leads to squamous cell debris leads to gland obstruction leads to changes in secretion)

  • conditions compromising blinking/eyelid function (Parkinson’s, computer work, exophthalmos)
  • hormones (oral contraceptives, menopause, low androgen levels)
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14
Q

what are 2 types of risk factors for the eye?

what are some examples of each?

A

non-modifiable

  • female sex
  • increasing age
  • Sjogren syndrome
  • Meibomian gland dysfunc
  • thyroid disease
  • diabetes
  • rosacea

modifiable

  • androgen deficiency
  • computer use
  • environment
  • eye surgery
  • medications (anticholinergics, antidepressants, some NHPs, antihistamines, SSRIs)
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15
Q

DED goals of therapy (3)

A
  • Ease discomfort and minimize symptoms
  • prevent/delay complications
  • Educate patients about their condition and encourage adherence to therapy
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16
Q

Non-pharm treatment for aq deficient dry eye?

A
  • reassess current medications
  • include omega-3 fatty acids in diet (fish/flax seed oil)
  • punctal occlusion (temp or permanent plugs to stop tear drainage from nasolacrimal ducts)
17
Q

Non-pharm treatment for evaporative dry eye?

A
  • apply a warm compress to the eyelids for a 5-10 mins at a time
  • “LipiFlow” (a procedure which unblocks meibomian gland ducts)
18
Q

Non-pharm treatment with environmental/lifestyle management?

A
  • lower temp/avoid extreme heat
  • use humidifiers
  • maintain hydration
  • avoid smoking/smoke
  • decrease screen time and make efforts to blink, look away every 10-20 mins
19
Q

Pharm treatment - artificial tears

  • Start anywhere and do a trial and error for 1-2 weeks for a product (little evidence to support use of one over another)

Name 4 common ingredients in artificial tears

A
  • viscosity agents
  • electrolytes
  • lipids
  • preservatives
  • preservatives free
20
Q

Pharm treatment - artificial tears

Name 4 viscosity agents
what is their purpose?

A
  • carboxymethylcelluose
  • hyaluronic acid
  • polyethylene glycold
  • petrolatum - is viscous and is a lipid (2 roles)

Determine length of action

  • lower viscosity = shorter action, more frequent use, drops
  • high viscosity = gels or ointments, longer duration of action, short term blurriness, before bedtime is more appropriate
21
Q

Pharm treatment - electrolytes

Name 2
what is their purpose?

A
  • potassium chloride
  • sodium bicarbonate

mimic composition of natural tears (salt content)

22
Q

Pharm treatment - lipids

Name 2
what is their purpose?

A
  • castor oil
  • mineral oil

prevent tear evaporation

23
Q

Pharm treatment - preservatives

purpose
name 3 common preservatives
name 3 safer preservatives

A
  • Preservatives prevent microbial growth and increase shelf life - have side effects
  • 4 times a day over weeks or months, consider other options maybe
  • Preservative free - may be pricey lose adherence due to cost

common

  • benzalkonium chloride (BAK)
  • EDTA
  • Lanolin

safer

  • PolyQuad
  • Purite
  • Sodium perborate
  • oxidative preservatives, safe alternatives
24
Q

Name 4 preservative free artificial tears

A
  • Minums - single use system
  • Tears Naturale
  • Thera Tears
  • Hylo
25
Q

DED OTC Products

what are two types of pts

A

Artificial Tears

  • Systane Ultra, Balance
  • Refresh Tears, Optive Active
  • Blink Eye Tears

Artificial Gels and Ointments

  • Systane Gel Ointment
  • Refresh PM
  • Liposic
  • Lacrilube
26
Q

DED Rx Pdts

Topical corticosteroids
MOA?
AE
duration of use

A 
- MOA
    Inhibits inflamm processes/mediators
- Drugs
    - Lotemax - loterprednol 0.5%
    - FML - fluorometholone 0.1%
- Side Effects
    blurred vision, photophobia, irritation
- Use
    14-28 days
27
Q

DED Rx Pdts

Restasis - cyclosporine
MOA?
AE
duration of use

A 
- MOA
  Unknown - increases globlet cell density to increase mucin or could be immunomodulator effect
- Side Effects
    irritation
- Use
    6-12 weeks; lifelong therapy
28
Q

DED Rx Pdts

Xiidra - lifitegrast 5%
MOA?
AE
duration of use

A 
- MOA
    thought to inhibit inflamm markers
- Side Effects
    dysguseia (altered taste), blurred vision, irritation
- Use
    2-12 weeks; lifelong therapy
29
Q

DED Monitoring
- what to monitor for

F/U time

A
  • preservative toxicity (stinging) or conjunctival inflamm (worsening redness)
  • 3-5 days
30
Q

Contact Lens Care

How do contact lenses work? What are some advantages over trad glasses?

A
  • Can correct near-sightedness, far-sightedness, astigmatism
  • Sit on tear film
  • Act as barrier b/w cornea and tear supply
  • advantages: natural appearance, increased field of vision, no image size distortion, no fogging or reflections
31
Q

What are 2 types of contact lenses

A

soft

  • silicone hydrogens for short-term use (daily/weekly/monthly)
  • increased comfort - increased risk of lens deposits and irritation

rigid, gas-permeable (RPG)

  • uncommon
  • intended for long term use ~5 years
  • more difficult to adjust to, better visual acuity, few complications

combination RPG/soft

32
Q

Contact Lens Care

what questions should you ask the contact lens wearer?

A
  • symptoms (assess for red flags)
  • what type of lenses do you wear?
    • what is your replacement schdeule?
  • how long have you used contact lenses
  • what products do you use to clean them; how do you do so?
  • what meds are you taking?
  • cleaning procedures should not be changed w/o consultation with eye care provider
33
Q

Contact Lens Care

red flags (4)

A
  • pain
  • poor vision
  • fog or halos
  • discharge
34
Q

Contact Lens Care

What drugs affect lenses or the wearer?

A

oral contraceptives (Alesse): exacerbation of dry eye

antihistamines, sedatives, hypnotics (benadryl): decreased blink rate

muscle relaxants (Robax pdts, cyclobenzaprine): incomplete blinking

aspirin: ocular irritation, redness

antibiotics (nitrofurantoin, others): discoloration of lenses

ophthalmic products (BAK, decongestants like phenylephrine, tetrahydrozoline): concentrates in lenses and leads to irritation, dark discoloration with repeated use

ASA, anticholinergic drugs, isotretinoin

  • Some drugs require taking lens off for 15 minutes
  • Rewetting drops as artificial tears compatible with contact lenses
35
Q

Contact Lens Care

What is the purpose of cleaning solutions?

A
  • enhance wettability and comfort
  • disinfect/kill microorganisms
  • denature protein deposits
  • prevent lens deposits
  • maintain optimal pH
36
Q

Contact Lens Care

What are the goals of therapy (3)?

A
  • optimize vision
  • optimize contact lens comfort
  • minimize complications
    • improper lens care may significantly affect vision, eye health, lens life
      • irritation (discomfort, corneal ulcers)
      • infections (microbial keratitis)
      • intolerance to lenses
37
Q

Lens Care Products

What are the 2 types of cleaning solutions for soft lenses? For RGP lenses?

A

soft lenses

  • saline-based
  • hydrogen peroxide-based

RGP lenses

  • multi-step solutions (enzymatic cleaners)
  • one-step solutions (hydrogen peroxide)
  • Multi-purpose are most common
  • Allergies to preservatives - hydrogen peroxide - see eye care professional first
  • Now - have platinum disk at bottom of contact lens to neutralize it
  • If neutralization doesn’t happen fully - it can lead to corneal irritation
  • Case needs to be replaced after some time
  • RGP cleaners are more viscous
38
Q

Contact Lens Care

Monitoring

A

pt education for meds, contact lens care

39
Q

Lens care procedures

A

multipurpose: rub lens w/ sltn on each side for 20 s, rinse with sltn, soak for 4-8 h, wash hands with soap and water before inserting lens, discard old sltn and let case air dry, replace every 3 months

hydrogen peroxide: rub lens w/ sltn on each side for 20 s, rinse with H2O2, soak for 4-6 h with case upright, wash hands with soap and water before inserting lens, discard old sltn and let case air dry (don’t rinse with H2O2), replace every 3 months

Pharmacotherapy (14 decks)

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