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CDM 3 Exam 1 > Lecture 2 - Ophthalmic Disorders > Flashcards

Lecture 2 - Ophthalmic Disorders Flashcards

1
Q

Acute angle closure glaucoma

A

occurring suddenly due to mechanical blockage of trabecular meshwork** usually medical emergency

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2
Q

Primary open angle glaucoma

A

occurring slowly due to decreased drainage of aqueous humor through trabecular meshwork

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3
Q

Keratoconjuncitivitis sicca

A

Dry eye

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4
Q

Hordeolum

A

Stye

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5
Q

Blepharitis

A

infection of lid margins and meibomian gland openings

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6
Q

Cap colors

A

cap colors on cap correspond to what the MOA of eye drops

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7
Q

exclusions for eye self care

A
  1. pain
  2. Blurred vision not associated w/ us of ointments
  3. Sensitivity to light
  4. H/x of contact lens wearing..poor hygiene
  5. Blunt trauma to eye
  6. Chemical exposure to eye
  7. eye exposure to heat…not sun
  8. > 72hrs S/x
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8
Q

Gritty sensation but no foreign material could be….

A

dry eye

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9
Q

H/x of “pink eye” exposure, cold, or flu could be….

A

Viral conjunctivitis

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10
Q

H/x of allergies could be….

A

Allergic conjunctivitis

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11
Q

Mucous discharge could be….

A

Bacterial conjunctivitis

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12
Q

Starburst/Halos could be….

A

Corneal edema

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13
Q

Tear volume determined by…

A

Tear production
Tear outflow
Evaporation on surface

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14
Q

Signs/Symptoms of dry eye

A

Slight redness
Watering
Sensation of something in the eye

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15
Q

Risk factors for dry eye

A

Meds
Older age
Women>men
Dry environment
H/x of LASIK/cornea surgery
Cornea/eyelid disorders
Medical conditions
Irritants/Allergies

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16
Q

T/x for Dry eye

A

Artificial tears: used throughout day, 2-4times, can be used every 30-60min

Lubricant ointments: used at night due to blurry vision

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17
Q

T/x goal for dry eye

A

prevent corneal scarring and perforation

Choose therapy based on frequency of use, preservatives, allergies, lvl of discomfort and cost

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18
Q

Preservative vs Preservative Free drops

A

Preservative free = $$$$, inc infection but sometimes better tolerated and unit dosed

Preservative = cheaper, dec infection but possible inc irritation

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19
Q

Restasis info

A

Reduce inflam = inc tear production

takes months to work

AE: burning
0.05% cyclosporine

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20
Q

Cequa info

A

Reduce inflam = inc tear production
Better eye pen

AE: eye pain, redness
0.09% cyclosporine

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21
Q

Xiidra info

A

AE: Blurry vision, irritation, altered taste

Blocks T-cell activation

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22
Q

How to use meds for dry eyes

A

Try OTCs first, and if that doesn’t work you can bridge with a steroid towards one of the others like Cyclosporine or Xiidra

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23
Q

Non-pharm treatment for Dry eyes

A
  1. avoid dry environments
  2. wear sunglasses outside
  3. wear goggles if windy
  4. Avoid prolonged periods of not blinking
  5. Screen breaks
  6. Omega-3-fatty acid sup
  7. surgery - perm tear duct occlusion
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24
Q

Stye treatment

A

Warm compress for ~ 10min has needed throughout the day

Dont press/squeeze to drain

If doesn’t improve in 2-3 days, contact provider

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25
Q

Stye prevention

A
  1. Clear contacts
  2. Dont leave makeup on overnight
  3. Dont use old/expired cosmetics
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26
Q

Belpharitis treatment

A
  1. warm compresses
  2. lid scrub with gentle shampoo
  3. artificial tears
  4. can use antibiotics, use topical 1st (bacitracin/erythromycin)
  5. can use oral for resistant cases
  6. refractory can req topical steroid or cyclosporine
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27
Q

Belpharitis info

A

usually improper hygiene

older adults at risk due to dec tear production/defense mechanisms

can lead to corneal scarring, and infections

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28
Q

Corneal edema info

A

fluid in/around cornea

caused by those who dont take their contacts out

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29
Q

Signs and symptoms of corneal edema

A

Halo effect in vision

vision may or may not be limited

diagnosed by eye care provider

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30
Q

Corneal edema treatments

A
  1. topical hyperosmotic agents = draw water out (Muro 128)
  2. start eye drops, then go to ointment and then inc % if nothing gets better
31
Q

Age-related macular degeneration info

A

Most occurs in women and is genetic

32
Q

Risk factors for macular degeneration

A

Genetic:
White> non-white
Women>men
Positive family history

Modifiable:
Smoking
Excess body weight
Antioxidant, vitamin, zinc deficiency

33
Q

Non-exudative vs Exudative

A

Non = non-neovascular or dry AMD, early stages..85%

Exudative = neovascular or wet AMD, later stages…15%

no cure for either

34
Q

Clinical presentation of AMD

A

blurred vision

plagues form in the back of eye (dry)

big loss of vision, macular area surrounded with fluid of blood (wet)

35
Q

Tx to slow progression of Non-neovascular AMD

A

Vitamins

smokers = formulation w/o beta-carotene**

36
Q

Tx for neovascular AMD

A

Verteporfin photodynamic therapy
VEGF antagonists

37
Q

AMD Monitoring

A

Vision loss
progression of disease
Quality of life eval

38
Q

Allergic conjunctivitis

A
  1. usually seasonal
  2. often in both eyes
39
Q

Bacterial conjunctivitis

A

Often associated with some sticky/yellow discharge

starts in one eye and then spread to other eye

Highly contagious

can be acute + chronic

Self-limiting, most resolve 2-5 days

40
Q

Viral conjunctivitis

A

Most common one

usually effects one eye first and then spreads to other eye, very contagious

No crusting usually

ie. Pink eye

41
Q

Allergic conjunctivitis prevention + general tx

A

avoid allergens

Tx: dont rub eyes + cold compress 3-4 times/day

42
Q

Allergic conjunctivitis tx

A

1.Vasoconstrictor/antihistamine(3-4/day)

  1. Antihistamine/mast cell stabilizers (most BID)
  2. Mast cell stabilizers (usually Rx, QID so not used much..have to use for awhile)
43
Q

Hyperacute bacterial conjunctivitis

A
  1. usually caused by N.gonorrhoeae
  2. tx with ceftriaxone IM, Azimuth/doxy PO
44
Q

Acute bacterial conjunctivitis

A
  1. caused by skin flora
  2. 3-4 weeks full resolution
45
Q

Bacterial conjunctivitis info

A
  1. contagious about 7 days after “2nd eye”
  2. consider delayed therapy if symptoms resolve themselves
  3. Azithromycin PO or Erythromycin ointment Tx choice
46
Q

Antibiotic choice for Bacterial conjunctivitis

A

Azithromycin-
Cipro-
Oflo-

all more expensive than other options

47
Q

Viral conjunctivitis info

A

Commonly adenovirus

Tx:: cold compress, artificial tears and ophthalmic decongestants

usually resolves in 1-2 weeks

48
Q

HSV conjunctivitis info

A

topical:
Ganciclovir
Trifluridine
Acyclovir

Systemic:
Acyclovir
Valacyclovir
Famciclovir

start with topicals, move to systemic

usually taper, and then Long term for suppressive therapy

49
Q

Normal IOP

A

10-20mmHG

50
Q

Occular hypertension

A

IOP > 21mmHG
no optic disk changes

51
Q

Normal tension Glaucoma

A

IOP < 21mmHG + optic disk changes and visual field loss

20-30% pts

52
Q

Primary Open-Angle Glaucoma

A

Normal/elevated IOP
Optic disk changes/visual deficits
Majority of glaucomas

usually peripheral vision, late stage can be central vision

53
Q

Acute angle-closure glaucoma

A

acute, painful attack
Elevated IOP w/ visual field loss
5-10% of primary glaucomas

rapid onset, medical emergency

54
Q

Glaucoma risk factors

A

Inc age
FH
Congential abnormalities
Increased IOP
Comorbidities
Trauma
Med induced

55
Q

Treatment goals for glaucoma

A

reduce IOP
prevent further loss + angle closure

Strategies: start tx in 1 eye, determine drug and takes 4-6wks for response

56
Q

Prostaglandin analogs MOA

A
  1. increase outflow of aqueous humor
  2. Decreases IOP by 25/30%
57
Q

PGA dosing

A

usually qHS, can be qAM

BID decreases IOP lowering effect

58
Q

PGA drugs

A

Latanoprost (Xalatan, Xelpros) - F2 agonist
Latanoprostene bunod (Vyzulta) - F2 agonist
Tafluprost (Zioptan) - F2 agonist
Travoprost (Travatan Z)- F2 agonist
Bimatoprost (Lumigan) - Prostamide analog

59
Q

PGA Side effects:

A
  1. increase brown iris pigmentation = irreversible
  2. Eyelash lengthening
  3. eyelid skin darkening
  4. local reactions
60
Q

Beta-blocker MOA

A

act on beta-receptor in ciliary epithelium
dec aqueous humor production
Lowers IOP 20-25%

61
Q

Beta-blocker AE

A

Local-dry eye, blurred vision, infection, local reaction
Systemic- bradycardia, hypotension,etc

** Caution in HF, COPD, bradycardia, asthma **

62
Q

Beta-blocker dosing

A

Typically BID or TID

63
Q

Beta-blocker drugs

A

Non-selective:
Timolol (Timoptic, Betimol)
Carteolol (Ocupress)(ISA)
Levobunolol (Betagan)
Metipranolol (OptiPranolol)

Selective:
Betaxolol (Betopic S, Betopic)

64
Q

Alpha Agonists MOA

A
  1. Dec production of aqueous humor and increase outflow
  2. Dec IOP by 20-25% at peak, ~10% after 8-12hrs
65
Q

Alpha Agonists AE

A

Concern for tachyphylaxis

burning, stinging, blurring, etc
dizziness, fatigue,somnolencedry mouth etc

66
Q

Caution Alpha-agonists in patients with…

A

CVD
renal/hepatic dysfunction
depression
eye disease caused by diabetes

67
Q

Drugs in Alpha-agonist class

A

Apraclonidine
Brimonidine (Alphagan)
w/ preservative = Alphagan -P
ocular redness = Lumify

68
Q

Carbonic Anhydrase Inhibitors MOA

A

Dec flow of bicarb, water and sodium into posterior chamber

Dec in IOP by 15-25%

Contains sulfonamides - allergies

69
Q

Drugs in CAI class

A

Brinzolamide (Azopt)
Dorzolamide (Trusopt)

Oral = Acetazolamide (Diamox)

70
Q

Caution CAI in….

A

renal/hepatic dysfunction
can cause Kidney stones**
sickle cell disease
respiratory alkalosis
pulmonary disorders

71
Q

Example of OA treatment algo

A
  1. Monotherapy = PGA
  2. If AE, try BB,CAI or AA
  3. if no response, add 2nd drug trio different class
  4. if no response, surgical procedure

assess responses 2-4wks

72
Q

Proper Eye drop instillation

A
  1. wash/dry hands
  2. shake bottle if suspension
  3. tilt head back, pull down outer portion of lower eyelid
  4. 1 drop into eye at time, close lid for 30-60sec
  5. dont rub or blink
  6. recap and store as instructed
  7. wait 1 min between drops, 5min if dif meds
73
Q

Nasolacrimal occlusion (NLO)

A

press finger against inner eye, hold for 1-3 min after instilling drop

don use more than 1 drop

separate by 3-5min if multiple drops

CDM 3 Exam 1 (10 decks)

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