Ocular Inflammatory Disease Flashcards
1
Q
Sympathomimetics
A
- Used in differential diagnosis of scleritis and episcleritis
- Alpha adrenergic agonists
- Entry level
- Phenylephrine 2.5 and 10%
- Avoid using 10% in the elderly due to systemic side effects
- Contraindications: Cardiac disease, HBP, DM, aneurysms, asthma, hyperthyroidism, Px on MAOIs, Px with narrow angles
- Ocular Side Effects: Photophobia, mydriasis, corneal clouding (if epithelium is damaged)
2
Q
NSAIDs
A
- Inhibit COX enzyme to prevent prostaglandin synthesis
- Many are non-selective i.e inhibit COX 1 and 1
- Entry and IP level
- Topical and Systemic administration
3
Q
Systemic NSAIDs in Inflammatory Eye Disease
A
- Wide range of indications, can be used to manage mild and moderate pain
- 3 major properties: Anti-inflammatory, anti-pyrexic, analgesic
- Cautions: Aspirin allergy, Blood clotting disorders, GI problems, may exacerbate asthma
- Entry Level Examples: Aspirin, ibuprofen
- IP Level Examples: Diclofenac sodium, naproxen, flurbiprofen
4
Q
Topical NSAIDs in Inflammatory Eye Disease
A
- Greater ocular effect with fewer systemic side effects, ocular side effects are minimal
- Used to control and provide relief from ocular inflammation
- IP Level
- Indications: Corneal abrasion, FB, Seasonal allergic conjunctivitis, Episcleritis
- Examples: Diclofenac sodium, flurbiprofen
5
Q
Corticosteroids
A
- Inhibit release of phospholipase A2 enzyme
- Controls inflammation, reduces tissue damage from inflammation and reduces pain
- Indications: Scleritis, anterior uveitis, AKC and post surgery
- Contraindications: Undiagnosed red eye, infectious keratitis
6
Q
Corticosteroids Dosage In Inflammatory Eye Disease
A
- 1 drop every 2 hours for fist 48 hrs
- Reduce to 4x daily if responding well
- Taper over a couple of weeks until eye is quiet
7
Q
Corticosteroids Medicinal Forms
A
- Fluoromethalone (FML)
- Betamethasone
- Loteprednol
- Prednisolone
- Dexamethasone
8
Q
Corticosteroid ADRs
A
- Steroid glaucoma
- Corneal/scleral thinning
- PSCC
- CSR
- Secondary infection
- Reduced corneal healing
9
Q
Steroid Glaucoma
A
- IOP increase as drug deposited in meshwork
- Monitor IOP 2 weekly
- IOP normalises 1 to 2 weeks after treatment ended
- Glaucoma medications can be used to continue treatment
10
Q
Management of Episcleritis
A
- Reassurance that condition is not sight threatening, will typically resolve in just over a week but that It can be recurrent
- Artificial tears for discomfort
- Cold compresses for 5 minutes 2x daily for discomfort
- If persisting after 1 week
- Topical NSAID (diclofenac sodium 0.1%)
- Topical steroids (FML 0.1%)
- Systemic NSAIDs (Flurbiprofen 100mg) - If persisting after 2 weeks
- Increased dosing by IP optom
- Refer routinely to HES if more than 3 episodes
- Systemic investigation
11
Q
Management of Scleritis
A
- Ensure dilated fundus exam performed
- Oral analgesia
- Discuss with Ophthalmology
- Urgent referral
- Topical steroids (Pred forte), Systemic NSAIDs (fluribiprofen 100mg) and Systemic steroids (Prednisolone) are all options
- Normally requires systemic steroids
12
Q
Acute Anterior Uveitis Management
A
- Patient Advice
- Explain diagnosis and recurrent nature
- Sunglasses for photophobia
- Near add for cycloplegia
- Ensure to assess
- Assess both eyes
- Assess IOP
- Assess posterior eye
- Assess cornea to rule out herpes
- Break synaechiae if present
- Pharmacological Management
- Cyclopentolate 1% 3x daily
- Prednisolone/Dexamethosone 1% every waking hour for 2 days
- Review after 2 days
- Taper steroid
- every second waking hour for 7 days
- 6x daily for 7 days
- 4x daily for 7 days
- Continue to taper if eye is quiet after 21 days
13
Q
When to Refer Uveitis
A
- Posterior involvement
- Bilateral involvement
- Children
- Severe pain
- High IOPs
- Hypopyon
- Unable to break synaechiae
- Suspicion of systemic involvement
