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PHAR154 > Ophthalmic > Flashcards

Ophthalmic Flashcards

1
Q

Describe the cornea.

A

transparent, anterior portion of the eye
pain receptors present
no blood vessels

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2
Q

Describe the sclera.

A

posterior aspect of the eyes outer surface
continuous with cornea
white, fibrous tissue

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3
Q

Describe the conjunctiva.

A

membrane covering the sclera and inside the eyelids
blood vessel supply

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4
Q

How cautious are we with eye conditions?

A

start to think referral if its been longer than 2 days

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5
Q

When is a black eye worrisome?

A

direct hit to the eye
swelling does not recede after a few days
changes in vision (especially double vision)
severe pain starts
signs of infection
behavioural changes, lethargy
nausea, vomiting, dizzy
inability to move eye
blood in eye itself
any laceration to the eye area

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6
Q

How long does it take for a black eye to heal?

A

1-2 weeks

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7
Q

What is the treatment for black eyes?

A

cold compress
-15 minutes every few hours
analgesics

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8
Q

What are the symptoms that occur immediately upon a foreign body entering the eye?

A

tearing
irritation/scratchy

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9
Q

True or false: rubbing your eye to try get rid of a foreign body is a good move

A

false
avoid rubbing when there is a foreign body in the eye

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10
Q

What can we do for a foreign body in the eye?

A

gentle rinsing with warm water
if object cant be removed, cover eye and get MD care
do not try to remove a foreign body with a Q-tip, match, etc

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11
Q

Regarding ophthalmics, what is a good item to add to your first aid kit?

A

saline solution

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12
Q

What is phantom movement?

A

when looking somewhere with one eye, the other eye follows
can be damaging if you have a patch over an eye

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13
Q

What do we do for chemical contact in the eyes?

A

flush eye, pull eyelids away from eye at times, at least 15min
transfer to MD
take offending chemical container with you if possible

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14
Q

What are the eye symptoms from radiant energy?

A

red eyes
itchy
foreign body sensation

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15
Q

What can we do for eye symptoms from radiant energy?

A

cool compresses
non-medicated eye drop (Murine or Systane)
sunglasses for few days
contact lenses can help people who have them (source of fluid)

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16
Q

What does Visine contain to make it medicated?

A

decongestant

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17
Q

Describe the layers of tear film.

A

outer surface is oily (prevents evaporation of middle layer)
middle layer is mainly aqueous
inner layer is mucoidal

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18
Q

What is the function of tears?

A

lubricating
protecting
nourishing

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19
Q

What can occur if tear film is compromised?

A

dry spots on eye surface

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20
Q

What is the etiology of dry eyes?

A

changes to any tear component
alteration in blink frequency/efficiency

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21
Q

What are the two main types of dry eyes?

A

evaporative dry eye
-eyes make tears but they dont last long
-blocked glands can contribute to lipid deficiency
-most common
aqueous deficient dry eye
-eyes dont make enough water

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22
Q

What percentage of patients benefit from artificial tears?

A

15%

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23
Q

What are the symptoms of dry eyes?

A

difficulty blinking
generally less tears produced
-can also see more tearing (ineffective tears)
light sensitivity
redness
blurry vision

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24
Q

True or false: stringy discharge is a common symptom of dry eyes

A

false
more so viral conjunctivitis

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25
Q

Are drops a quick and easy fix for dry eyes?

A

no, we should be careful of using drops as a quick fix
should be checked out by MD or optometrist

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26
Q

What are some factors that can contribute to dry eyes?

A

age
blepharitis (oil glands can be compromised)
medications (Acutane, anticholinergic drugs)
Sjogren’s syndrome
menopause
allergic conj
rosacea
computer use
eyelid hygiene
contacts
arthritis
lasik (cuts the nerves)

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27
Q

What are the symptoms of Sjogren’s syndrome?

A

dry eyes
dry mouth
arthritic joint pain

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28
Q

What is an OTC treatment for dry eyes?

A

artificial tears

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29
Q

Do artificial tears actually mimic real tears?

A

no company can mimic all three layers of tears
basically like putting a bandaid over it and adding some lipids

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30
Q

Do we care about the ingredients in artificial tears?

A

no
check for: use with contact lenses, preservative

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31
Q

How should artificial tears be used?

A

use frequently, dont play catch up (they are very safe)
trial and error until one works for the patient

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32
Q

What is a disappearing preservative?

A

preservative that dissociates in the eye

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33
Q

Which version of artificial tears is a good level to start at?

A

preserved artificial tears
-most common solution
-provide moisture and comfort
-multi dose bottles

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34
Q

What are the LiquiGel artificial tears?

A

doesnt come viscous, forms a film over the eye
better at bedtime as it can cause blurry vision

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35
Q

If someone were using ointment/gel formulations of artificial tears, when would be the best time to use them?

A

HS dosing
-can cause blurry vision
-recommended for more intense, dry sensitive eyes

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36
Q

How do preservative-free artificial tears come packaged?

A

single-use vials

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37
Q

True or false: there is no king of artificial tears, as in one is the best

A

true
its all trial-and-error

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38
Q

What is Hylo?

A

was just another version of artificial tears
super expensive ($55)
used to be popular because its preservative free

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39
Q

What is Thealoz Dup?

A

just another version of artificial tears
try out the simple versions before trying one like this

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40
Q

What is different about Clear Eyes Pure?

A

the bottle has a purifying filter to prevent stuff from getting in
other than that, its just another version of artificial tears

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41
Q

True or false: artificial tears should be administered on a prn basis

A

false
should be administered on a regular schedule

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42
Q

What are some other options for dry eyes, aside from artificial tears?

A

humidifier (if winter)
lid margin hygiene
plug the ducts
cyclosporine drops (Restasis)
omega-3 fatty acids
lifitegrast drops
heat at night

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43
Q

If someone is using Restasis for dry eyes, what is it very important you do as the pharmacist?

A

can take months to work, thus its important to handle patient expectations

44
Q

What is the MOA of cyclosporine for dry eyes?

A

anti-inflammatory in eyes and tear ducts
helps improve the bodys ability to make tears

45
Q

Are omega-3 drops any different than other artificial tears?

A

not at all

46
Q

What are the anti-inflammatory (Rx drugs) that can be used for dry eyes?

A

cyclosporine (Restasis)
lifitegrast (Xiidra)

47
Q

How does varenicline work for dry eyes?

A

activates the trigeminal nerve–>cholinergic stim–>increased tear film
comes as nasal spray

48
Q

What is the etiology of a stye?

A

staph aureus infection in an eyelash follicle

49
Q

What are the symptoms of a stye?

A

swelling (can come to a head)
tenderness
red bump on edge of eyelid

50
Q

What is the treatment of styes?

A

warm compresses
no squeezing (esp if it hasnt come to a head)

51
Q

Are topical antibiotics used for styes?

A

no
not even the eye drops because the stye is on the eyelid

52
Q

What is a chalazion?

A

obstruction of an oil gland
can be painless or tender
slow to develop
higher up than a stye

53
Q

What is the treatment of a chalazion?

A

warm compresses + massage

54
Q

What do we do in most chalazion cases?

A

can speculate on cause but likely refer

55
Q

What is a sub-conjunctival hemorrhage?

A

vessel under conjunctiva bursts
~7-10 days to clear

56
Q

Can decongestants clear up a sub-conjunctival hemorrhage faster?

A

no
decongestants need healthy vessels to work

57
Q

What is the etitology of conjunctival hyperemia?

A

dust, smoke, chlorine
low humidity
eye strain
symptom of ocular conditions (Blepharitis, Rosacea)
contact lenses

58
Q

What is the treatment for conjunctival hyperemia?

A

cool compress
eye washes:
-Murine (less viscous)
-Optrex (99.9% saline, more volume)

59
Q

What are the ingredients of Optrex?

A

99.9% normal saline
boric acid
witch hazel
allantoin

60
Q

What are examples of ophthalmic decongestants? Rank them from shortest acting to longest acting.

A

phenylephrine (shortest)
naphazoline
tetrahydrozoline
oxymetazoline (longest)
zinc sulfate (historical and not a decongestant)

61
Q

What are the uses of ophthalmic decongestants for conjunctival hyperemia?

A

cosmetic reasons
not for: seasonal allergies, chronic redness, contact lens problems

62
Q

What is the concern with ophthalmic decongestants?

A

rebound redness

63
Q

What is the agent that does not cause rebound redness?

A

brimodidine
-QID for red eyes
-alpha 2 agonist rather than alpha 1

64
Q

What is blepharitis?

A

eyelid disorder
can lead to problems with dry eye

65
Q

What is the etiology of blepharitis?

A

disorder of the Meibomian gland
bacterial (more so younger adults and children)
seborrheic (more so adults)
-combo of both types is common

66
Q

What are the symptoms of blepharitis?

A

more noticeable in adults
inflammation of eyelid margins
-red, scaly, NO discharge
-scales=yellowish, bit greasy if seborrheic
eyes can become irritated, dryness
vision normal (some blurring)
rarely disappears completely and is often chronic

67
Q

True or false: if you are unsure about a possible blepharitis case it would be wise to refer

A

true

68
Q

What is the treatment for both forms of blepharitis?

A

bacterial:
-eyelid hygiene
-topical antibiotics
-Blephamide (antibiotic+steroid)
seborrheic:
-eyelid hygiene
-check/treat scalp–>antifungal
-tx lasts 3 weeks and up to months

69
Q

What are the different forms of conjunctivitis?

A

viral
bacterial
allergic
viral and bacterial are referred to as Pink eye

70
Q

What is our comfort in prescribing for each form of conjunctivitis? What about in regards to age groups?

A

most comfortable with allergic:
-refer bacterial quicker than viral
more comfortable with adults than paeds

71
Q

True or false: perennial allergy sufferers are more likely to experience ocurlar symptoms

A

false
seasonal is more likely

72
Q

How many eyes are typically involved in allergic conjunctivitis?

A

both eyes

73
Q

What are low-level non-pharm treatments for allergic conjunctivitis?

A

cool compress/non-medicated drops
-flush out allergens
allergen avoidance

74
Q

What does the “A” stand for on a box of Naphcon A?

A

antihistamine
-no “A” means its straight decongestant

75
Q

Are OTC topical antihistamines good for allergic conjunctivitis?

A

no
the antihistamines are garbage and theres a decongestant so theres worry about rebound redness

76
Q

What are examples of OTC topical antihistamines? What about Rx?

A

OTC: pheniramine, pyrilamine, antazoline
Rx: ketotifen, emedastine
-MUCH BETTER

77
Q

What is the drawback of OTC topical cromolyn?

A

frequency of dosing
-QID or >
-almost no systemic se

78
Q

How does cromolyn work?

A

mast cell stabilizer

79
Q

Describe Rx cromolyn-like products.

A

Alocril (nedrocomil)
-mast cell stabilizer
-BID
Patanol (olopatadine)
-mast cell stabilizer + antihistamine
-BID (Pataday is OD)
Alomide (lodoxamide)
-mast cell stabilizer
-QID

80
Q

True or false: oral decongestants work for allergic conjunctivitis

A

no shot

81
Q

Are topical ocular steroids good for allergic conjunctivitis?

A

would be great except for concern for increased IOP and cataracts

82
Q

What is the topical ocular steroid associated with less steroid-induced side effects in allergic conjunctivitis?

A

loteprednol (Lotemax)

83
Q

What are the symptoms of bacterial conjunctivitis?

A

exudate from eyelid
exudate from lid margin (but blepharitis also does)
both eyes

84
Q

What are the symptoms of viral conjunctivitis?

A

starts in 1 eye, moves to 2nd eye in 1/3 of cases
often follows a cold
profuse tearing

85
Q

What is the treatment of viral conjunctivitis?

A

symptomatic care
-drops

86
Q

What is the treatment of bacterial conjunctivitis?

A

topical antibiotics
-3 day window or start using
Polysporin more so 2nd line

87
Q

Describe bacterial vs viral conjunctivitis in adults.

A

viral causes more common (7 days of symptoms)
both are self-limiting
if contact lenses involved: refer

88
Q

What is the efficacy of antibiotics in bacterial conjunctivitis?

A

shorten course by 1-3 days
decreases spreading
should see improvement in 2 days

89
Q

True or false: bacterial conjunctivitis is more common than viral conjunctivitis in kids

A

true

90
Q

What are the symptoms in a kid <6 that tells you its likely bacterial conjunctivitis?

A

discharge
eyes glued shut in AM
eye pain
Refer to MD or prescribe

91
Q

Will Polysporin drops work for blepharitis or sties?

A

unlikely, how will the drop hit the site?
can be used in bacterial conjunctivitis but not commonly done

92
Q

What is the regimen of Polysporin drops for bacterial conjunctivitis?

A

QID x 7-10d + 2 days after symptoms clear

93
Q

What can be done if instilling eye drops is an issue for children?

A

close eyes
place drops in corner of eye
open eyes

94
Q

What is periorbital cellulitis?

A

infection of the skin around the eye

95
Q

What are floaters?

A

little dot like things that appear in your vision
could be normal in an older person
if quick onset, could be more serious

96
Q

What is blepharospasm?

A

benign twitches in eyelids

97
Q

What are obstructed tear ducts?

A

tears do not drain away
seen in newborns
most clear on their own

98
Q

What is the cause of bags under eyes?

A

thinning skin with age and genetics

99
Q

Differentiate between dry type and wet type AMD.

A

dry type:
-90%
-fat deposits
-stages: early–>intermediate–>advanced
wet type:
-10%
-vascular issues
-automatically advanced

100
Q

What can we do for AMD at an OTC level?

A

SECONDARY PREVENTION, not helpful for primary prevention
ARED vitamins:
-25% reduction of intermediate–>advanced

101
Q

What is the formulation of AREDS?

A

beta carotene (25,000IU)
vitamin C (500mg)
vitamin E (400 IU)
zinc (80mg)
copper (2mg)

102
Q

What are the changes that got made to AREDS2?

A

omega 3 added (no value)
beta carotene removed (did not reduce value)
less zinc (just as effective)
lutein and zeaxanthin added (not helpful)

103
Q

Would taking lutein or omega-3 on their own be enough for AMD?

A

no
give people the AREDS formula

104
Q

What got removed from the AREDS formula for Vitalux S?

A

beta-carotene
AREDS2 is practically Vitalux S

105
Q

What are some miscellaneous ophthalmic agents?

A

topical NSAIDs
-Acular/LS (ketorolac)
-Voltaren Ophtha (diclofenac)
-Ocufen (flurbiprofen)
local anesthetics
-Alcaine (proparacaine)
-Pontocaine (tetracine)
topical steroids
-Maxidex (dexamethasone)
-Flarex (fluorometholone)
-FML (fluorometholone)
-Pred Mild/Forte (prednisolone)
-Vexol (rimexolone)
-loteprednol (only one that doesnt increase IOP)
combination products
-Blephamide (sulfacet + pred)
-Vasocidin (sulfacet + pred)

PHAR154 (18 decks)

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