Eye Conditions Flashcards
What are the major anatomical features of the eyes?
Cornea: transparent, anterior portion of the eye (pain receptors present, but no blood vessels)
Sclera: posterior aspect of the eye’s outer surface and it is continuous with the cornea (white, fibrous tissue)
Conjunctiva: membrane covering the sclera and inside the eyelids (blood vessel supply)
As a general rule of thumb, when should pharmacists refer ophthalmic conditions to an MD?
2 days for ophthalmic conditions (especially if injury is bad)
Is black eye a minor injury?
Depends if bone or eye got hit directly
If you see the following, get medical attention:
Swelling does not start to recede after a few days
Changes in vision
Severe pain starts
SIgns of infection
Behavioural changes, lethargy (concussion)
Nausea, vomiting, dizzy
Inability to move eye
Blood in eye itself
Any lacerations to eye area
What are some treatment options for black eyes?
Cold compress (any cold object is fine
Analgesics (Advil, but cold compress does much of the heavy lifting)
What are some signs of a foreign body in the eye?
See immediate increase in tearing, irritation/scratchy (this feeling can linger after this object is out of the eye)
What can patients do about removing foreign bodies from the eye?
Gentle rinsing with warm water or saline is appropriate. An eye bath can make this easier if you are on your own
If an object can’t be removed, cover both eyes (due to phantom movement) and get MD care
What should patient do if a chemical gets into the eye?
Flush eye (pull out eyelid for 15 min)
Leave contact lenses in (protective until MD care)
See MD if flushing does not work (take offending chemical container)
What should a patient do if you get snow blindness from radiant energy reflecting of the snow and into your eyes?
Eyes will be red and have an itchy and foreign body-like sensation
Treatments:
Cool compress
Non-medicated eye drops (1-2 drops)
Sunglasses for a few days
If patient regularly wears contacts, feel free to use them as they are hydrating (can help reduce irritation)
What are the levels in the tear film that covers the eyes?
Outer surface is oily (lipid based and prevents evaporation of lower layers)
Middle layer is mainly aqueous
Inner layers is mucoidal
What can happen when the outer surface of the tear film is compromised?
This can result in spot evaporation of lower layers. This can cause dry eyes
What are some symptoms associated with dry eyes?
Difficulty blinking
Generally less tears produced (can also result in more tearing, but those tears are ineffective)
Should pharmacists immediately give patients with dry eyes artificial tears?
Sure, but should be checked out by an MD or Optometrist
What are some factors that can cause dry eyes?
Age
Blepharitis (infection of eye lid margin, reduces secretion of lipid outer layer)
Drugs (Accutane and anti cholinergic drugs)
LASIK Surgery (nerves are cut in this procedure)
Sjogren’s Syndrome (classic major side effect, dry eyes and mouth, and arthritic joint pain)
Can artificial tears fully mimic real tears?
No, can only provide lubrication. They can only try to replicate tears
Do the different ingredients in artificial tears matter in terms of efficacy?
No, it is irrelevant.
If patient wears contacts, ensure product is compatible with their use
What are the instructions for artificial tear use?
Need to use them regularly. Tolerance does not develop and natural tear production wil not change.
Difference agents may have different efficacy or irritants (try different formulations to find the best one for patient)
Newer generation artificial tears have disappearing preservatives, helps reduce irritation
What formulations of artificial tears are best for night use?
OIntments and gels are better if patient experiences dry eyes during sleep
Will patients become tolerant to artificial tears?
No, use them if you need them. Artificial tears can be used indefinitely without any consequences
What are some non-artificial tears treatments for dry eyes?
Humidifier
Lid margin hygiene (prevents blepharitis)
Plug the ducts
Cyclosporine drops (reduce inflammation associated with dry eyes and improves the composition of tears. Can take months before seeing effects unlike artificial tears)
Omega 3 fatty acid drops (low efficacy)
Lifitegrast drops (anti-inflammatory, more effective than omega 3, can take more than a few days to see effects)
Heat at night
What is stye?
It is a Staph aureus infection in an eyelash follicle (feels like a pimple on the eye lid margin)
It can be swollen or tender
Stye can last up to 7 days
Do not pop or squeeze unless head has emerged
What are some treatments for stye?
Warm compresses (can speed up the process of a stye coming a head)
Pink eye antibiotic drops (not effective because contact time is too short)
What is Chalazion?
They are less common compared to styes (They are plugged oil ducts)
Chalazions can be located offset from the eye lid margin, while styes are always on the eye lid margins
How are chalazions treated?
May need MD care to rule out other conditions
Warm compress and massage are the standard therapy
What is conjunctival hyperemia?
Irritation of the conjunctiva (allergies, dry air, wind, etc.)
It is a mild form of conjunctivitis
What is sub-conjunctival hemorrhage?
A blood vessel below the conjunctiva in the sclera breaks. Fairly benign and will clear in about 7-10 days
Do not decongestants here (blood vessels are already broken, decongestants work best when blood vessels are intact)
What can cause conjunctival hyperemia?
Dust, smoke, chlorine
Low humidity
Eye strain
Symptoms of ocular conditions (Blepharitis,Rosacea, and contact lenses)
What are some non pharmacological treatments for conjunctival hyperemia?
Flush out eyes (dust, yes. Iron filing, maybe)
Cool compress
What are some pharmacological treatments for conjunctival hyperemia?
Topical decongestants (phenylephrine, naphazoline, oxymetazoline)
When is it appropriate to use topical decongestants for conjunctival hyperemia?
We have to be judicious in patient use of topical decongestants in the eyes due to concerns about rebound
Cosmetic reason: sure
Seasonal allergies: No, use steroids instead or Cromolyn
Chronic redness: no, find out what is causing redness
Contact lens problems: no
What is Blepharitis?
It is an eyelid disorder of the Meibomian glands and can lead to problems worth dry eyes (due to reduced secretion of outer lipid layer)
It presents with scales on the eyelids.
Usually not a serious condition, but needs MD referral
What are the two different types of blepharitis?
Optometrists can differentiate between the two, but pharmacist cannot
Bacterial (younger adults + children)
Seborrheic (more so older males, may need antifungal)
What are the symptoms of blepharitis?
More noticeable scaling (yellow flakes) in the morning
Inflammation of eyelid margins (red, scaly, but no discharge)
Vision is normal (or some blurring if blepharitis is partially severe)
Review slides 63-64 for images of Blepharitis presentation
How is bacterial Blepharitis treated?
Eyelid hygiene is key
Topical antibiotics
Blephamide (antibiotic + steroid)
How is seborrheic Blepharitis treated?
Eyelid hygiene is important
Check/treat scalp with antifungal shampoo
Warm compress/massage (can improve glandular secretions)
Treatment can last 3 weeks and up to months
Can pharmacists prescribe for conjunctivitis?
Yes, especially allergic conjunctivitis (usually affects both eyes due to equal environmental exposure)
Be more likely to refer in viral or bacterial conjunctivitis (more likely to have only one eye affected) or if patient is a child
What is conjunctivitis?
It can be caused by viruses, bacteria, or allergies (diverse etiology)
Viral and bacterial conjunctivitis is collectively known as Pink Eye
What are some features of allergic conjunctivitis?
Seasonal allergies: allergic conjunctivitis hits hard, but has shorter duration
Perennial: allergic conjunctivitis is less irritating, but lasts for a prolonged duration
Usually both eyes are affected
What are some treatment options for allergic conjunctivitis?
Cool compress/non-medicated drops to help flush out allergens. Will not be enough on their own, so combine with one of the following agents:
Rx topical cromolyn (Patanol, Alocril, Alomide)
Rx 2nd gen antihistamines (emedastine and ketotifen)
Topical decongestant (Work great, but have side effects associated with long-term use)
Ocular steroids (concerns with increased IOP=drug induced glaucoma and cataracts)
What is the differentiating presentation of bacterial conjunctivitis?
Can show exudate from eye or eye margin
Can be hard to differentiate between bacterial conjunctivitis and blepharitis
What is the differentiating presentation of viral conjunctivitis?
Starts in 1 eye (moves to the 2nd eye in 1/3 of cases and often follows a cold a week later)
Profuse tearing
Review slide 85 for differentiating between viral and bacterial conjunctivitis
How is viral conjunctivitis usually treated?
Most references suggest symptomatic care (no need for antivirals)
How is bacterial conjunctivitis usually; treated?
There are concerns about antibiotic resistance.
Shorten course of infection by 1-3 days, should see improvement in 2 days
But there are no severe outcomes if not treated with antibiotics (unlike untreated step throat)
What should pharmacists do if patient with infectious conjunctivitis wears contact lenses?
People who leave their contacts in over extended periods of time, they can develop reservoirs of gram -ve bacteria.
Therefore all contact lens wearers with infectious conjunctivitis should be referred to MD
Is bacterial conjunctivitis more common in the general public vs. viral conjunctivitis?
No, viral conjunctivitis is more common
What factors make bacterial conjunctivitis more likely to be the cause of infectious conjunctivitis in kids?
If the following apply, it might be a good idea to refer even though we can prescribe here
Child is under 6
Discharge
Eyes glued shut in the morning
Eye pain
Are non-medicated drops useful in infectious conjunctivitis?
Yes, they can help flush out gunk
Review slide 94 for treatment choices for conjunctivitis (viral, bacterial, and allergic)
Can untreated bacterial conjunctivitis in most cases cause permanent damage?
Not in most cases. Bacterial conjunctivitis is usually self-limiting (Get over the worst in 2-3 days)
But in some cases, bacterial conjunctivitis can get worse to a point where permanent damage actually increases
Review slide 99 for comparing the presentations of different eye conditions
What are floaters?
They are air bubbles inside the eye
These are fairly benign and are left untreated in most cases
What is Blepharospasm?
Benign twitches in eyelids (Can take Botox to help calm down blepharospasms)
What is obstructed tear duct?
Tears do not drain away and build up under the skin of the eyelids
Seen in newborns
Most clear in their own
What can cause dark circles?
Genetics (main cause, some associate ion with a lack of sleep)
Thinning skin with age
What are some treatments for eye bags?
Preparation H under the eyes (used by models to reduce bags under eyes)
What is Age-related Macular Degeneration (AMD)?
There are two types:
Dry type (90%):
Fat deposits in the ocular vasculature causes progressive damage as we age
Wet type (10%):
Vascular leakage from the macula (very advanced form of AMD)
What happens to vision in AMD?
Loosing middle of your field of view. The circle of darkness spreads outwards as AMD progresses
What is involved in the secondary prevention of AMD?
AREDS2 vitamins can reduce the progression of Intermediate AMD into Advanced AMD in 25% of patients on AREDS2 supplements
What ingredients are in AREDS2 formulations?
Vitamin C
Vitamin E
Zinc
Copper
Lutein
Zeaxanthin
Can patients just use Lutein for AMD and have a similar effect as AREDS2 formulations?
Although Lutein seems to be the most important ingredient, perhaps you need all of the ingredients to help reduce the progression of AMD in 25% of patients
Review slide 119 for a summary of ophthalmic agents
