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
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
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
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
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
6
Q
Allergic conjunctivitis tx: Antihistamines
A
- Pheniramine maleate
- Dose: 1-2 drops TID-QID
- can cause stinging, burning, discomfort
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
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
9
Q
Allergic conjunctivitis counseling pts
A
- advise of side effects
- pts w/contacts should not wear until condition is resolved
- screen for contraindications
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
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
12
Q
Medical conditions associated with dry eye
A
rheumatoid arthritis sarcoidosis Sjogren syndrom Lupus DM Thyroid disorders Vit A deficiency Inflammation
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
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
15
Q
Dry eye diagnosis: ocular surface dye staining
A
know name
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
A
know name
18
Q
Dry eye diagnosis: osmolarity test
A
know name
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
Dry eye: gel drops
- 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
Dry eyes: Advanced/triple action solutions
- 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
Dry eyes: Retain MGD
- 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
Dry eye: Refresh Optive Mega-3 preservative free
- newest class
- omega-3 oil
- flaxseed and castor oil to protect tears from evaporating
- should resemble body's own oils
29
Dry eye: Non-medicated ointment
- 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
Benzalkonium Chloride
BAC
preservative
newer products don't use
31
Dry eye: mild to moderate tx
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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
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32
Administering eye drops
- 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
Administering eye ointment
- 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
Minor ocular irritation
- 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
Corneal edema
- 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
Stye
- 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
Drug-induced eye disorders
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Abx
Anticholinergics (warn pts with glaucoma)
Biphosphonates
Cancer drugs
Erectile dysfunction drugs
Glucocorticoids
Digoxin
Tamsulosin
See chart for more detail (slide 28)
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38
eye vitamins
Vitamin C, E, Beta-carotene and zinc (age-related macular degeneration)
Lutein and zeaxantin
