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Eye disorders Flashcards

1
Q

Allergic conjunctivitis background

A
  • occular allergy, inflammation of the conjunctiva
  • 20% of people suffer from it
  • NOT contagious
  • characterizations: redness of conjunctiva, increased tearing, itchiness, burning, blurred vision
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2
Q

Allergic conjunctivitis differential diagnosis

A
  • Etiology: allergy to pollen, dander, etc
  • Signs/sx: itching, sandy/gritty feeling, redness, tearing
  • Involvement: bilateral
  • Contagious: NO
  • Tx: lubricants, decongestants, antihistamines
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3
Q

Bacterial Conjunctivitis dx

A
  • Etiology: bacterial infection
  • Sx: itching, redness, thick yello/white discharge
  • Involvement: Unilateral initially, may spread
  • Contagious: YES
    Tx: Abx, eye drops
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4
Q

Viral Conjunctivitis dx

A
  • Etiology: Viral infection
  • Sx: burning or sandy/gritty feeling, redness, watery or mucous discharge, possible viral prodrome
  • Involvement: Unilateral with spread to bi
  • Contagious: YES
  • Tx: self-limiting, lubricants/steroids
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5
Q

Allergic conjunctivitis tx: Decongestant

A
  • phenylephrine, naphazoline, oxymetazoline, tetrahydrolozine
  • Dose: 1-2 drops TID-QID
  • Cannot use for more than 3 days (rebound congestion)
  • DO NOT USE in pts with narrow anterior chamber or glaucoma
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6
Q

Allergic conjunctivitis tx: Antihistamines

A
  • Pheniramine maleate
  • Dose: 1-2 drops TID-QID
  • can cause stinging, burning, discomfort
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7
Q

Allergic conjunctivitis tx: Ketotifen

A
  • 0.25%
  • MOA: mast cell stabilizer and H1 antagonist
  • 1 drop Q8-12h
  • can cause burning and stinging and dilation
  • NO rebound congestion
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8
Q

Allergic conjunctivitis tx: Brimonidine

A
  • new drug; low % selectively restricts vein in eye and increases O2 to tissues to reduce inflammation/redness
  • Dose: 1 drop Q6-8h
  • b/c selective, no tolerance, redness, or loss of effectiveness
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9
Q

Allergic conjunctivitis counseling pts

A
  • advise of side effects
  • pts w/contacts should not wear until condition is resolved
  • screen for contraindications
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10
Q

Xerophthalmia (dry eyes) Etiology

A

tear evaporation, environmental conditions (dust/smoke), advanced age, female (hormones), medical conditions, medications, LASIK or other surgery, contact lenses, eye injury/surgery
- too many tears can be sign of dry eyes b/c eye overproduces to compensate

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11
Q

Dry eye manifestations

A
  • dry, gritty, irritated, scratchy, or filmy feeling (MAIN - KNOW)
  • burning/itching
  • redness
  • blurred vision
  • excess tears
  • light sensitivity
  • strained eyes
  • contact lens discomfort
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12
Q

Medical conditions associated with dry eye

A 
rheumatoid arthritis
sarcoidosis
Sjogren syndrom
Lupus
DM
Thyroid disorders
Vit A deficiency
Inflammation
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13
Q

Medications that can cause dry eyes

A 
antihistamines
decongestants (anticholinergic)
anti-HTN drugs (diuretics and B-blockers)
Acne tx
Birth control
Drugs for Parkinson's
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14
Q

Dry eye diagnosis: blink rate and tear break-up test

A
  • special dye put into eye, stains cornea
  • measure time it takes for tears to evaporate
  • reflection of how much lipid are in tears
  • more lipids = more time to break up tears
  • short tear break-up = evaporates faster = dry eyes
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15
Q

Dry eye diagnosis: ocular surface dye staining

A

know name

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16
Q

Dry eye diagnosis: aqueous tear production (Schirmer test)

A
  • determines if eye produces enough tears to keep it moist.
  • used when pt experiences very dry eyes or excessive eye watering
  • negative (more than 10 mm of moisture in 5 min) = NORMAL
17
Q

Dry eye diagnosis: lacrimal gland function test

18
Q

Dry eye diagnosis: osmolarity test

19
Q

Dry eye potential compications

A
  • corneal ulceration
  • functional vision loss
  • infections
  • neovascularization
  • scarring
20
Q

Dry eye exclusions for self-care

A
  • eye pain (extreme or doesn’t go away = refer)
  • blurry vision
  • light sensitivity
  • hx of contact lens wear
  • blunt trauma to eye
  • chemical exposure to eye
  • conjunctivitis or eyelid infections
  • eye exposure to heat (not sun exposure)
  • sx for more than 3 days
  • other conditions: conjunctivitis, infections, foreign particles in eye, ocular abrasions
21
Q

Blunt trauma to eye sx

A
  • ruptured blood vessels
  • bleeding into tissue
  • swelling
  • ocular discomfort
  • facial drooping
    complications:
  • internal eye bleeding
  • secondary glaucoma
  • detached retina
  • periorbital bone fractur
22
Q

Chemical exposure to eye sx

A
  • reddened eyes, watering, difficulty opening
  • complications: scarring and loss of vision
  • to prevent scarring: flush for 10 min with sterile water or saline -> go to ED
23
Q

Dry eye: NON-pharmacological tx

A
  • tx underlying cause if you can identify it
  • avoid meds with anticholinergic or diuretic properties
  • frequent breaks from reading/screens
  • avoid low humidity and winds (add humidifier indoors)
  • plugs: Lacrisert
  • Hot compress
  • Eyelid scrub/massage
  • blinking
  • avoid smoke
24
Q

Dry eye: Artificial tears

A
  • protects surface cells of the eye
  • Ocular lubricants:
  • colorless and vary in viscosity
  • hydroxypropyl methylcellulose (0.3%, 0.8%), carboxymethylcellulose (CMC) (0.5 or 1%), PVA 1.4%
  • combining drugs increases viscosity = enhanced drug action
  • no irritation or toxicity to tissue
    Refresh dry eye therapy
  • glycerin, polysorbate, CMC, boric acid, castor oil, erythritol,
  • oil in water emulsion supplements lipids in tears
  • lubricates for longer period
  • gel is better
  • unit dose is better
25
Q

Dry eye: gel drops

A
  • extended tx
  • expands tears
  • clinically proven to provide relief
    Systane:
  • gelling and polymer system
  • forms gel-like environment that stays in contact with ocular surface longer
  • creates ocular shield, allowing epithelial repair
    Refresh Optive:
  • combo CMC and glycerin
  • osmotic protective effect
  • formula without preservatives less likely to irritate
26
Q

Dry eyes: Advanced/triple action solutions

A
  • triple action
  • works on all three layers of tear film
  • helps hydrate, lubricate, and prevent tears from evaporating
    Refresh optive advanced and preservative free:
  • gel and polymer system
  • forms gel-like environment that stays in contact with eye longer
  • creates ocular shield
27
Q

Dry eyes: Retain MGD

A
  • 30 single dose vials
  • 4th generation
  • moisturizes, lubricates, and protects
  • blend of heavy and light mineral oils plus emollients
  • MOA: electrostatic attraction to stabilize tear film and retain lipids; hypotonicity lubricates and protects
  • target pts: Meibomian Gland Dysfunction (MGD) - tear evaporates too quickly
  • instill 1-2 drops in eye prn
28
Q

Dry eye: Refresh Optive Mega-3 preservative free

A
  • newest class
  • omega-3 oil
  • flaxseed and castor oil to protect tears from evaporating
  • should resemble body’s own oils
29
Q

Dry eye: Non-medicated ointment

A
  • advantage is enhanced retention time in the eye = enhances integrity of tear film
  • BID, or prn depending on pt
  • SE: blurred vision
  • preservative free (best option)
30
Q

Benzalkonium Chloride

A

BAC
preservative
newer products don’t use

31
Q

Dry eye: mild to moderate tx

A 
Mild: 
education, environmental modification
eliminate offending agent
artificial tear substitutes, gels/ointments
warm compress
Moderate:
same as for mild, plus:
- anti-inflammatory agent
- punctal plugs
- spectacle side shields and moisture chambers
32
Q

Administering eye drops

A
  • wash hands
  • don’t touch dropper to eyes
  • tilt head back
  • grasp lower eyelid and pull away from eye
  • look up
  • close eyes for 3 min, minimize blinking
  • blot excess from eye
33
Q

Administering eye ointment

A
  • wash hands
  • if after a drop, wait 10 min
  • place 1/4-1/2 inch strip of ointment inside lower eyelid
  • close eyes for 1-2 min
34
Q

Minor ocular irritation

A
  • responds well to artificial tear solutions or non-med ointments
  • zinc sulfate, mild astringent, may be recommended
  • dose: 1-2 drops up to QID
  • homeopathic Similasan eye drops no efficacy
35
Q

Corneal edema

A
  • hyperosmotic agents 1st line
  • MOA: increase tonicity
  • OTC as sodium chloride
  • instill 2% solution up to QID
  • add 5%hs if sx persist, refer if sx still persist
36
Q

Stye

A
  • avoid rubbing eyes
  • apply warm compress for 10 min, 3x/day until it drains
  • prevention: wash hands
  • referral: if persists for more than 2 days of home tx, interferes with vision, many styes at once
37
Q

Drug-induced eye disorders

A 
Abx
Anticholinergics (warn pts with glaucoma)
Biphosphonates 
Cancer drugs 
Erectile dysfunction drugs
Glucocorticoids
Digoxin
Tamsulosin
See chart for more detail (slide 28)
38
Q

eye vitamins

A

Vitamin C, E, Beta-carotene and zinc (age-related macular degeneration)
Lutein and zeaxantin

5112 (12 decks)

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