opthamalic Flashcards
Do not self treat eye disorders
-pain
-blurred vision
-light sensitivity
-contact lens
-blunt trauma
-chemical exposure to eye
-eye exposure to heat
-symptoms longer than 72 hours
Causes of dry eye
-physical abnormalities
-contact lenses
-health conditions: Sjoogren’s syndrome, XXX, RA, thyroid
-Medications: antihistamines, TCAs, diuretics, some XXX
-envirorment
Symptoms of dry eyes
-normal to XXX
-discomfort
-blurred vision
-discharge from excessive XXX
-urge to rub eyes
-sensation of something in eye
non pharmacologic dry eyes
-avoid enviormental trigggers
-humidify dry air
-change meds
-cool compress
OTC treatments dry eyes
-artificial tear
-non medicated ocular gels
-non medicated opthalmic ointment
Follow up reccomendation dry eyes
-after 1 week: refer severe discomfort
-worsenting condition
artificial tears MOA
-Prevent/reduce tear evaporation, stabilize tear film
-Facilitate wetting of cornea by increasing XXX
-coat surface of eye, protect underlying cornea cells + conjunctiva
-MOA povidone: forms hydrophilic layer on cornea (like mucin)
artificial tears dosing
-Initial: BID to once daily
-maintenance: 1-2-3x/daily to hourly
artificial tears side effects
-rippled surface of cornea
-preservative toxicity
-cellulose ethers: XXX on eye lids
-Dextran 70: temporary stinging
-temporary blurred vision
artificial tears drug interactions
-PVA may react to cause thickening of solution containing PVA: Reacts with: sodium bicarbonate, sodium borate, sodium/potassium/zinc sulfate
artificial tears product selection
-balance: number of drops, viscosity, preservatives
- more drops=higher risk of toxicity
-non preserved products: discard unused immediately
ocular gel and ointment MOA
Occlusive film on eye
surface
ocular gel ingrediants
same as solution with additional agents to creat gel
ointment ingrediants
white petroleum, mineral oil, lanolin
How to manage blurred vison
XXX or use just at bedtime
symptoms of Allergic Conjunctivitis
-red eye and watery discharge
-ocular XXX
-ocular burning
-blurred vision due to tearing
no pharma Allergic Conjunctivitis
-cool, moist compress 3-4 times day
-trigger avoidance
OTC treatment for Allergic Conjunctivitis
-ocular: lubricants, decongestants, antihistamines, decongestant/antihistamines, antihistamines-mast cell stabilizer
-oral antihistamines
-combo eye and oral
Follow up reccomendations for Allergic Conjunctivitis
-24 hours: tears
-72 hours: everything else
Ocular decongestants(-ine drugs) MOA
alpha receptor agonism; reduces redness via vasoconstriction
of XXX
Pharmacodynamics of ocular decongestants/vasoconstrictors
-Duration:
–Phenylephrine: 30 to 90 minutes
–Tetrahydrozoline: 1-4 hours
–Naphazoline: 3-4 hours
–Oxymetazoline: 4-6 hours
–Brimonidine: 6-8 hours
Ocular decongestants/vasoconstrictors side effects
-rebound congestions
-hyperemia
-allergic conjuctivitis
-pupil dilation
-momentary stinging
-epithelial zerosis
Ocular decongestants/vasoconstrictors drug interaction
-possible but unlikely: atropine, TCAs, MAOIs, methyldopa
when to avoid Ocular decongestants/vasoconstrictors
-glaucoma
-hyperthyroidism
-children < 6
-ASCVD, arrhythmias, DM, BPH
Avoid: use longer than 72 hours! (brimonidine: 4 wks)
Ocular decongestants/vasoconstrictors dosing
-1-2 drops
-Tetrahydrozoline: every 4 hr
-Others: every 6 hours
Ocular decongestants/vasoconstrictors in pregnancy/lactation
likely ok but check with healthcare provider
Ocular antihistamines/MC stabilizers MOA
-H1 -receptor antagonists: pheniramine
-H1 -receptor antagonist/mast cell stabilizer: ketotifen, olopatadine
Ocular antihistamines/MC stabilizers pharmacodynamics
-Pheniramine: 3-4 hours
* Ketotifen: 8-12 hours
* Olopatadine: depends on dosing: Twice daily with lower concentration: 8 hours or Once daily with higher concentration: 16 hours
Ocular antihistamines/MC stabilizers side effects
momentary stinging/burning, eye redness, pupil dilation
When to avoid Ocular antihistamines/MC stabilizers
not for contact lens irritation, avoid if narrow-angle glaucoma;
72 hour warning for pheniramine combo
Ocular antihistamines/MC stabilizers Dosing
-5 min apart from other eye meds,10 minutes before inserting contact lenses
-Pheniramine combo: 1-2 drops 3-4x/day
-Ketotifen: 1 drop twice daily (age 3 & older)
-Olopatadine: 0.1%: 1 drop twice daily, separated ___ hours, ages 2 & older, 0.2%: 1 drop ONCE daily (ages 2 & older)
Ocular astringents MOA
help dry eye
Ocular astringents
-zinc sulfate and benzalkonium chloride(BAK_
-combination with and decongestant or antihistamine/MC stabilizer
Causes of corneal edema
-prolonged wearing of contacts
-surgical damage
-hereditary conditions
-glaucoma
-iritis
-infection
corneal edema symptoms
-blurred/foggy vision
-light halos/starbursts
-blisters which may rupture
OTC treatments corneal edema
-sodium chloride: 2% soln., 5% soln., 5% oint
corneal edema follow up recomendations
-1 week
corneal edema treatment algorithm
-1st line: 2% soln 4x/day
-2nd line: add 5% oint at night
-3rd line: switch to 5% soln 4x/day and continue ointment
Sodium chloride 2%, 5% MOA
increase tonicity of tear film which moves water from cornea to tears
–> removed by tear flow
Sodium chloride 2%, 5% side effects
momentary burning, eye irritation, eye redness, vision
changes (all = more common with ____)
Sodium chloride 2%, 5% dosing
-1-2 drops every 3/4 hours
-ointment: thin ribbon at bedtime
Sodium chloride 2%, 5% in pregnancy/lactation
check with healthcare provider
Removal of foreign object in eye
-blink/tear
-flush with water
Avoid with Ophthalmic irritants
open wounds in/near eyes, eye pain, vision changes, ongoing
redness/irritation, EYE CUPS
how to use ocular irritant solution
1)wash hands
2)head over sink with head tilted
3)hold eyelids apart and flush with solution
4) discard remaining solution and bottle
non pharma Minor eye irritation
-cool, moist compress
Minor eye irritation OTC treatment
-artificial tears/ointments
-zinc sulfate soln
Minor eye irritation follow up recomendation
72 hours
Zinc sulfate ophthalmic solution MOA
astringent; shrinks mildly inflamed tissues; dries excess
secretions
Zinc sulfate ophthalmic solution side effects
eye irritation, reddness
Zinc sulfate ophthalmic solution dosing
1-2 drops 4x/day
Avoid Zinc sulfate ophthalmic solution in…
children younger than XXX
causes of Blepharitis
S. epi, S. aureus,
seborrheic dermatitis
Blepharitis symptoms
-pruritis
-burning
-eyelids: red, scaly, thickened, loss of eyelashes
non-pharma Blepharitis
-hot compress 15-20 min BID to QID
OTC treatments for Blepharitis
-lid scrubs: baby shampoo, eye scrub soln, lid wipes, ocu soft soln.
Hordeolum (Stye) symptoms
-nodule
-tender, palpable
-eyelid swelling
Hordeolum (Stye) referral
> 1 week or chronic
Hordeolum (Stye) non pharma treatment
-hot compress 3-4 times day for 5-10 min
-gentle pressure
Hordeolum (Stye) pharmacologic treatment
-internal: oral antibiotic after 1 week of compresses
-external: topical antibiotic if not cleared after 1 week of compresses
-surgery
