G: Ocular Flashcards by Jenna Wilkerson

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

dry eyes
presbyopia
floaters
cataracts
Low/moderate concern

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

dry eyes
glaucoma
age-related macular degeneration
High concern

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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

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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

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

Mucin layer, inner layer of tears

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What is the purpose of the eyelids

The normal lid position allows for uniform distribution of tears

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Where are the meibomian glands found

eyelids

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What are the 4 major causes of dry eye

Decreased tear production
Increased tear evaporation
Tear layer instability
Inflammation

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What causes decreased tear production

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

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What causes increased tear evaporation

Meibomian gland dysfunction or blepharitis such as capped/stenosed glands

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Define the two categories of blepharitis

Anterior: bacteria/mites
Posterior: lid inflammation

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Cause of tear layer instability

loss/atrophy of Goblet cells

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First line of treatment for dry eye management

OTC artificial tears

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

Solution/drop
Gel
Ointment
Preserved vs non-preserved

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What are the 3 main second line treatments?

punctual occlusion/cauterization
scleral contact lenses
moisture chambers for sleep

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How to treat anterior blepharitis

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

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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

1. primary open angle 2. acute angle closure 3. 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

1. enhance aqueous outflow 2. 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

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)

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