Ophthalmics Flashcards
Cornea:
Refractive element of eye
Rate limiting step for drug absorption
Tears:
Lubricate eye surface, remove debris, antimicrobial
Dilutes and removes medications with reflex tearing
Dry Eye characteristics:
Causes: Aging, eyelid defects, corneal defects, sjogrens syndrome
Medications: anticholinergics, decongestants, diuretics, beta blockers
Symptoms: White or mildly red eye, sandy or gritty feeling, sensation of something in the eye, excessive tearing.
Goals: alleviate and control the dryness to relieve symptoms and prevent possible tissue and corneal damage.
Dry Eye treatment (non-pharmacologic):
Avoid environments that increase evaporation of the tear film.
- Avoid dry, dusty places
- Use humidifiers
- Avoid prolonged use of computer screens
- Wear eye protections
Warm compresses, eyelid hygiene, omega 3 fatty acid supps
Artificial tear solutions
They are pharmacologic.
They reduce tear evaporation and stabilize the tear film.
Dosing: 1-2 times daily, may increase to 3-4 times daily up to hourly for severe cases
Common active ingredients: Hydroxypropyl methylcellulose, Carboxymethylcellulosse, PVA, and povidone
Dry Eye treatment approach?
- Non-pharmacologic treatment
- Add artificial tear solution +/- ophthalmic ointment
- Not relieved, refer to eye care provider
Allergic Conjunctivitis (AC):
Causes:
Allergens (pollen, animal dander, make-up, topical eye preparations)
Patients often report allergic rhinitis as well
Symptoms:
Itching, red eye, watery discharge
Possible blurred vision from excessive tearing
Typically occurs in both eyes
Goals:
Remove or avoid the allergen
Relieve symptoms and protect the ocular surface
Non-pharmacologic treatment for AC
Removing/avoiding exposure to offending allergen
Avoid contact lenses
Cold compresses 3-4 times daily to reduce redness and itching
Keep doors/windows closed and use air conditioning and air filters
Pharmacologic Treatments for AC:
Decongestants: constrict blood vessels reducing redness, vascular congestion and eyelid edema.
Dose: 3-4 times daily
Counseling points: Do not use >72 hours.
Avoid in patients with glaucoma, HTN, Cardio diseases, Diabetes, and hyperthyroidism
Common active ingredients: Phenylephrine, naphazoline, tetrahydrozoline, and oxymetazoline
Pharmacologic Treatments for AC:
Antihistamines:
H1-antagonists prevents histamine mediated responses
Dosing: 3-4 times daily
Only available in combination with decongestant because more effective
Counseling points:
Avoid if glaucoma risk
Burning, stinging, and discomfort are most common side effects
Common active ingredients: (in combination with naphazoline)
- Pheniramine
- Antazoline
Pharmacologic Treatments for AC:
Antihistamine/Mast cell stabilizer
Prevents acute histamine-mediated response and prevents the release of inflammatory mediators
Dosing: 2 times daily
Counseling point:
Safe to use in ages 3 and up
Avoid if glaucoma risk
Burning, stinging, and discomfort are most common side effects
Common active ingredients: Ketotifen fumarate (Brands: Zaditor, Alaway)
AC treatment approach:
- Removing/avoiding allergen
- Artificial tears as needed
- Ketotifen twice daily +/- oral antihistamine
- Decongestant +/- antihistamine
- Medical refferal if symptoms still persist
Bacterial Conjunctivitis
Symptoms: itching, red eye, crusting of eyelids and lashes, purulent discharge
Highly contagious
Begins in one eye then spreads
Self-limiting within 2 weeks
May require medical referral for antibiotic
Viral Conjunctivitis
Symptoms: red eye, watery discharge, itching, highly contagious
Begins in one eye and then spreads
Self-limiting in 2-3 weeks
Requires medical referral if symptoms > 7-10 days
Diagnosed Corneal Edema:
Causes: Over wear of contact lenses, surgical discharge to the cornea inherited corneal dystrophies
Fluid accumulation around the cornea
Symptoms: Halos or starbursts around lights with or without reduced vision
Goals: Draw fluid out from cornea, relieve symptoms
Treatment for Diagnosed corneal edema:
Pharmacologic
Hyperosmotics to draw fluid out of cornea
NaCl 2% solution (preferred for long term use)
NaCl 5% solution or ointment (tends to cause burning and stinging)
Do not make homemade saline solutions - infection risk!!!
Diagnosed corneal edema treatment approach:
- NaCl 2% solution 4 times daily
- Add NaCl 5% ointment at bedtime
- Increase to NaCl 5% solution four times daily + NaCl 5% ointment at bedtime
- Still symptomatic? Refer to eye care provider
Loose Foreign Debris Treatment
Flush eye with water from sink or hose
Pharmacologic: Ocular irrigants to flush debris from eye…typically saline and preservatives
Do not use for open wound in or near eye
Treatment approach for loose foreign debris:
- Flush eye with ocular irrigant solution.
- If irrigant solution unavailable, may use water from sink or hose
- Apply eye ointment at bedtime
- Refer to eye care provider
Chemical Burn characteristics:
Causes: Exposure to alkali (oven cleaner), acids (battery acid, vinegar), various solvents and irritants (mace)
Symptoms: Pain, irritation, photophobia, tearing.
Severe - hyperemia, eyelid edema, first or second degree burns of eyelids/outer skin
Chemical Burn Treatment options
Not appropriate for self-care
Irrigation with sterile saline or water, continued until eye care provider can be seen
EMERGENCY situation.
Artificial Eye Care
Causes: Dried mucus or fluid build up on surfaces
Goal: To prevent infections
Treatment: Mild, non-allergenic soap and water
Pharmacologic: Tyloxapol/BAK solution (3-4 times daily) - clean and lubricate artificial eye
Clean eye regularly with soap and water - prevent bacterial growth
Contact Dematitis
Causes: Reaction to allergen or irritant (make-up, medications, foreign substance)
Symptoms: Swelling, scaling, redness of eyelid, itching
Treatment: Discontinuing/avoiding offending agent.
Cold and compress 3-4 times daily
Pharmacologic: Oral histamine
Preservatives do what?
Destroy or limit growth of microorganisms for multi-dose bottles
May cause irritation, allergic reaction, dry eye, damage to epithelial cells, conjunctivitis
Contact Lenses
Can trap medications, chemicals, debris under lens
Avoid using with PVA
-Solution can thicken or gel when exposed to certain compounds
