Eye Lecture Part 1 Flashcards
Identify the different anatomical parts of the eye
iris
lens
pupil
cornea
retina
sclera
optive nerve
Iris
colored part; contains muscles to help change shape of pupils
Lens
what we see with; helps us focus
Pupil
tunnel for light to see
Cornea
clear film on outside of eye, protective layer; bends light so we can see it; has nerve fibers, are sensitive
Retina
processes the light
Sclera
helps keep the shape of the eye
Optic nerve
what transmits everything we are seeing and sends it to the brain
Outline steps for proper administration of ocular medications
local drug delivery: eye drops, ointments, gels
systemic drug delivery: injections, oral medications
Topical drug delivery - eye drop considerations
limited volume capacity: tear volume = 7-9 microliters, volume delivered by eyedroppers = 35-36 microliters
built in defense mechanisms: sudden increase in tear volume, rapid reflex blinking; corneal protection barrier
residence time: drugs reside in the conjunctiva ~ 3-5min to actually have an affect
Topical drug delivery - eye ointment considerations
drug depot: serves as a drug depot in the conjunctival sac resulting in enhanced/sustained absorption
blurry vision: blurred vision reported after administration and can last up to 30 min
challenging to apply: difficult to apply exact dose
Eye drop administration
- wash hands with soap and water; remove contacts if applicable
- while tilting head back, pull down lower lid of eye with index finger to form a pocket
- hold the dropper with the other hand, as close to the eye as possible without touching it
- while looking up, squeeze the dropper so that a single drop falls into the pocket made by the lower eye lid
- remove your index finger from the lower eyelid; close your eyes for 2-3min and tip your head down towards the floor
- place a finger on the tear duct and apply gentle pressure
Eye ointment administration
- wash hands with soap and water; remove contacts if applicable
- holding the tube between your thumb and forefinger, place it as near to your eyelid as possible without touching it
- while tilting your head back, pull down the lower lid of your eye with your index finger to form a pocket
- squeeze ribbon of ointment or gel into pocket made by the lower eyelid
- remove your index finger from the lower eyelid; blink your eye gently, then close your eye for 1-2 min
- wipe excess ointment or gel from the eyelids and lashes; with another clean tissue, wipe the tip of the tube clean
Administration tips
take out contact lenses prior to eye drops/ointments; wait 15 min after eye drops to reinsert contacts, eye ointments generally not recommended with contacts
Timing of administration
2 drops same med: wait 5 min b/w drops
2 drops diff meds: wait 5-10 min b/w drops
2 ointments: wait 30 min b/w ointments
1 ointment + 1 drop: use the drop FIRST, wait 5-10 min b/w
Prescription SIG
o = eye
a = ear
s = left
d = right
u = both
Classify conjunctivitis as bacterial, viral, or allergic based on patient specific characteristics and provide treatment options for each type
conjunctivitis - inflammation of the conjunctiva
Bacterial conjunctivitis
presentation: redness, discharge; eye stuck shut in morning; discharge from eye is yellow, white, or green; typically effects only one eye
common causes: bacteria
highly contagious
Bacterial conjunctivitis treatment
non-pharmacologic: avoid sharing tissues, towel, cosmetics, linens; remove contact lenses - don’t wear again until eye is white with no discharge for 24 hrs after antibiotics
pharmacologic: often self-limited, topical antibiotics shorten clinical course; antibiotic treatment required in contact wearers; ointment preferred over drops in children and risk of poor compliance
Bacterial conjunctivitis antibiotics (RX)
erythromycin ointment; moxifloxacin solution, ofloxacin solution, trimethoprim-polymyxin B solution
treat for 5-7 days
Viral conjunctivitis
presentation: water eyes, burning, sandy, gritty feeling; pus in morning crusting followed by watery discharge throughout the day; often involves both eyes; part of viral upper respiratory infection
common causes: adenovirus
highly contagious
Viral conjunctivitis treatment
NO role for antibiotics or antivirals
non-pharmacologic: avoid sharing tissues, towels, cosmetics, linens, utensils; remove contact lenses- don’t wear again until eye is white with no discharge for 24 hrs
symptomatic relief only: warm/cool compress; topical decongestant (no more than 72 hr use, rebound congestion)
Viral conjunctivitis decongestants (OTC)
naphazoline solution
tetrahydrozoline solution
acute use only - no more than 72hrs
Allergic conjunctivitis
presentation: redness, watery discharge, itching; morning crusting; both eyes involved; accompanied by other allergic symptoms, nasal congestion, sneezing, wheezing; eye rubbing worsens symptoms
common causes: airborne allergens
Allergic conjunctivitis treatment
non-pharmacologic: do not rub eye, COOL compresses, avoidance or reduction of contact with known allergen
pharmacologic: antihistamines, mast cell stabilizers, multiple acting agents
Allergic conjunctivitis - antihistamines
olopatadine solution (RX and OTC)
azelastine solution (RX)
epinastine solution (RX)
patients may also take oral antihistamines if other sx present
Allergic conjunctivitis - mast cell stabilizers (RX)
cromolyn sodium solution
lodoxamide solution
nedocromil solution
Allergic conjunctivitis - mutli-acting agents (OTC)
ketotifen solution
alcaftadine solution
work on both histamine and mast cells
Anterior uveitis
intraocular inflammation
presentation: patterned (wagon wheel) redness associated with iritis; dilated pupil; complains of discomfort and sensitivity to light
treatment: topical glucocorticoids; mydriatic/cycloplegic (nothing OTC)
Uveitis treatment considerations
referral to ophthalmologist or optometrist for treatment
treatment for 4-6 weeks (no more than, can cause glaucoma)
opthalmic steroid toxicity: secondary infections, secondary open-angle glaucoma
increase in intraocular pressure
risk factors: primary open-angle glaucoma, ocular hypertension, elderly, children, connective tissue disease, T1D with myopia
Differentiate between dry and wet macular degeneration and their respective treatment options
macular degeneration: neovascularization, overgrowth of blood vessels in eye, cause fluid to build up leading to vision loss
top risk factors: age + smoking
dry: common > 50 yrs, 90% of MD cases, usually both eye affected, gradual loss of vision
wet: advanced MD, vision loss rapid, loss of central vision due to abnormal growth of new blood vessels
macular degeneration is the leading cause of blindness
Macular degeneration treatment goals
slow progression & prevent severe visual impairment or blindness
Macular degeneration - choosing a safe supplement
AREDS
AREDS 2 - contains beta carotene; beta carotene has an increased risk of lung cancer in smokers
Macular degeneration RX treatment
vascular endothelial growth factor inhibitors: prevent formation of new blood vessels and vascularization of tissues
shown to slow disease progression and may cause moderate gains in vision
SEs: increased BP, retinal detachment, increased IOP, eye infection, vitreous floaters
injected directly into eye
VEGF inhibitors/photodynamic therapy
bevacizumab
ranibizumab
aflibercept
pegaptanib
verteporfin
used for wet/severe pts
given at intervals
all intravitreal injections
Causes of dry eyes
decreased tear production - Sjogren’s syndrome (autoimmune disease characterized by lymphocytic infiltration of exocrine glands resulting in xerostomia and dry eyes) vs non Sjogren’s syndrome
increased evaporative loss
Dry eyes risk factors and presentation
risk factors: advanced age, female, contact lens wearers, low humidity environments, meds (anticholinergics, SSRIs, antihistamines)
presentation: dryness, red eyes, general irritation, gritty sensation, blurred vision, light sensitivity
Recommend both pharmacologic and nonpharamcologic treatment for dry eyes
step 1: tear supplementaion, WARM compress, address environmental factors, discontinue meds worsening dryness
step 2: topical treatment: secretagogues - liftegrast, cyclosporine; in office procedures
step 3: oral drug therapy - antioxidants, omega-3 FAs; sclera contact lenses; surgery; investigation drugs
Tear supplementation
aqueous supplementing (always start with 1st): carboxymethylcellulose
hydroxypopylcellulose
polyethylene glycol, propylene glycol, lipid supplementing: DMPG, propylene glycol, mineral oil
Tear supplementation clinical pearls
Try to avoid benzalkonium chloride – check inactive ingredients
Preservative-free (PF) is often more-expensive, but is it BETTER?
PF less likely to cause adverse effects or further exacerbate dry/red eyes
-
PF often packaged in individual vials, only 24-hour shelf life
Meibomian gland dysfunction (MGD) or evaporative should be treated with lipid-supplementing artificial tears
Hard to tell the cause of dry eyes in an outpatient pharmacy setting, consider lipid-containing if patient fails aqueous
Recognize medications that may cause drug-induced opthalmic disorders
cataracts
intraoperative floppy iris syndrome
optic neuropathy
retinopathy
Drug-induced cataracts
corticosteroids, phenothiazine, alkylating agents, and statins
surgical removal of lens may be necessary to restore vision
Drug-induced intraoperative floppy iris syndrome
alpha-1 antagonists
irreversible
Drug induced optic neuropathy
amiodarone, ethambutol, linezolid, and PDE-5 inhibitors
discontinuation of agent generally leads to reversal of symptoms
Drug induced retinopathy
aminoquinolines, antiestrogen agents, phenothiazines, and retinoids
nonreversible
Drug induced dry eyes treatment/management
nonpharmacologic therapy: warm compress, increased fluid intake, use humidifier
increase tear volume: aritifical tears or other ocular lubricants
decrease inflammation: restasis or xiidra eye drops
medication changes: discontinue causative agent if possible, switch to preservative free eye drops
Amiodarone
corneal deposits; optic neuropathy
Digoxin
yellow tinted vision/halos (toxicity)
Anticholinergic agents
blurred vision; dry eyes
Antidepressants
blurred vision; dry eyes
PDE-5 inhibitors
color changes (blue tint)
Bisphosphonates
inflammation/redness
Topiramate
angle closure glaucoma
SSRIs
eye tics
