Eye drops and ointments from work book Flashcards
Reasons for instilling drops or applying ointments
therapeutic medication
to dilate the pupil prior to examination or surgery
to anaesthetise the eye prior to medical or nursing intervention
to lubricate the eye
to treat the lacrimal apparatus
where might ointments be prescribed for application
eyelid margins
eyelid/eyebrow wound
instillation into the eye
Common Mydriatics
topicamide
atropine
cyclopentolate (Mydrilate)
phenylephrine
Mydriatics
A mydriatic is an agent that induces dilation of the pupil. Drugs such as tropicamide are used in medicine to permit examination of the retina and other deep structures of the eye, and also to reduce painful ciliary muscle spasm.
Main reason why you would use topicamide?
to dilate the patient’s pupil in order for the doctor to examine the fundus. The wider the pupil the greater the area of the fundus will be seen on examination.
What two strengths does Tropicamide come in?
0.5% and 1%
Action of Tropicamide
stimulates the dilator muscles and also weakly paralyses (cycloplegic) the ciliary muscles
Effect of tropicamide
is to dilate the pupil - mydriasis
Side effects of Tropicamide
may cause an attack of acute glaucoma- in patients who are susceptible.
mydriatic drops sting
contact dermatitis - any patient with a known contact dermatitis should not have topicamide.
What two strengths does Atropine come in?
1% or 2%
Atropine
natural alkaloid of Belladonna, derived from deadly nightshade. It is an infrequently used mydriatic and produces mydriasis in half an hour and almost complete cyclopegia
Is Atropine Long or Short acting?
Long its effects can last up to 14 days
miotics and atropine
atropine’s action cannot be reversed bby miotics which is a great disadvantage.
Side effects of atropine
raised intraocular pressure raised blood pressure sensitivity psychotic disturbance and hallucinations contact dermatitis
Cyclopentolate (Mydrilate)
Cyclopentolate is a medication commonly used during pediatric eye examinations that dilates the eye (mydriatic), prevents accommodation of the eye to different distances (cycloplegic), and blocks specific receptors called muscarinic receptors (muscarinic antagonist).
how long does it take Cyclopentolate to produce cyclopegia and dilation? and how long will the effect last for?
produce cyclopegia and dilation within half an hour
effect lasts for 24 hour
Where must Cyclopentolate be stored?
the fridge
Cyclopentolate side effects:
Ocular side-effects of mydriatics and cycloplegics include transient stinging and raised intra-ocular pressure; on prolonged administration, local irritation, hyperaemia, oedema and conjunctivitis can occur. Contact dermatitis can occur with the antimuscarinic mydriatic drugs, especially atropine.
Systemic side-effects of atropine and cyclopentolate can occur, particularly in children and the elderly.
Phenylephrine 2.5% or 10%
non-cyclopegic mydriatic pwerful mydriatic and is capable of breaking up adhesions (posterior synechiae). no effect on accommodation stings on instillation very irritant in the anterior chamber
posterior synechia
adhesion of the iris to the capsule of the lens or to the surface of the vitreous body.
annular synechia
adhesion of the whole rim of the iris to the lens.
anterior synechia
adhesion of the iris to the cornea.
total synechia
adhesion of the whole surface of the iris to the lens.
adhesion
union of two surfaces that are normally separate, such as in wound healing or in some pathological process. Surgery within the abdomen sometimes results in adhesions from scar tissue; as an organ heals, fibrous scar tissue forms around the incision and may cling to the surface of adjoining organs. Adhesions are usually painless and cause no difficulties, but occasionally they produce pain, with or without obstruction or malfunction, by distorting the organ.
non-cyclopegic mydriatic that is sometimes used in the treatment of Open Angle Glaucoma
phenylephrine because of its ability to lower intra-occular pressure.
what could a darker iris indicate?
more resistance to the effect of mydriatics and caution should be exercised to avoid overdose.
Common Miotics
Pilocarpine
timoptol
trusopt
cospot
Miotics
These medications reduce eye pressure by increasing the drainage of intraocular fluid through the trabecular meshwork.
Preparations pilocarpine comes in
1%, 2%, 4% and occasionally 6%
Pilocarpine
commonly used miotic
can be used for long periods without causing irritation of the eye
used in the treatment of open angle glaucoma
Pilocarpine action
acts to contract the pupil and ciliary muscles
miosis lasts up to four hours - therefore can be instilled sometimes four times per day.
spasms of accommodation lasts about 2 hours
Pilocarpine side effects
small pupil
blurring of vision
browache
Timoptol
beta-blocker
works by reducing the production rate of aqueous tumour
use twice per day
Timoptol side effects
can have systemic effects e.g. broncho constriction
trusopt 2%
a buffered, slightly viscous, aqueous solution of dorozolamide
when used alone may be instilled three times per day
with adjunct treatment trusopt is instilled twice per day
effective in the treatment of open angle glaucoma and ocular hypertension
trusopt 2% side effects
ocular burning and stinging, blurred vision, itching, tearing, conjunctivitis, lid inflammation, irritation, redness. some patients complain of signs and symptoms including: headache, fatigue, dizziness, skin rash, bitter taste in mouth.
USE IN CAUTION IN PATIENTS WITH HEPATIC DISEASE
cospot
isotonic, slightly buffered, viscous aqueous solution
contains 20mg dorzolomide and 5mg timolol
used to treat intraocular pressure and open angle glaucoma
corticosteriod drops
betamethasone
dexamethasone
betamethasone 0.1% supplied as betnesol or
betnesol-N - containing antibiotic Neomycin sulphate 0.5%
indicated for use in the short term treatment of inflammation.
should not be used in the treatment of undiagnosed red eye- because if the red eye is caused by a virus the corticosteriods could aggravate the condition and cause blindness
prolonged treatment could result in the condition steroid glaucoma in patients predisposed to this condition.
Dexamethasone supplied as maxidex 0.1% or
Maxitrol 0.1% which contains 0.35% Neomycin
used in the short term local treatment of inflammation
Local anaesthetics
Minims Benoxinate
Lignocaine
fluorescein
minims benoxinate
oxybuprocaine 0.4% widely used topical local anaesthetic
Lignocaine and fluorescein
lignocaine 4% and fluorescein 0.25%
topical local anaesthetic combined with fluorescein both of which are necessery for tonometry.
Diagnostic drops
fluorescein
rose bengal
Fluorescein 2%
orange coloured dye
does not penetrate, intact cell membranes
if there is damage to the epithelial layer, it gains access to the bowmans membrane, the stroma and the aqueous.
what colour is damaged tissue visualised as with fluorescein
green fluorescence
alternative uses for fluorescein
other than diagnosis of abraded, broken surface of the cornea
contact lens fitting
goldman applanation tonometry
siedel’s test for leaking cornea-scleral wound
test for patency of lacrimanl drainage system
fundu photography
goldman applanation tonometry
Applanation tonometry: measures IOP by providing force which flattens the cornea.
Variable force applanation tonometers (Goldmann, Perkins, Draeger, MacKay-Marg, and Tono-Pen and Pneumatonometer): area of the cornea being applanated held constant, variable for applied.
siedel’s test for leaking cornea-scleral wound
the test used to reveal ocular leaks from the cornea, sclera or conjunctiva following injury or surgery and sometimes disease is called Seidel test.
fundu photography
Fundus photography documents the retina, the neurosensory tissue in our eyes which translates the optical images we see into the electrical impulses our brain understands. The retina can be photographed directly as the pupil is used as both an entrance and exit for the fundus camera’s illuminating and imaging light rays. The patient sits at the fundus camera with their chin in a chin rest and their forehead against the bar. An ophthalmic photographer focuses and aligns the fundus camera. A flash fires as the photographer presses the shutter release, creating a fundus photograph like the picture above. Ophthalmologists use these retinal photographs to follow, diagnose, and treat eye diseases.
Rose Bengal
dye selectively stains all devitalised corneal and conjunctival cells a readily visible red colour. More effective than flourescein and is considered a more sensitive test for keratoconjunctivitis sicca - sjorgen’s syndrome.
discomfort and irritation
eye drop antibiotics
chloramphenicol ciprofloxacin gentamicin fucithalmic floxacin
chloramphenicol
in drop and ointment form
when used systemically can cause blood dyscrasions
penetrates the cornea
ciprofloxacin
broad spectrum antibiotic
used to treat superficial bacterial infections
especially useful in the treatment of bacterial ulcers
ciprofloxacin side effects
local burning and itching
crusting on the lid margins
not recommended for children under 12 and should be used in caution with those pregnant of breast feeding.
Gentamicin 0.3%
broad spectrum antibiotic particulary useful in infections caused by pseudomonas auruginosa
toxic if used for long term therapy
fucithalmic 1%
useful for treating staphylococcal infections. presents as eyedrops in a gel base.
floxacin 0.3%
broad spectrum antibiotic
side effects
local irritation, photophobia, dizziness, nausea and vomiting, headache.
antivirals
acyclovir 1%
herpes simplex
