Eyes and ears Flashcards
presentation of dry eye disease
discomfort, sandy or gritty feeling, sensation that something is in the eye, and mildly red eye
causes of dry eye disease
aging, dry or dusty working environments, humidity, vitamin A deficiency, surgery, or anticholinergic drugs
examples of drug classes that can cause dry eye disease
- antihistamines
- TCAs
- decongestants
- diuretics
- beta blockers
goals of therapy for dry eye disease
- alleviate ocular surface dryness
- relieve symptoms; improv QOL
- prevent tissue damaga
non- pharm treatment or DED
warm compresses, humidifier, good eyelid hygiene, and environmental modifications
first line pharm treatment for dry eye disease
artificial tears
other treatments for dry eye disease
nonmedicated ophthalmic ointments
exclusions for self-care of DED
- pain
- unresponsive to therapy for more than 72 hours
- evidence of damage to cornea
- suspected systemic disease
- severe discomfort
examples of ocular lubricants
polyethylene glycol, polyvinyl alcohol, povidone, and propylene glycol
examples of preservatives
benzalkonium chloride, chlorhexidine, chlorobutanol, methyl paraben, propylparaben, sodium perborate
shelf-life for eye drop medications containing preservatives
typically 28 days after opening
shelf-life for eye drop medications that are preservative free
discard immediately after open and used
do you look down at the floor or up at the ceiling after applying eyedrops
down at the floor and apply gentle pressure with finger to tear duct opening
how long do you wait between multiple drops
at least 5 minutes
would you place a suspension first or last if you had more than one dosage form
last
drops need to be administered _____________ before ointment
10 minutes
presentation of allergic conjunctivitis
pruritis, red eye + watery discharge, excessive tearing
causes of allergic conjunctivitis
pollen, animal dander, topical eye preparations
goals of therapy for AC
remove or avoid allergen, reduce severity of allergic reaction, relieve symptoms, and protect ocular surface
non pharm treatment for AC
cold compress 3-4 times daily, check pollen count, run air condition, use air filters, wear sunglasses
first line treatment for AC
artificial tears prn
second line treatment for AC
ketotifen fumarate
MOA of ketotifen fumarate
blocks histamine release, inhibits release of mediators from mast cells, and contains preservatives
third line treatment for AC
add an oral antihistamine or ophthalmic decongestants
presentation of loose foreign substances in the eye
mild pain and tearing/watering of eye
treatment for loose foreign substances in the eye
irrigation
- rinse with ocular irrigate solution
- nonmedicated eye petroleum application at bedtime
exclusions to self-care of loose foreign substances
- systemic symptoms
- wood or metal fragments
- severe eye pain
- vision changes
- continued redness or irritation
- condition persists or worsens after treatment
- open would in or near the eyes
presentation of minor eye irritation
eye redness or feeling of sand in eyes
causes of minor eye irritation
loose foreign substances in the eye, contact lens, wind/sun/snow, chemical fumes, chlorine
first line therapy for minor eye irritation
artificial tears
other treatments for minor eye irritation
non medicated ointments or zinc sulfate
exclusions for minor eye irritation
- systemic symptoms
- eye pain
- blurred vision
- blunt trauma to eye
- chemical exposure
- sensitivity to light
- history of wearing contacts
- symptoms longer than 72 hours
presentation of excessive or impacted cerumen
ear fullness or dull pain, discomfort, itching, tinnitus, dizziness, vertigo, cough, hearing loss
causes of excessive or impacted cerumen
narrowing or irregular shape of EAC, presence of excessive hair, irritation from foreign objects, use of cotton-tipped swabs, increasing age
non pharm treatment for excessive or impacted cerumen
only remove when migrated to outer portion, curette –> removes cerumen
pharm treatment for excessive cerumen if symptomatic
carbamide peroxide 6.5%
application of carbamide peroxide
twice daily for up to 4 days, 5-10 drops instilled and leave in ear up to 15 minutes
ADE carbamide peroxide
pain, rash, irritation, tenderness, redness, discharge, and dizziness
exclusions for impacted or excessive cerumen
- systemic symptoms or signs of infection
- incapable of following instructions
- less than 12 years
- pain with or without ear discharge
- bleeding/signs of trauma
- ruptured tympanic membrane
- tympanostomy tubes present
- ear surgery within prior 6 weeks
- after 4 days symptoms or ADE persist
presentation of water-clogged ears
sensation of hearing impairment, localized discomfort, and sensation of fullness
causes of water-clogged ears
excessive moisture, wax or debris buildup, excessive hair growth, narrowing of ear canal, overproduction or the absence of cerumen, sweating, humidity, and swimming
non pharm treatment for water-clogged ears
prevention of water retention (ear plugs/bathing cap), lowest heat setting on blow dryer
pharm treatment for water-clogged ears
isopropyl alcohol 95% in anhydrous glycerin 5% (drying agent, 4-5 drops in ear)
exclusions for self-care of water-clogged ears
- systemic symptoms or signs of infection
- pain associated with ear discharge
- bleeding or trauma
- ruptured tympanic membrane
- tympanostomy tubes present
- ear surgery in past 6 weeks
- ear surgery in past 6 weeks
- no improvement after 4 days of therapy
- < 12 years of age
