Ophtalmic Disorders EXAM III Flashcards
The most common disorder of the anterior eye
Dry eye(5-15% of the population)
(Women have a higher tendency for dry eye)
What are the causes of dry eye?
-Age/Gender
-Eye defects (e.g., Lacrimal, Lid, Corneal)
-Environmental (e.g., dry air, dust, ACHV)
->Humidifier as remedy
-Diseases (e.g., Sjogren’s syndrome - Rheumatoid Arthritis)
-Contact Lenses
-Medications (Anticholinergics)
-Inflammation
(Prescription for eye treatment: Restasis (Cyclosporin)
What are the three layers that prevent dry eyes?
Lipid layer
Aqueous layer
Mucin layer
How do the layers of the eye affect eye dryness?
-when we blink, tears are distributed and a film is built over the eye
-when tears lack the components to build the eye film, or there are too few tears produced the eye’s tear film breaks down
- Abnormal tear layer
- Reduced lubrication
- Inadequate tear production
Symptoms of dry eyes
-Scratchy, gritty eyes
-red eyes
-desire to rub
-excessive tearing (body’s response to dry eye to keep it moisture)
Treatment for dry eye
Artificial tears (for mild to moderate eye disorders)
Preservative: can be used multiple times, but can cause damage and discomfort over time -> best for short-term, temporary use
Non-preservative: better for patients who need drops multiple times a day; more costly
Non-medicated Ointments
-most viscous
-the more viscous the longer it stays in the eye
-cause blurry vision, may sting
-ointments are used in more serious cases
How to treat mild forms of eye diseases?
-Patient education
-local environmental change
-diet (omega-3-fatty acid diet reduces eye symptoms)
-review medication that may cause symptoms (anticholinergics)
-warm compress
-Artificial tears
How to treat moderate-severe forms of eye diseases?
-Preservative-free artificial tears
-Ointment
-Prescription therapy for dry eye
How to treat severe forms of eye diseases?
Prescription therapy
-if the disease is resistant to treatment -> SURGERY
How do Cellulose ethers and polyvinyl alcohol (PVA) 1.4% work in artificial tears?
Ingredient of Artificial tears
-Stabilize tear film, retards evaporation
-the higher the concentration, the more viscous
Examples of Cellulose ethers
-Hydroxypropyl methylcellulose (HPMC) 0.3-0.8%
-Carboxymethylcellulose (CMC) 0.5-1.0%
How does Povidone (0.6-2%) work in artificial tears?
Ingredient of Artificial tears
Mucin mimetic; Forms hydrophilic layer
and promotes ocular wetting
How do Glycerin 0.5-1.0%, polysorbate 80, and
castor oil work
Ingredient of Artificial tears
Supplements lipid component of tear film
Polyethylene glycol 400, Propylene glycol, Hydroxypropyl guar
Ingredient of Artificial tears
-forms a gel-like environment keeping the
lubricant in contact with the ocular surface
-creates an “ocular shield”
According to a recent meta-study Polyethylene glycols work better than Cellulose ethers in reducing symptoms
True or False
True
Which ingredients are used as preservatives?
-Benzalkonium Chloride (BAK)
-Chlorohexidine
-Thimerosal
-Adverse effects increase with chronic use
What type of artificial tears are appropriate for chronic eye diseases (use for a longer period of time)?
-No preservative
-containing disappearing preservatives (Refresh Liquid gel)
-> Sodium perborate
->Purite (oxychloro complex)
degraded into non-toxic substances
Dosing Artificial tears
-Start with twice a day
-increase 3-4 times a day
-can be increased, there is no harm bc these are non-medicated (as long as w/o preservatives or disappearing preservatives)
What are the ingredients in non-medicated Ointments?
-White petrolatum 60% (Lubricant)
-Mineral oil 40% (help melt the ointment at body temperature)
-Lanolin (prevents evaporation)
-for moderate-severe disease
Non-medical Ointment dosing
-¼ - ½ inch QHS
-Start at bedtime, due to blurry vision, and eyes are closed
-increase to twice a day based on response
How are Red Eyes (bloodshot eyes) treated?
Artificial tears with decongestants
Ingredients in drugs for red eyes
MOA: localized vasoconstriction, Mixed α1/α2 agonist
-Naphazoline
-Tetrahydrozoline
-Phenylephrine
-Oxymetazoline
selective α2 agonist:
Brimonidine 0.025% (used for Glaucoma with higher dose - prescription)
How do selective α2 agonists affect Conjunctivitis medicamentosa in red-eye?
selective α2 agonists only constrict the venules, it is believed that solely constricting venules ensures blood supply, thereby preventing the body from reacting with dilation to counteract low blood supply (due to artery constriction with α1/α2 constrictor)
–> No rebound congestion
-could be used more than 72 hours
Artificial tears with decongestants dosing
Red eye treatment
-1-2 drops into affected eyes up to 4 times daily
-No more than 72hrs (except brimonidine)
What is the most common symptom and potential allergens in Allergic conjunctivitis?
-Itching, allergic rhinitis (nasal congestion) often present; also Bloodshot eyes, watering eyes
-Allergens:
Grass/Pollen
Mold
Pet Dander
How to treat Allergic conjunctivitis?
-Ocular antihistamines (H1 antagonists)
-Ocular antihistamines + mast cell stabilizers (H1 antagonist + inhibition of inflammatory mediators)
-Ocular vasoconstriction (mixed α1/α2 agonist)
OTC products combine these ingredients
Ocular antihistamines (H1 antagonists)
-Pheniramine
-Antazoline
Ocular antihistamines (H1 antagonists) + Mast cell stabilizer
-Ketotifen
-Olopatadine (Pataday)
Ocular vasocontrictor
-Naphazoline
-Tetrahydrozoline
-Phenylephrine
-Oxymetazoline
Allergic Conjunctivitis Dosing
-Antihistamine/Decongestant
1-2 drops into affected eyes up to 4x daily (no more than 72hrs)
-Antihistamine/Mast Cell Stabilizer
1 drop into affected eyes once or twice daily
Allergic Conjunctivitis
Counseling
-Avoid allergens
-Avoid eye-rubbing
-Decongestants and antihistamines are more effective than either component alone
-combining decongestants with oral antihistamines may have added efficacy
Viral Conjunctivitis
-Pink eye (may affect only one eye)
-very contagious (for about 2 weeks)
-Usual precursors: Cold, sore throat
-Self-limiting: resolves after 1-3 weeks
Pharmacist Counseling
Viral Conjunctivitis
-Self-limiting
-No antibiotics or antiviral medications
-Strict hygiene measures
-Avoid cross-contamination
How to treat Viral Conictivitis
-No antibiotics or antivirals
-Artificial tears
-Ocular decongestants
-Cold compress (reducing perceived heat)
How to administer ophthalmic drops
Wash hands
1. Shake the bottle well
2. Tilt back or lie down
3. pull your lower eyelid down and build a pouch
4. hold the bottle above the eye, look up, and squeeze on drop into the pouch
-don’t let the tip of the bottle touch your eye or any surface
5. close your for a minute and press on the inside corner of the eye
6. close the bottle and store it away from heat and bright light (some meds may be stored in the fridge)
How to administer ophthalmic ointment
Wash hands
1. hold in your hands for a few minutes to warm the medicine to ease the flow from the bottle
2. tilt back or lie down, and pull the lower eyelid down to form a pouch
3. look up and squeeze the prescribed amount of ointment out of the bottle into the pouch
DONT let the lid touch your eye or any surface
4. blink a few times to help with spreading - DO NOT RUB your eye
5. close the bottle and store it away from heat and bright light
-your vision may be blurry - avoid driving
What are the symptoms of Corneal Edema?
-Foggy vision
-halos or starbursts around light
How is Corneal Edema treated?
-Hyperosmotics -> osmotic effect: pulling the water away from the cornea (swollen)
NaCl 2% or 5% solution
NaCl 5% ointment
(contains salt, might sting in the eye)
the patient has to be DIAGNOSED before!
Treatment Strategy for Corneal Edema
-Start with NaCl 2% solution 4x daily
-if no improvement:
NaCL 2% solution+ NaCl 5% ointment at bedtime
-NaCl 5% solution + NaCl 5% ointment at bedtime
-REFERRAL
Main symptom of Blepharitis
Inflammation of eyelid margins
Causes of Blepharitis
-Staphylococcus epidermidis
-Staphylococcus aureus
Treatment for Blepharitis
-Warm compresses - 3-4x daily
-Eyelid scrubs: remove oils, debris (dead skin), scaly skin
or Lid scrubs: ( ¼ tsp baby shampoo + 1 cup water)
Hallmark of Hordeulum
-Stye
-Inflammation of the eyelid gland
-Causes:
Staphylococcus epidermidis
Staphylococcus aureus
Treatment for Hordeulum
-Self-limiting, resolving within 5 to 7 days
-Warm compresses 3-4 times daily x 5-10 minutes
-Topical antibiotics may be needed
-Reoccurring = referral
When to immediately REFER
-extreme pain
-restriction of eye movement
-Diplopia (double vision)
-Photophobia
-Sudden onset of blurry vision or vision loss
-Decrease in visual fields
-Newly irregular or fixed pupils
-Corneal laceration/abrasion
-No improvement after 2-3 days of therapy
