Opthalmic Disorders Lecture

Question 1

What is the purpose of the eyelids?

Answer 1

Natural defense mechanism/protective elements
Limits damage to anterior surface of eye
Coat surface of eye with lubricating tears
Help in tear removal towards nose and drainage pathways

Question 2

What is the purpose of the tear layer?

Answer 2

Lubricates ocular surface
Removes debris on surface
Provides antimicrobial protection
Reflex tearing

Question 3

What are the three layers of the eye?

Answer 3

Lipid layer: prevents evaporation
Middle Aqueous layer: primary wetting layer
Inner mucin layer: helps other two layers adhere to eyed

Question 4

What is the lacrimal drainage system?

Answer 4

highly vascularized system of epithelium leading form lacrimal sac to nasal cavity
Site of systemic absorption of topically applied medication s in the eye

Question 5

What is the cornea?

Answer 5

Clear layer
Innervated
Avascular
Refracts light
5 layers --> impact PK of meds

Question 6

What is the sclera?

Answer 6

Tough, rigid/collagenous layer –> gives the eye its’ shape
Keeps internal structure in place
Epithelial layers contain vascular and lymphatic systems

Question 7

What is the iris?

Answer 7

Visible, colored portion of the eye located in the anterior segment (behind the cornea)
Regulates amount of light striking the retina

Question 8

What is the pupil?

Answer 8

Diameter controlled by 2 opposing muscles within the iris (sphincter and dilator)

Question 9

What does the sphincter do?

Answer 9

Closes through parasympathetic stimulation (rest/digest)

–> PGs lead to constriction

Question 10

What does the dilators do?

Answer 10

Open through sympathetic stimulation (flight/fight)

Question 11

What is conjunctiva?

Answer 11

Thin membrane that covers the inner surface of the eyelid and the white part of the eyeball (sclera)

Question 12

What is conjunctivitis?

Answer 12

Inflammation of the conjunctiva –> eye appears red

Question 13

What is the retina?

Answer 13

Responsible for initial processing and transmission of light signals

Question 14

What does the epithelium provide?

Answer 14

Vital electrical support to retina

Question 15

What does atrophy in pigment epithelium leads to?

Answer 15

Macular degeneration

Question 16

Who is dry eye common in and what causes it?

Answer 16

Older patients and females

Caused by eye lid defects, dry/dusty environments, various medical conditions, refractive surgery patients and MEDS

Question 17

What meds cause dry eye?

Answer 17

Drugs with anti-cholinaric properties (antihistamines, antidepressants)
Decongestants
Diuretica
Beta blockers

Question 18

What are sign and symptoms of dry eye?

Answer 18

Excessive tearing
Watering
Burning
Scratch/gritty sensation
White/mildly red eye

Question 19

What is the treatment goal of dry eye?

Answer 19

Alleviate and control dryness to relieve symptoms and prevent damage to the eye tissue (corneal surface)

Question 20

What are some non-pharmacological treatments of dry eye?

Answer 20

Avoid dry dusty environments
Position away from vents
Humidity air
Limit time focusing on a computer
Water intake
Wear eye protection
Cold compresses

Question 21

What are ocular lubricants?

Answer 21

Mainstay of OTC treatment for dry eyes because it reduces evaporation, replensishes/stabilizes tear-film, protect corneal/conjunctival cells, and reduce tear evaporation
Vary by viscosity/pH/preservatives

Question 22

The worse the dry eye…

Answer 22

The higher the viscosity needed to treat

Question 23

What is the use of artificial tear solutions?

Answer 23

Used for mild cases
Stabilized tear film and decreases tear evaporation
Start takid BID

Question 24

What is the use of artificial tear gels?

Answer 24

Used for moderate to severe cases
Mildly more viscous than solutions
Increase viscosity could potentially mess with vision

Question 25

What is the use of artificial tear ointments?

Answer 25

``` Severe cases White petrolatum/mineral oil/lanolin BID Can significantly alter vision Benefits: retained in eye longer and enhanced integrity of tear film ```

Question 26

What are artificial tear side effects?

Answer 26

Stinging Blured vision Preservative risk

Question 27

What are preservative issue ophthalmicly?

Answer 27

Must be steril Used to destroy or limit bacterial growth Can be toxic to ocular tissue Increased frequency of use increases toxicity risk

Question 28

What ophthalmic products do not require preservatives?

Answer 28

Unit dose kits | One time use

Question 29

What are the three types of conjunctivitis?

Answer 29

Allergic (itching) Viral (watery discharge) Bacterial (mucoid discharge)

Question 30

What are the hallmarks and signs and symptoms of allergic conjunctivitis?

Answer 30

Itching, seasonal allergic rhinitis and clear, watery discharge Itching, swollen or puffy sensation to lids, redness and bilateral

Question 31

What are treatments for allergic conjunctivitis?

Answer 31

Remove offending allergen Cold compressions First line: lubricants Second line: ocular antihistamines/mast cell stabilizers Third line: oral antihistamine may be added; ocular decongestant/antihistamine Referal

Question 32

What are ocular antihistamine/mast cell stabilizers?

Answer 32

Ketotifen fumarate Approved for children 3 + Works within minutes Side effects: headache, dry eyes, eye irritation, pain in eye, pharyngitis, rhinitis

Question 33

What are topical decongestants?

Answer 33

``` Phenylephrine Naphazoline Oxymetazoline Tetrahydrozoline - Direct-acting agents - Constrict conjunctival blood vessels/reduce redness - Can cause rebound congestion ```

Question 34

What are topical antihistamine or antihistamine/decongestant combination?

Answer 34

Pheneramine and antazoline Combined with naphazoline Adverse effects: stinging/burning on instillation, antichoinergic properties --> pupil dilation

Question 35

What are the hallmarks, signs and symptoms of bacterial conjunctivitis?

Answer 35

Colored mucoid discharges Diffuse redness, mucoid discharge, matter on lashes and lids, typically unilateral Discomfort, greenish/yellowish discharge, eyes can be matted shut Will require antibiotics

Question 36

What are the hallmarks, signs and symptoms of viral conjunctivitis?

Answer 36

Redness --> "pink eye" with watery discharge Diffuse redness Discomfort, watery, photophobia, foreign body sensation Usually clears on its own

Question 37

What is corneal edema?

Answer 37

Occurs due to a variety of conditions: over wear of contact lenses, surgical damage to cornea, inherited corneal dystrophies Hallmarks: halos or starbursts around light messing with vision (due to fluid accumulation)

Question 38

What are treatments of corneal edema?

Answer 38

Goal: withdraw fluid from the cornea Hyperosmotic agents --> first line: sodium chloride solution (only hyperosmotic OTC product) --> Augmented treatment: ointment --> no improvement: switch to 5% solution

Question 39

What if a foreign body gets into the eye?

Answer 39

Determine activity which resulted in injury Self-treatment appropriate with minor irritations Remove irritant by irrigating eye Refer if not obvious

Question 40

What are the causes and signs/symptoms of minor eye irritation?

Answer 40

Loose foreign body, contact lens wear, wind or sun exposure, smog, chemical fumes, chlorine Eye redness and or pain or gritty sensation

Question 41

What is the treatment for minor eye irritation?

Answer 41

Artificial tear solution Nonmedicated ointment Zinc sulfate drops

Question 42

What are chemical burns due to and what does severity depends on?

Answer 42

``` Alkali: oven cleaners, cement, lye Acids: battery acid, vinegar Detergents Other: solvents/irritants Depends on agent and exposure time ```

Question 43

Which chemical burns is most severe? Alkali, acids, detergents?

Answer 43

Alkali Continue to dissolve cornea Acids are neutralized rather quickly

Question 44

What are the goal for chemical burns?

Answer 44

Neutralize pH Irrigate immediately and continuously with sterile saline or tap water Irrigation must be continued until seen by eye care provider

Question 45

Characteristics of red eye surface?

Answer 45

``` Eye pain Blurred vision not associated with ointments Sensitivity to light History of contact lens wear FB with fragments Chemical exposure Eye exposure to heat No improvement after 72 hours ```

Question 46

Characteristics of eye lid disorder?

Answer 46

``` Red thickened eyelids, scaling, Blunt trauma to the eye Exposure to chemicals Head lice No improvement after 72 hours ```