Lecture 28+29 Eye diseases Flashcards
What are components of tears?
Lipid: slows down evaporation of tears
Aqueous: supplies moisture, aka watery component
Mucin: coats eye to allow aqueous layer to stick to a water repellent cornea
What are the different types of dry eye diseases?
refers to not producing enough aqueous or mucin
Aqueous Deficient ⇒ Type 1: Sjogren Syndrome: autoimmune disease that involves damage to goblet cells involved in tear production (mucin), Type 2: Non-Sjogren: primary or secondary lacrimal gland deficiencies, obstruction of lacrimal ducts, reflex hyposecretion
Evaporative Dry Eye (EDE): high level of tear evaporation, External Factors ⇒ high temp or low humidity, certain exposures to sun, dust and wind
Internal Factors: Meibomian gland dysfxn - chronic inflammation that leads to squamous debris, gland obstruction and changes in glandular secretion
conditions that affect closing of eyelids or decreased blinking, thyroid dysfxn, laser eye surgery, medications (oral contraceptives), excessive digital/screen time
What are non-pharm tx for dry eye diseases?
environmental management - humidifier or adjusting temp at home, blinking exercises
reassessing systemic meds
warm compress - use warm cloth, place over eyelids for 5-10 mins, pt must keep rewetting cloth, better solution is a bruder mask that stays hot for 10 mins
Other: lipiflow, radiofrequency, intense pulse light
What four categories are used to determine equivalencies between different eye drops?
cost
Viscosity - determines length of action, lower viscosity = short acting (eye drops) ⇒ good for all day use, doesn’t disrupt vision after use, needs to be used more often, higher viscosity = long acting (gels, ointments) ⇒ better for use at night or before bed due to blurry vision after use
Demulcents - protect and lubricates mucous membranes, relieves dryness, ⇒ Cellulose derivatives: carboxymethylcellulose, hypromellose
dextran, gelatin, liquid polyols: glycerin, PEG-400, sodium hyaluronate
Emollients - protect and soften tissues, prevents drying and cracking, ⇒ TGs, oleaginous: mineral or castor oil, petrolatum, wax
Also ⇒ Preservatives - prevents microbial growth
What are ways to pick between different artificial tear options?
Artificial tears without an emollient: usually cheaper and good place to start for dryness related to environment or screen time
tears with an emollient: more expensive but more appropriate for those with meibomian gland dysfxn
tears that are gels or ointments: can be more expensive and can disrupt vision after use, generally recommended for pt who may not close their eyes entirely all night,, tears without preservatives: more expensive and used in pt who need frequent tear use or sensitive to preservatives
Topical (ophthalmic) corticosteroids for dry eye (Drugs, MOA, AE, duration, onset of effect)
Drugs: lotemax/alrex (loteprednol 0.5%), FML (fluorometholone 0.1%)
MOA: anti-inflammatory, dose and duration of tx dependent on diagnosis and drug chosen ⇒ commonly tapered but not always
AE: blurred vision, photophobia, burning/stinging
Duration: 14-28 days
Onset: would expect benefit within a week
Restasis (Cyclosporine 0.05% ophthalmic solution) for dry eye (MOA, Dose/package, AE, Length of tx, Onset)
MOA: exact unclear, increases goblet cell density ⇒ increases mucin, allows tear film to bind
thought that its a partial immunomodulator in pt whose tear production is suppressed due to ocular inflammation
Dose: 1 drop into each eye BID, comes in emulsion (oily mix) in single-use dropper and multi use bottles
AE: burning eyes
Length: lifelong
Onset: expect benefit in 12 weeks
Cequa (Cyclosporine 0.09% ophthalmic solution) for dry eye (MOA, Dose/package, AE, Length of tx, Onset)
MOA: exact action unclear, increases goblet cell density ⇒ increases mucin, allows tear film to bind
thought that its a partial immunomodulator in pt whose tear production is suppressed due to ocular inflammation
Dose: 1 drop into each eye BID, comes in solution in a single-use dropper
AE: burning eyes
Length: lifelong,, Onset: some pt may expect benefit in 1 month but most expect benefit in 12 weeks
Xiidra (Lifitegrast 5% ophthalmic solution) for dry eye (MOA, Dose/package, AE, Length of tx, Onset)
MOA: exact unclear, blocks key inflammatory markers
Dose: 1 drop into each eye BID, comes in solution in single-use dropper
AE: dysgeusia (altered taste), blurred vision, irritation/burning eyes
Length: lifelong
Onset: some pt may experience improvement in sx as early as 2 weeks but can be up to 12 weeks
Regarding ophthalmic conjunctivitis, what is the pathophysiology, as well as sx?
Patho: hypersensitivity rxn to allergens
Seasonal - allergens such as pollen from trees, grass, weeds and flowers, timing usually in spring/summer/fall, depends what allergen pt sensitive to
Perennial - allergen from dust, pets (ex. dander from cats), can happen all year around
Sx: usually itchy, irritated and red eyes, often accompanied with nasal congestion or sneezing, sometimes swollen eyelid, NEVER OCULAR PAIN OR LIGHT SENSITIVITY, generally will see BOTH eyes affected
What is non-pharm tx for ophthalmic conjunctivitis?
avoid allergens, cold compresses, avoid rubbing of eyes, minimize contact lens wear
Artificial tears - may help move/flush allergens out of eye and reduce inflammatory response
can also use oral antihistamines
Antihistamine/decongestant for ophthalmic conjunctivitis (Drugs, MOA, Dose, AE, Length of tx, Onset)
Drugs: ex. pheniramine/naphazoline (Naphcon A)
MOA: block histamine receptors and provides faster relief than oral antihistamines, constrict blood vessels to reduce redness
Dose: 1-2 drops up to 4 times a day
AE: eye irritation or burning, CONTRA in pt with angle-closure glaucoma, and if used for extended time can cause rebound redness
Length: PRN
Onset: sx will start to improve within the day
Mast Cell Stabilizers for ophthalmic conjunctivitis (Drugs, MOA, Dose, AE, Length of tx, Onset)
Drugs: ex. cromolyn
MOA: prevents the mast cells from releasing contents that leads to inflammation
Dose: 1-2 drops up to 4 times a day
AE: burning
Length: PRN
Onset: 3-5 days before any relief
Combo mast cell stabilizer and antihistamine for ophthalmic conjunctivitis (Drugs, MOA, Dose, AE, Length of tx, Onset)
Drug: olopatadine (Patanol 1%, Pataday 2%, Pazeo 7%),, MOA: block histamine receptors and stabilizes mast cells
Dose: 1 drop once (Pataday, Pazeo) or twice a day (Patanol, Bepreve)
AE: eye irritation if used too long
Length: PRN
Onset: sx start to improve within the day
Immunomodulators for ophthalmic conjunctivitis (Drugs, MOA, Dose, AE, Length of tx, Onset)
Drug: cyclosporine 0.1% drops (Verkazia)
MOA: thought to act by blocking release of pro-inflammatory cytokines and interferes with allergy process
Dose: 1 drop 4 times a day
AE: burning eyes or pain
Length: tx can be discontinued after S&S resolve and can be reinitiated if there is recurrence
Onset: sx improvement within the hour
What are S&S as well as risk fx for bacterial and viral conjunctivitis?
S&S: Bacterial: ocular redness (one or both eyes), usually not itchy just uncomfortable, no hx of a cold/sinus problem, yellow discharge with crusts in morning, sticky eyelids, papillae on lid inversion
Viral: eye redness (one or both eyes), usually not itchy, pt getting over a cold/has cold, watery eyes, follicles upon lid inversion
Risk Fx: certain jobs - ex. hospital, daycare, work with children
contact lens wearer
Hx of Herpes (simplex or Zoster)
What is pharmacological tx options for bacterial conjunctivitis (Drugs, dose, AE, Length of tx with/without tx)
A: Topical (Ophthalmic) Antibiotics: Drugs - polymyxin B (Polysporin), tobramycin, moxifloxacin (Vigamox) ⇒ FOR TX RESISTANT
Dose - dependent on antibiotic, generally used 3-4 x per day
AE: based on agent, range from well tolerated to blurry vision/irritation
Length - 7-10 days versus 14 days without
B: Fusidic Acid (Fucithalmic) Eye Drops: commonly prescribed by family physicians
NOT A GOOD OPTION TO USE FOR THIS, organisms develop resistance readily therefore educate pt to see optometrist if this doesn’t improve in next 1-2 days
What is tx for viral conjunctivitis?
will resolve on its own, so sx management is all you can do ⇒ 1. cool compresses and artificial tears
- corticosteroids (for sx relief)
- length of disease with or without tx is 14-21 days
What is keratitis, S&S?
inflammation to the cornea most commonly due to bacteria or viral causes
S&S: Bacterial - eye redness and pain, no hx of a cold/sinus problems, yellow discharge with crusts in morning, foreign body sensation/photophobia
Viral - eye redness and pain, pt is getting over a cold/has a cold, clear and watery eyes, photphobia
What is pharmacological tx for keratitis?
Bacterial: topical (ophthalmic) antibiotics ⇒ fluoroquinolone eye drops Q1H, ex. besifloxacin, moxifloxacin, gatifloxacin
Viral: If HSV ⇒ topical trifluridine 1% (Viroptic) 8 x per day OR topical ganciclovir 0.15% gel (Eyezirgan) 5 x a day for 7 days then 3 x a day for 7 days
can use corticosteroids or oral antivirals as well
What is corneal abrasion, S&S?
refers to cut on cornea of the eye
S&S: eye redness, sudden sharp eye pain, watery eye, sometime light sensitivity (depending on how large cut is)
What is pharmacological tx for corneal abrasion (Drugs, dose, AE, length of tx)?
Topical (ophthalmic) antibiotics: Polymyxin B, tobramycin, moxifloxacin
Combo ophthalmic antibiotic and corticosteroid: tobradex
Dose: generally 4 x a day
AE: based on agent, range from tolerated to blurry vision/irritation
Length: 5-7 days
may also use artificial tears for comfort, sometimes if cut is bad enough an optometrist can put temporary bandage contact that will help cover cut and reduce pain, cornea will heal and regenerate in 2-3 days
What are S&S of subconjunctival hemorrhage and tx for it?
no pain or discharge, no light sensitivity/FB sensation
person didn’t notice until someone pointed it out
Tx: artificial tears (optional), self-limiting, will resolve in about 2 weeks
What is uveitis, patho, S&S?
refers to inflammation of this: the iris, ciliary body and choroid
Patho: generally triggered by underlying systemic inflammatory condition or infection, ex. RA, Herpes Simplex, Syphilis, can also be idiopathic
S&S: eye redness, blurry vision, extreme photophobia and painful, watery eyes when they look at light
What are pharmacological tx for uveitis (Drug, MOA, AE, duration of tx)
Topical Corticosteroid: ex. Prednisolone (Pred Forte) 1% suspension Q1H,, MOA: inhibits inflammation pathways
AE: blurry vision, irritation
Duration: until it resolves
PLUS one of the following mydriatics ⇒ atropine 1% drops OR cyclopentolate 1% drops
MOA: blocks response of sphincter muscle and relaxes ciliary body, addresses pain associated with constrictions and dilation
AE: blurred vision or irritation
Duration: until certain signs resolve
What is a hordeolum, patho, S&S?
an infection of a gland in the eyelid causing inflammation, causes can include poor lid hygiene or not using clean make up brushes, can be classed as internal or external, one example of one of these is a stye
Patho: infection of glands of eyelid, Internal: meibomian gland, External (stye): gland of zeis or moll
S&S: bump on eyelid that is tender to touch or sore, eyelid can look swollen, depending on infection discharge may be seen
What is a chalazion, S&S?
blockage of a meibomian gland which doesn’t allow oil to be secreted, this oil then hardens overtime
S&S: bump on eyelid that is hard and NOT tender to touch, generally no discharge
What are non-pharmacological tx for hordeolums and chalazions?
Hordeolum: Lid Hygiene - using lid scrubs most effective approach, ex. Lid-Care a gentle eyelid towelette cleanses, Systane lid wipes
Warm Compress - can help with clearing out blockage
Chalazion: Warm Compress - addresses the block by ‘melting’ away that hardened oil that has blocked the meibomian gland
What are pharmacological tx for hordeolums and chalazions?
Hordeolum: Oral antibiotics with Gram + coverage ⇒ is oral because topicals won’t penetrate soft tissue, ex. Cephalexin 500 mg BID, amoxicillin 500 mg TID, Azithromycin 500 mg STAT then 250 mg QD F4D
tx lasting 5-10 days
Chalazion: there is no pharm tx
What are the different types of contact lenses?
Soft: soft plastic lenses, come in variety of options: daily, bi-weekly, or monthly disposable
Rigid: hard plastic, annual contact lenses, requires special type of cleaning solution
Preview
Why do soft contact lenses need to be cleansed daily?
they will get protein deposits over time
What does proper care for contact lenses look like?
wash hands before inserting or removing
clean them as directed by optometrist
soak them in appropriate contact lens solution
replace case at least every 3 months with appropriate case
store them in dry and clean area
What are the types of cleaning solutions for contact lenses?
Soft Lenses: Saline Based Cleaning Solution, Hydrogen Peroxide Solution
Rigid Lenses: Hydrogen Peroxide Solution, Multi-Step Enzymatic Cleaner
When should you refer eye care to an optometrist?
hx of Herpes Simplex or Zoster
excessive tearing and photophobia - pt with sunglasses on their face even though they’re indoors
contact lens wearers
foreign body sensation
reduced vision
severe H/A with nausea
