G: Ocular Flashcards
4 expected changes in ocular health w/age
What level of concern are these?
- dry eyes
- presbyopia
- floaters
- cataracts
Low/moderate concern
3 unexpected changes in ocular health w/age
What level of concern are these?
- dry eyes
- glaucoma
- age-related macular degeneration
High concern
What part of the tear film is produced by the lacrimal gland? How much and where in the tear gland is this located?
Aqueous layer, the major layer in the middle
What part of the tear film is produced by the meibomian glands? Where in the tear film is this located?
Lip layer; the outermost layer of tears
What layer of the tears is produced in the goblet cells? Where in the tears is this found?
Mucin layer, inner layer of tears
What is the purpose of the eyelids
The normal lid position allows for uniform distribution of tears
Where are the meibomian glands found
eyelids
What are the 4 major causes of dry eye
- Decreased tear production
- Increased tear evaporation
- Tear layer instability
- Inflammation
What causes decreased tear production
Histopathologic changes of lacrimal gland such as atrophy, duct stenosis, fibrosis
What causes increased tear evaporation
Meibomian gland dysfunction or blepharitis such as capped/stenosed glands
Define the two categories of blepharitis
Anterior: bacteria/mites
Posterior: lid inflammation
Cause of tear layer instability
loss/atrophy of Goblet cells
First line of treatment for dry eye management
OTC artificial tears
What are the four major consistencies to consider with OTC artificial tears?
- Solution/drop
- Gel
- Ointment
- Preserved vs non-preserved
What are the 3 main second line treatments?
- punctual occlusion/cauterization
- scleral contact lenses
- moisture chambers for sleep
How to treat anterior blepharitis
warm compresses, lid scrubs (baby shampoo, cliradex), topical antibiotics possibly (erythromycin, bacitracin, polytrim)
How to treat posterior blepharitis
warm compresses, lid scrubs, and Likely antibiotics (same as anterior plus doxycycline, tetracycline, erythromycin), maybe omega-3 fatty acids
What are 3 special considerations with dry eye
- bacterial/viral infections can mimic dry eye symptoms
- recommend any patient taking Visine to stop because it has a harsh preservative + astringent
- if you consult with a patient who is not experiencing relief with general AT’s ask them to see an eye care professional
Define Presbyopia
natural change in the physiological lens of eye where lens can no longer change shape to adjust the focus of the eye
Define floaters
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
What are cataracts and the 3 major contributors
any opacity in the physiological lens and there are many different types
Contributors:
1. age
2. trauma
3. environmental stress
How to manage presbyopia
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)
How to manage floaters
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
How to manage cataracts and what is the follow up care
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
What are the 3 types of glaucoma
- primary open angle
- acute angle closure
- normal tension
What is primary open angle glaucoma (POAG)
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
What is acute angle closure (AACG)
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
What is normal tension glaucoma
spikes in IOP at times when patient is not being checked
Do you manage all glaucoma the same and if so, how?
Yes, all treatment is basically the same for all types of glaucoma. The key is REDUCING IOP
What are the two main types of glaucoma medications/what do they do
- enhance aqueous outflow
- decrease aqueous production
What is the first line treatment for POAG and how do they work?
What are some examples?
How are they taken?
Prostaglandin analogs
Increase aqueous outflow
Latanoprost, travoprost, bimatoprost
Dosed QHS
How are α1/2 and ß1/2 work to treat glaucoma
Examples
- stimulating alpha receptors -> ↓ aq production
- stimulating beta receptors - ↑ aq production
- alpha adrenergic agonists stimulate alpha2 receptors and cause ↓ productions
- 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)
How do carbonic anhydrase inhibitors treat glaucoma
Examples
What line of treatment are these
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
Pros of combination drops and examples used for treating glaucoma
improved compliance, reduced side-effects of drugs individually
Examples: simbrinza (brinzolamide + brimonidine) and combigan (brimonidine + timolol)
What is a possible cause of age-related macular degeneration (AMD) and name the two categories
lipofuscin builds up in retinal pigment epithelium
Categories:
dry/atrophic or non-exudative
wet/exudative
Describe dry/atropic or non-exudative AMD
early stage of AMD
Hallmark signs are pigment deposition in macula and drusen (lipofuscin)
-hard drusen
-soft drusen
-geographic atrophy
Describe wet/exudative AMD
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
How to treat dry AMD
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
