Eye Disease Flashcards
highlights of eyedrops administration
contacts must be removed
pull eyelid back to form pocket
don’t touch eye with dropper
keep eye closed 1-3 min following administration
wait 10 minutes between administration of multiple drugs
nasal lacrimal occlusion
essential part of eye drop administration
cover the nasal lacrimal duct with index finger to prevent systemic absorption
decreases side effects and dose, allows for better drug potency
eye ointment administration highlights
warm ointment in hand 1-2 minutes
discard first .25 in of medication
close eye and don’t rub for 1-2 minutes
eye diseases
cataracts
macular degeneration
retinopathy
glaucoma
leading cause of blindness around the world
cataracts
cause of cataracts
aging **
also sunlight, smoking, family history, trauma, DM and steroid use
clinical features of cataracts
yellowing of the lens
myopic shift (brief improvement in near vision)
lost color discrimination and distant vision
cataracts pathophys
as lens ages, new layers are added
these layers compress lens nucleus and it becomes harder
yellowing of lens
cataracts dx and treatment
opthalmic exam (slit lamp, direct light) and decreased visual acuity
treatment: surgery (lens implant)
2 blood supplies to retina
choroidal blood vessels (outer retina, photoreceptors -75%)
central retinal artery (supplies central portion of retina)
retinopathy risk factors
DM
HTN
smoking
hyper cholesteremia
diabetic retinopathy (clinical features)
asymptomatic finding
loss of vision
diabetic retinopathy fundus exam findings
cotton wool patches
neovascularization
cotton wool patches
diabetic retinopathy
caused by infarcted nerve fibers
neovascularization
diabetic retinopathy
hypoxia of retina causes formation of new blood vessels in the eye
hypertensive retinopathy
asymptomatic but can have decreased vision
hypertensive retinopathy fundoscopic exam findings
papilledema
AV nicking
Retinal hemorrhages
AV nicking
hypertensive retinopathy
indentation in veins where there are arteries that cross
macular degeneration
degenerative changes to central retina
causes loss of central vision
macular degeneration risk factors
age family history female caucasian smoking
macular degeneration exam
ophthalmic exam shows scattered pale yellow spots
pharmacologic treatment of macular degeneration
ranibizumab/Lucentis
ranibizumab/Lucentis
Indication
neovascular macular degeneration
improves remaining vision, may preserve vision
ranibizumab/Lucentis
MOA
inhibits VEGF so REDUCES new blood vessel growth
via monthly eye injections
ranibizumab/Lucentis
ADR
increased IOP
Traumatic cataract
detached retina
vitamins used in macular degeneration
ascorbic acid vitamin E beta carotene Zinc Oxide Cupric oxide
Open angle glaucoma
pathophysiology not understood BUT
decreased aqueous humor outflow and increased aqueous production
clinical features of open angle glaucoma
asymptomatic
slow loss of vision (peripheral first then central)
optic neuritis
testing for open angle glaucoma
peripheral and central field examination
measure IOP
OAG goals of therapy
prevent further loss of visual function
minimize adverse effects of therapy
maintain IOP below pressure at which further optic nerve damage is unlikely
which agents increase aqueous humor outflow
prostaglandin analogs
a-adrenergic agonists
cholinergics
classes of agents that decrease aqueous humor production
b-adrenergic antagonists
a-adrenergic agonists
carbonic anhydrase
first line agents in OAG
b-blockers
prostaglandin inhibitor
second line agents in OAG
selective a-2 receptor agents
cholinergic agents
third line agents in OAG
topical carbonic anhydrase
b-blockers
traditional first line for both open and closed angle glaucoma
decrease IOP by reducing formation of aqueous humor
b-blokcers list
timolol (Timoptic)
levobunolol (betagan)
betaxolol (Betoptic)
B-blockers adr (systemic)
bronchospasm
pulmonary edema
respiratory arrest
bradycardia
CIs to beta blockers
COPD
Asthma
CHF
PE
betazolol is less likely to cause some of these diseases
prostaglandin
1B agent in treating OAG
better compliance but more expensive $$$
prostaglandin local ADR
increased iris pigmentation
hypertrichosis (excessive hair growth)
darkening of eyelashes
A-2 adrenergic agonists (list)
bromonidine/Alphagen
combination w/t 1st line agents
A-2 adrenergic agonists MOA
decreases IOP by increasing humor outflow
carbonic anhydrase inhibitors
route + indication
brinzolamide/Azopt (Topical/DROPS) - open angle
acetazolamide/Diamox (systemic) - closed angle
carbonic anhydrase inhibitors CI
SULFA ALLERGIES
cholinergic lis and MOA
pilocarpine soln/isopto carpine
increase outflow by pulling open trabecular meshwork
cholinergic and angle closer glaucoma treatment
pilocarpine doesn’t work until we already get the pressure reduced
Pinguecula
yellow-white, flat/raised lesions over the sclera
doesn’t involved cornea
slit lamp exam
protect eyes, moisture, topical steroid or NSAIDS
Pterygium
fold of fibrovascular tissue that extends onto cornea
slit lamp dx
topical steroid or NSAID, surgical exception if in visual access
ophthalmic lubricants
indicaitons and MOA
relief of eye irritation and dry eyes
tonicity, adjust pH, increase eye contact time
OTC
Opthalmic NSAIDs
list of drugs (2)
Ketoralac (Acular)
Diclofenac (Voltaren)
ophthalmic NSAID indications (4)
post operative inflammation after cataract surgery
ocular itching
Pingueceula
pterygium
ophthalmic NSAID MOA
reduce prostaglandin E2 production
minimal systemic absorption
ophthalmic corticosteroids
prenisolone (Pred-Forte)
Triamcinolone (Triesence)
Tobamycin/Dexamethasone (tobraDex)
ophthalmic corticosteroids indications
ocular inflammatory conditions
ophthalmic corticosteroids ADRS
can cause glaucoma
ophthalmic corticosteroids
CIs
pts w/herpes keratitis
pts w/problems of elevated IOP
blepharitis
clinical features
crusty, thick eyelid margins
itching, burning, foreign body sensation, tearing
blepharitis treatment
scrub margins with baby shampoo
warm compress
if severe can add ABX
Dacryoadentitis
inflammation of lacrimal gland
pain, swelling, redness over outer one third of upper eyelid
must rule out cellulitis
dacryoadentitis treatment
mild cases treat augmenting or kelfex
severe- admit with IV ABX
chalazion clinical features
sub acute
non tender papule on inner surface of eyelid
cause: blocking meibomian gland
chalazion treatment
warm compress
refers if not relieved
hordeolum
“sty:
rapid onset
painful, tender, erythematous pustule on lid of margin
commonly caused by staph aureus
