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Management/Geriatrics > G: Ocular > Flashcards

G: Ocular Flashcards

1
Q

4 expected changes in ocular health w/age
What level of concern are these?

A
  1. dry eyes
  2. presbyopia
  3. floaters
  4. cataracts
    Low/moderate concern
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2
Q

3 unexpected changes in ocular health w/age
What level of concern are these?

A
  1. dry eyes
  2. glaucoma
  3. age-related macular degeneration
    High concern
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3
Q

What part of the tear film is produced by the lacrimal gland? How much and where in the tear gland is this located?

A

Aqueous layer, the major layer in the middle

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4
Q

What part of the tear film is produced by the meibomian glands? Where in the tear film is this located?

A

Lip layer; the outermost layer of tears

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5
Q

What layer of the tears is produced in the goblet cells? Where in the tears is this found?

A

Mucin layer, inner layer of tears

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6
Q

What is the purpose of the eyelids

A

The normal lid position allows for uniform distribution of tears

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7
Q

Where are the meibomian glands found

A

eyelids

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8
Q

What are the 4 major causes of dry eye

A
  1. Decreased tear production
  2. Increased tear evaporation
  3. Tear layer instability
  4. Inflammation
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9
Q

What causes decreased tear production

A

Histopathologic changes of lacrimal gland such as atrophy, duct stenosis, fibrosis

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10
Q

What causes increased tear evaporation

A

Meibomian gland dysfunction or blepharitis such as capped/stenosed glands

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11
Q

Define the two categories of blepharitis

A

Anterior: bacteria/mites
Posterior: lid inflammation

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12
Q

Cause of tear layer instability

A

loss/atrophy of Goblet cells

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13
Q

First line of treatment for dry eye management

A

OTC artificial tears

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14
Q

What are the four major consistencies to consider with OTC artificial tears?

A
  1. Solution/drop
  2. Gel
  3. Ointment
  4. Preserved vs non-preserved
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15
Q

What are the 3 main second line treatments?

A
  1. punctual occlusion/cauterization
  2. scleral contact lenses
  3. moisture chambers for sleep
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16
Q

How to treat anterior blepharitis

A

warm compresses, lid scrubs (baby shampoo, cliradex), topical antibiotics possibly (erythromycin, bacitracin, polytrim)

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17
Q

How to treat posterior blepharitis

A

warm compresses, lid scrubs, and Likely antibiotics (same as anterior plus doxycycline, tetracycline, erythromycin), maybe omega-3 fatty acids

18
Q
A
19
Q

What are 3 special considerations with dry eye

A
  1. bacterial/viral infections can mimic dry eye symptoms
  2. recommend any patient taking Visine to stop because it has a harsh preservative + astringent
  3. if you consult with a patient who is not experiencing relief with general AT’s ask them to see an eye care professional
20
Q

Define Presbyopia

A

natural change in the physiological lens of eye where lens can no longer change shape to adjust the focus of the eye

21
Q

Define floaters

A

natural change in vitreous body in which hyaluronic acid that is responsible for the gel consistency of eye breaks down and becomes more liquid than gel

22
Q

What are cataracts and the 3 major contributors

A

any opacity in the physiological lens and there are many different types

Contributors:
1. age
2. trauma
3. environmental stress

23
Q

How to manage presbyopia

A

Only viable treatment is bifocal/multifocal glasses or contact lenses

Other less effective/not effective
1. surgery on ciliary body
2. implant multifocal intra-ocular lenses
3. eye drops (ineffective)

24
Q

How to manage floaters

A

Wait them out/get used to them is most common

Other less effective strategies
1. laser surgery/vitrectomy
2. New injection: Ocriplamin - Jetrea
3. Pellets: not effective

25
Q

How to manage cataracts and what is the follow up care

A

Surgery is the only viable option
Post-operative management: topical
1. antibiotic 1 week
2. steroid 3-4 weeks
3. NSAID 3-4 weeks

Eye drops not effective treatment

26
Q

What are the 3 types of glaucoma

A
  1. primary open angle
  2. acute angle closure
  3. normal tension
27
Q

What is primary open angle glaucoma (POAG)

A

no signs or symptoms for patients but often have elevated IOP causes damage to optic nerve head/fibers
↑ aq production
↓ aq outflow
Vision SLOWLY reduced from periphery to central

28
Q

What is acute angle closure (AACG)

A

aqueous cannot drain the way it should due to anatomy of anterior chambers causing IOP to build up quickly
patient typically experience headache, nausea, eye pain

29
Q

What is normal tension glaucoma

A

spikes in IOP at times when patient is not being checked

30
Q

Do you manage all glaucoma the same and if so, how?

A

Yes, all treatment is basically the same for all types of glaucoma. The key is REDUCING IOP

31
Q

What are the two main types of glaucoma medications/what do they do

A
  1. enhance aqueous outflow
  2. decrease aqueous production
32
Q

What is the first line treatment for POAG and how do they work?
What are some examples?
How are they taken?

A

Prostaglandin analogs
Increase aqueous outflow
Latanoprost, travoprost, bimatoprost
Dosed QHS

33
Q

How are α1/2 and ß1/2 work to treat glaucoma
Examples

A
  1. stimulating alpha receptors -> ↓ aq production
  2. stimulating beta receptors - ↑ aq production
  3. alpha adrenergic agonists stimulate alpha2 receptors and cause ↓ productions
  4. Beta blockers reduce aqueous production

Examples
alpha agonists: brimodine, apraclonidine (BID/TID)
beta blockers: timolol/Timoptic, levobunolol/Betagan, carteolol/Ocupress, metipranolol/OptiPranolol (BID)
B1 selective: betaxolol/Betopic (BID)

34
Q

How do carbonic anhydrase inhibitors treat glaucoma
Examples
What line of treatment are these

A

Carbonic anhydrase is an enzyme needed to generate bicarbonate ions for aqueous secretion; inhibiting it reduces aqueous production
Examples: dorzolamide/Trusopt, brinzolamide/Azopt (TID)
Last line due to common troubling side effects

35
Q

Pros of combination drops and examples used for treating glaucoma

A

improved compliance, reduced side-effects of drugs individually
Examples: simbrinza (brinzolamide + brimonidine) and combigan (brimonidine + timolol)

36
Q

What is a possible cause of age-related macular degeneration (AMD) and name the two categories

A

lipofuscin builds up in retinal pigment epithelium

Categories:
dry/atrophic or non-exudative
wet/exudative

37
Q

Describe dry/atropic or non-exudative AMD

A

early stage of AMD
Hallmark signs are pigment deposition in macula and drusen (lipofuscin)
-hard drusen
-soft drusen
-geographic atrophy

38
Q

Describe wet/exudative AMD

A

later stage of disease
Hallmark signs include macular thickening and neovascularization, followed by scar tissue
Breaks in Bruch’s membrane allows blood/vessels
Vascular endothelial growth factor causes new growth

39
Q

How to treat dry AMD

A

No proven effective treatment but possible treatments include
1. Avoid UV exposure
2. smoking cessation (if a smoker)
3. vitamins and minerals as found by the age-related eye disease study
–lutein and zeaxanthin
–vitamin C, vitamin E, cupric oxide, omega-3 FA, zinc
–do not use beta-carotene
4. Ocuvite or PreserVision

40
Q
A

Management/Geriatrics (3 decks)

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