Eye and Ear Conditions Flashcards
What questions do you need to ask further if patient tells you she has dry eyes and want eye drops?
Hint: What do each question mean given the response?
- When do you experience these symptoms? (Tease out aggravating factors like contact lens, computer use, aging)
- Have you tried any eye care products to help with the symptoms? (Eye ointments can cause blurriness)
- Any medications, medical conditions, allergies? (Tease out the causes)
- Any other symptoms experienced? (Rule out self-care)
What 9 eye symptoms warrant a referral to the doctor and why (4 reasons)?
Symptoms:
1. Eye pain
2. Blurred vision not due to eye ointment
3. Light sensitive
4. Blunt trauma
5. Chemical / heat exposure
6. Eye operation
7. Persisting symptoms for 72 hours
8. Sticky discharge
9. Prescription Medications with this side effect
Reasons:
1. Infection need prescription of antibiotic
2. Need to assess for serious underlying conditions (e.g. neuropathy)
3. Blindness and injury are serious issue, not to play
4. Self-treat but no use means it doesn’t work
What medications cause dry eyes? (2 most common, 5 suggestive)
Most common:
- Antihistamines
- Hormone replacement
Suggestive:
- TCAs, SSRIs
- Diuretics
- Beta blockers
- Isotretinoin
- Chemotherapy (Systemic)
What 5 conditions can cause the patient to have dry eyes? (May be medical procedure, daily use of some things, patient profile related etc.)
- Old age = Less production of lacrimal fluid
- LASIK / refractive surgery = Disrupt the lacrimal reflex arc
- Long term contact lens wearer
- Computer use
- Smoking / Low humidity
Product considerations for Dry Eye
- Viscous or not? Depends on severity of Dry Eye
- Preservatives or not? Should be free of preservative if:
- Frequent eye drop user (4-6 times a day)
- Recent eye surgery
- Allergy to preservative - Single or multi-dose? Depends on storage vs frequency of use vs need for preservative-free
Name the common preservatives in eye drops and list in descending order of toxicity.
Explain what is toxic about it
BAK > Sodium Perborate > Polyquad > EDTA > Stabilized Oxychloro Complex
Toxicity:
- May breakdown corneal epithelium and disrupt lipid component of tear film
- Irritation in severe dry eye
Name the products containing preservatives
BAK: Hialid, Rinz, Optrex, Eyemo
Sodium Perborate: Genteal, TheraTears
Polyquad: Tears Naturale, Systane
EDTA: Rohto
Oxychloro: Refresh, Blink
What other contents can help with recovery and protection of corneal epithelium?
- Electrolyte: Potassium
- Bicarbonate (TheraTears)
- Osmolarity (Glycerin, glycol found in Optive, Refresh)
- Viscosity for retention (CMC, HPMC, PVA)
- Wound healing (Hyaluronic acid)
Which hydrogels has the longest retention time (brand and ingredient)?
Visidic Gel (Carbomer)
GenTeal (Hypromellose and carbomer)
What should you know about all eyedrops? Which is better?
No clinical efficacy differences
Discard within 30 days of opening for eyedrop bottles and discard after one time use for eyedrop vials
Only Hylo-comod has 6 months use due to mechanism of bottle preventing air from getting in contact with liquid
Name 2 oil containing eye ointments. What is good about them?
Duratears (White petrolatum)
Cationorm (Mineral oil)
Good:
- Viscosity retention for severe discomfort
- No preservatives
What supplements can help with dry eye?
- EPA (Omega-3)
- TheraTears Capsules - Arachidonic acid (Omega-6)
- Vitamin A
Why do dry eyes produce poor quality tears?
When oil glands (Meibomian) do not produce sufficient oily layer, your tear film does not work properly and evaporates quickly (Evaporative dry eye)