Ophthalmology Flashcards
Primary Open Angle Glaucoma Pathophysiology
increase in IOP due to decrease outflow of aqueous humor through trabecular meshwork and schlemm’s canal
Primary Open Angle Glaucoma symptomatology
rarely experience symptoms until progression of central tunnel vision
ocular hypertension
two instances of IOP over 25 mmHg
sometimes 22
angle closure glaucoma
closure of the anterior chamber angle
medical emergency
30 mmHg or higher
acute Angle closure glaucoma symptomatology
decreased vision
halos around lights
headache
severe eye pain
N/V
chronic angle closure glaucoma symptomatology
symptom free
or decrease in central vision
Normal flow rate of aqueous humor
8-22 mmHg
IOP > 40 mmHg
Emergency referral
IOP 30-40 mmHg
Urgent referral if no symptoms suggesting acute glaucoma
IOP 25-29 mmHg
Evaluation within one week
IOP 23-24 mmHg
Repeat measurement to confirm and/or referral for eye exam
Individuals over age ____ should undergo periodic comprehensive eye evaluations.
40
The rapidity and degree of _____ elevation from _____ determines whether symptoms occur.
IOP
angle-closure
Diagnostic Techniques for Glaucoma
Tonometry
Fundoscopic Exam
Visual Field Exam
Contraindication for asthma or COPD with glaucoma
Ipratropium bromide (Atrovent)
Tiotropium bromide (Spiriva)
Contraindication for cold/flu remedies with glaucoma
OTCs that contain decongestants like pseudoephedrine or phenylephrine
Contraindication for incontinence or overreactive bladder with glaucoma
Tolterodine (Detrol)
Oxybutynin (Ditropan)
Contraindication for allergy relief and decongestion with glaucoma
Diphenhydramine (Benadryl)
Loratadine (Claritin)
Fexofenadine (Allegra)
Cetirizine (Zyrtec)
Contraindication for migraine attacks with glaucoma
Sumatriptan (Imitrex)
Contraindication for prevention of motion sickness with glaucoma
Scopolamine patches
Contraindication for depression/anxiety with glaucoma
Fluoxetine (Prozac)
Paroxetine (Paxil)
Amitriptyline (Elavil)
Tofranil (Imipramin)
Duloxetine (Cymbalta)
Glaucoma Treatments
Direct-acting Cholinergic Agonists
Beta-Adrenergic Blockers
Alpha-2 Agonists
Carbonic Anhydrase Inhibitors
Prostaglandin Agonists
Rho Kinase Inhibitors
Direct-acting Cholinergic Agonists
Pilocarpine (Isopto-Carpine)
Carbachol (Miostat)
Direct-acting Cholinergic Agonists MOA
Enhances outflow of aqueous humor
Direct-acting Cholinergic Agonists Side Effects
Miosis, periorbital pain, brow ache, myopia, blurred vision
Cholinergic effects
Direct-acting Cholinergic Agonists Administration
Four times a day
Beta-Adrenergic Blockers
Timolol (Timoptic, Timoptic XE, Betimol)
Betaxolol (Betoptic)
Carteolol
Beta-Adrenergic Blockers MOA
Decreases production of aqueous humor
Beta-Adrenergic Blockers Side Effects
stinging, burning
bradycardia, heart block, reduced BP
bronchospasm
depression
All beta blockers are nonselective except _____.
Betaxolol (Betoptic)
Alpha-2 Agonists
Brimonidine (Alphagan P)
Apraclonidine (Iopidine)
Alpha-2 Agonists MOA
Decreased production and increased outflow of aqueous humor
Alpha-2 Agonists Side Effects
red eye and ocular irritation
Carbonic Anhydrase Inhibitors (topical)
Dorzolamide (Trusopt)
Brinzolamide (Azopt)
Carbonic Anhydrase Inhibitors MOA
Decreased production of aqueous humor
Carbonic Anhydrase Inhibitors Side Effects (topical)
burning, stinging, altered taste
contraindicated in sulfonamide allergies
Carbonic Anhydrase Inhibitors oral preparations
Acetazolamide (Diamox)
Methazolamide (Neptazane)
Most potent for reducing IOP
Prostaglandin Agonists
Lantoprost (Xalatan)
Bimatoprost (Lumigan)
Latanoprostene buniod (Vyzulta)
Travoprost (Travatan)
Tafluprost (Zioptan)
Prostaglandin Agonists MOA
Enhances outflow of aqueous humor
Prostaglandin Agonists Side Effects
darkening of eye color and eyelid, hyperemia, blurred vision, eyelash lengthening
Which medication is marked only for eyelash hypotrichosis?
Latisse (bimatoprost 0.03%)
Rho Kinase Inhibitors
Netarsudil (Rhopressa)
Rho Kinase Inhibitors MOA
Enhance outflow of aqueous humor
Rho Kinase Inhibitors side effects
red eye and ocular irritation
Combination Products
Combigan: timolol + brimonidine
Cosopt PF: dorzolamide + timolol
Simbrinza: brinzolamide + brimonidine
Rocklantan: netarsudil + latanoprost
First Line Therapy for Glaucoma
Prostaglandin agonist
OR
Topical beta-blocker
Second Line Therapy for Glaucoma
Increase concentration
Switch to alt first-line or add second first line
Consider adding other class alternatives: brimonidine (alpha 2) or TOPICAL carbonic anhydrase inhibitor
Third Line Therapy for Glaucoma
Consider adding direct-acting cholinergic agonist or replace with cholinesterase inhibitor
May add ORAL carbonic anhydrase inhibitor instead of topical
Blepharitis
Infectious disorder of eyelids caused by staph aureus and epidermidis or inflammation/hypersecretion of sebaceous glands
First Line Therapy for Blepharitis
Erythromycin oint
OR Bacitracin oint
OR Azithromycin solution
Second Line Therapy for Blepharitis
Topical glucocorticoids
topical cyclosporine
Oral antibiotics (doxycycline, tetracycline, azithromycin)
Hordeolum (Stye)
infection of hair follicles or seb glands of eyelids caused by seborrhea and staph infections
Hordeolum (Stye) Treatment
Hot compress
Conjunctivitis (pink eye)
inflammation of conjunctiva due to bacteria, viruses, chemical irritants, or allergies
Bacterial conjunctivitis
Adults and children:
Staph and Strep
Moraxella and Haemophilus
Neonates:
N. gonorrhoeae and chlamydia
First Line of Therapy for bacterial conjunctivitis
Erythromycin oint
OR
Polymyxin B - trimethoprim
Second Line of Therapy for bacterial conjunctivitis
Azithromycin solution
OR Neosporin
OR Bleph -10
Preferred agents to treat bacterial conjunctivitis in contact lens wearers or risk of keratitis (Pseudomonas)
Fluoroquinolones
Aminoglycosides
Fluoroquinolones
Moxifloxacin (Vigamox)
Gatifloxacin (Zymaxid)
Besifloxacin (Besivance)
Preferred Fluoroquinolones and Aminoglycosides
Tobramycin (Tobrex)
Gentamicin
Ciprofloxacin
Ofloxacin
First Line Therapy for Viral Conjunctivitis
Topical antihistamines/decongestants
OR
Artificial Tears
Treatment of Allergic Conjunctivitis
Mast Cell Stabilizers
Antihistamine/Mast Cell Combination
Topical Decongestants
Topical Decongestants/Antihistamine Combo
Mast Cell Stabilizers
Cromolyn
Nedocromil (Alocril)
Antihistamine/Mast Cell Stabilizer Combination
Azelastine
Epinastine (Elestat)
Ketotifen
Olopatadine
Topical Decongestants
Naphazoline
Tetrahydrozoline
Topical Decongestants/Antihistamine Combination
Naphazoline/Pheniramine (Naphcon)
Topical NSAIDs
Ketorlac (Acular)
Flurbiprofen
Do NOT use topical decongestants for more than _____.
72 hours
Keratitis
Infections of cornea secondary to trauma or contacts
Caused by pseudomonas aeruginosa, staph. aureus, strep. pneumoniae
Keratitis Treatment
Cefazolin or vancomycin in combo with gentamicin drops or subconjunctival injections
Moxifloxacin
Besifloxacin
Gatifloxacin
Concurrent _____ should be avoided in acute phase of infectious keratits.
glucocorticoid eye drops
Ocular Herpes Simplex Infections
Keratitis cased by herpes simplex virus
Treatment of Ocular Herpes Simplex Infections
Oral/topical antiviral therapy
Oral acyclovir or valacyclovir
Topical acyclovir or ganciclovir (alternative)
Trifluridine
Dry Eye Syndrome (DES) Symptoms
Stinging, burning
Excessive tearing
Sandy/gritty sensation
Blurred vision
Redness
First Line Therapy for DES
Artificial Tear Substitute
Second Line Therapy for DES
Cyclosporine emulsion
Lifitegrast (Xiidra)
Varenicline (Tyrvaya)
Perfluorohexyloctane (Miebo)