Lecture 2 - Ophthalmic Disorders Flashcards
Acute angle closure glaucoma
occurring suddenly due to mechanical blockage of trabecular meshwork** usually medical emergency
Primary open angle glaucoma
occurring slowly due to decreased drainage of aqueous humor through trabecular meshwork
Keratoconjuncitivitis sicca
Dry eye
Hordeolum
Stye
Blepharitis
infection of lid margins and meibomian gland openings
Cap colors
cap colors on cap correspond to what the MOA of eye drops
exclusions for eye self care
- pain
- Blurred vision not associated w/ us of ointments
- Sensitivity to light
- H/x of contact lens wearing..poor hygiene
- Blunt trauma to eye
- Chemical exposure to eye
- eye exposure to heat…not sun
- > 72hrs S/x
Gritty sensation but no foreign material could be….
dry eye
H/x of “pink eye” exposure, cold, or flu could be….
Viral conjunctivitis
H/x of allergies could be….
Allergic conjunctivitis
Mucous discharge could be….
Bacterial conjunctivitis
Starburst/Halos could be….
Corneal edema
Tear volume determined by…
Tear production
Tear outflow
Evaporation on surface
Signs/Symptoms of dry eye
Slight redness
Watering
Sensation of something in the eye
Risk factors for dry eye
Meds
Older age
Women>men
Dry environment
H/x of LASIK/cornea surgery
Cornea/eyelid disorders
Medical conditions
Irritants/Allergies
T/x for Dry eye
Artificial tears: used throughout day, 2-4times, can be used every 30-60min
Lubricant ointments: used at night due to blurry vision
T/x goal for dry eye
prevent corneal scarring and perforation
Choose therapy based on frequency of use, preservatives, allergies, lvl of discomfort and cost
Preservative vs Preservative Free drops
Preservative free = $$$$, inc infection but sometimes better tolerated and unit dosed
Preservative = cheaper, dec infection but possible inc irritation
Restasis info
Reduce inflam = inc tear production
takes months to work
AE: burning
0.05% cyclosporine
Cequa info
Reduce inflam = inc tear production
Better eye pen
AE: eye pain, redness
0.09% cyclosporine
Xiidra info
AE: Blurry vision, irritation, altered taste
Blocks T-cell activation
How to use meds for dry eyes
Try OTCs first, and if that doesn’t work you can bridge with a steroid towards one of the others like Cyclosporine or Xiidra
Non-pharm treatment for Dry eyes
- avoid dry environments
- wear sunglasses outside
- wear goggles if windy
- Avoid prolonged periods of not blinking
- Screen breaks
- Omega-3-fatty acid sup
- surgery - perm tear duct occlusion
Stye treatment
Warm compress for ~ 10min has needed throughout the day
Dont press/squeeze to drain
If doesn’t improve in 2-3 days, contact provider
Stye prevention
- Clear contacts
- Dont leave makeup on overnight
- Dont use old/expired cosmetics
Belpharitis treatment
- warm compresses
- lid scrub with gentle shampoo
- artificial tears
- can use antibiotics, use topical 1st (bacitracin/erythromycin)
- can use oral for resistant cases
- refractory can req topical steroid or cyclosporine
Belpharitis info
usually improper hygiene
older adults at risk due to dec tear production/defense mechanisms
can lead to corneal scarring, and infections
Corneal edema info
fluid in/around cornea
caused by those who dont take their contacts out
Signs and symptoms of corneal edema
Halo effect in vision
vision may or may not be limited
diagnosed by eye care provider
Corneal edema treatments
- topical hyperosmotic agents = draw water out (Muro 128)
- start eye drops, then go to ointment and then inc % if nothing gets better
Age-related macular degeneration info
Most occurs in women and is genetic
Risk factors for macular degeneration
Genetic:
White> non-white
Women>men
Positive family history
Modifiable:
Smoking
Excess body weight
Antioxidant, vitamin, zinc deficiency
Non-exudative vs Exudative
Non = non-neovascular or dry AMD, early stages..85%
Exudative = neovascular or wet AMD, later stages…15%
no cure for either
Clinical presentation of AMD
blurred vision
plagues form in the back of eye (dry)
big loss of vision, macular area surrounded with fluid of blood (wet)
Tx to slow progression of Non-neovascular AMD
Vitamins
smokers = formulation w/o beta-carotene**
Tx for neovascular AMD
Verteporfin photodynamic therapy
VEGF antagonists
AMD Monitoring
Vision loss
progression of disease
Quality of life eval
Allergic conjunctivitis
- usually seasonal
- often in both eyes
Bacterial conjunctivitis
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
Viral conjunctivitis
Most common one
usually effects one eye first and then spreads to other eye, very contagious
No crusting usually
ie. Pink eye
Allergic conjunctivitis prevention + general tx
avoid allergens
Tx: dont rub eyes + cold compress 3-4 times/day
Allergic conjunctivitis tx
1.Vasoconstrictor/antihistamine(3-4/day)
- Antihistamine/mast cell stabilizers (most BID)
- Mast cell stabilizers (usually Rx, QID so not used much..have to use for awhile)
Hyperacute bacterial conjunctivitis
- usually caused by N.gonorrhoeae
- tx with ceftriaxone IM, Azimuth/doxy PO
Acute bacterial conjunctivitis
- caused by skin flora
- 3-4 weeks full resolution
Bacterial conjunctivitis info
- contagious about 7 days after “2nd eye”
- consider delayed therapy if symptoms resolve themselves
- Azithromycin PO or Erythromycin ointment Tx choice
Antibiotic choice for Bacterial conjunctivitis
Azithromycin-
Cipro-
Oflo-
all more expensive than other options
Viral conjunctivitis info
Commonly adenovirus
Tx:: cold compress, artificial tears and ophthalmic decongestants
usually resolves in 1-2 weeks
HSV conjunctivitis info
topical:
Ganciclovir
Trifluridine
Acyclovir
Systemic:
Acyclovir
Valacyclovir
Famciclovir
start with topicals, move to systemic
usually taper, and then Long term for suppressive therapy
Normal IOP
10-20mmHG
Occular hypertension
IOP > 21mmHG
no optic disk changes
Normal tension Glaucoma
IOP < 21mmHG + optic disk changes and visual field loss
20-30% pts
Primary Open-Angle Glaucoma
Normal/elevated IOP
Optic disk changes/visual deficits
Majority of glaucomas
usually peripheral vision, late stage can be central vision
Acute angle-closure glaucoma
acute, painful attack
Elevated IOP w/ visual field loss
5-10% of primary glaucomas
rapid onset, medical emergency
Glaucoma risk factors
Inc age
FH
Congential abnormalities
Increased IOP
Comorbidities
Trauma
Med induced
Treatment goals for glaucoma
reduce IOP
prevent further loss + angle closure
Strategies: start tx in 1 eye, determine drug and takes 4-6wks for response
Prostaglandin analogs MOA
- increase outflow of aqueous humor
- Decreases IOP by 25/30%
PGA dosing
usually qHS, can be qAM
BID decreases IOP lowering effect
PGA drugs
Latanoprost (Xalatan, Xelpros) - F2 agonist
Latanoprostene bunod (Vyzulta) - F2 agonist
Tafluprost (Zioptan) - F2 agonist
Travoprost (Travatan Z)- F2 agonist
Bimatoprost (Lumigan) - Prostamide analog
PGA Side effects:
- increase brown iris pigmentation = irreversible
- Eyelash lengthening
- eyelid skin darkening
- local reactions
Beta-blocker MOA
act on beta-receptor in ciliary epithelium
dec aqueous humor production
Lowers IOP 20-25%
Beta-blocker AE
Local-dry eye, blurred vision, infection, local reaction
Systemic- bradycardia, hypotension,etc
** Caution in HF, COPD, bradycardia, asthma **
Beta-blocker dosing
Typically BID or TID
Beta-blocker drugs
Non-selective:
Timolol (Timoptic, Betimol)
Carteolol (Ocupress)(ISA)
Levobunolol (Betagan)
Metipranolol (OptiPranolol)
Selective:
Betaxolol (Betopic S, Betopic)
Alpha Agonists MOA
- Dec production of aqueous humor and increase outflow
- Dec IOP by 20-25% at peak, ~10% after 8-12hrs
Alpha Agonists AE
Concern for tachyphylaxis
burning, stinging, blurring, etc
dizziness, fatigue,somnolencedry mouth etc
Caution Alpha-agonists in patients with…
CVD
renal/hepatic dysfunction
depression
eye disease caused by diabetes
Drugs in Alpha-agonist class
Apraclonidine
Brimonidine (Alphagan)
w/ preservative = Alphagan -P
ocular redness = Lumify
Carbonic Anhydrase Inhibitors MOA
Dec flow of bicarb, water and sodium into posterior chamber
Dec in IOP by 15-25%
Contains sulfonamides - allergies
Drugs in CAI class
Brinzolamide (Azopt)
Dorzolamide (Trusopt)
Oral = Acetazolamide (Diamox)
Caution CAI in….
renal/hepatic dysfunction
can cause Kidney stones**
sickle cell disease
respiratory alkalosis
pulmonary disorders
Example of OA treatment algo
- Monotherapy = PGA
- If AE, try BB,CAI or AA
- if no response, add 2nd drug trio different class
- if no response, surgical procedure
assess responses 2-4wks
Proper Eye drop instillation
- wash/dry hands
- shake bottle if suspension
- tilt head back, pull down outer portion of lower eyelid
- 1 drop into eye at time, close lid for 30-60sec
- dont rub or blink
- recap and store as instructed
- wait 1 min between drops, 5min if dif meds
Nasolacrimal occlusion (NLO)
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
