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Stage 3 Case 3 > Pathophysiology of eye and care > Flashcards

Pathophysiology of eye and care Flashcards

1
Q

80% of vision loss is causes by 5 conditions

A
  1. Age related macular degeneration (AMD)
  2. Cataract
  3. Diabetic retinopathy
  4. Glaucoma
  5. Under-corrected and uncorrected refractive error
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2
Q

What percentage of vision loss is preventable and treatable?

A

75%

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3
Q

People with vision impairment are at a greater risk of suffering from secondary conditions (6)

A
  1. Falls
  2. Depression
  3. Early special accommodation
  4. Increased risk of hip fracture
  5. Increased early mortality
  6. Social isolation
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4
Q

Vitreous body is filled with vitreous fluid (humor) purpose

A

Allows the eye to keep its shape

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5
Q

Conjunctiva

A

A thin mucus membrane that covers the eye

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6
Q

Bulbar conjunctiva with sclera beneath

A

The white of the eye

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7
Q

Limbus

A

The junction of cornea and sclera

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8
Q

How does the lens work?

A

Lens projects inverted image on to retina which produces a signal and sends to the brain to invert it back.

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9
Q

2 types of photosensitive cells

A

Rods (120 million) and cones (6 million)

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10
Q

Rods are sensitive to…

A

light

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11
Q

Cones are sensitive to…

A

colours

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12
Q

Purpose of retinal blood vessels

A

Nutrition and blood supply to the retina.

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13
Q

Where in the fovea?

A

The centre of the macula

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14
Q

What is in the fovea?

A

Cones (colours)

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15
Q

What is in the periphery of the retina?

A

There are more rods and it becomes slightly thinner

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16
Q

Retinal detachment from bleeding in the eye can cause…

A

blindness

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17
Q

What is retina detachment?

A

The retina is lifted or pulled from normal position. Usually occurs when small areas of the retina become torn.

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18
Q

What is the macula?

A

The area next to optic disc that defines fine details at the centre of visual field

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19
Q

What is age-related macular degeneration (AMD)?

A

A chronic degenerative condition that affects the central vision; not enough blood supply to area.

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20
Q

What part of the eye is affected in age-related macular degeneration (AMD)?

A

The macular, disappearance of central vision due to deterioration of pigment layer of retina

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21
Q

What causes degeneration of the macular?

A

Abnormal blood vessels leaking fluid or blood into the macular.

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22
Q

How does age-related macular degeneration affect the vision?

A

Black/dankness at the centre of vision.

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23
Q

Functional implications of AMD (7)

A
  • Difficulty distinguishing people’s faces
  • Difficulty with close work
  • Perceiving straight lines as distorted or curved
  • Unable to differentiate between the footpath and road
  • Difficulty identifying the edge of steps if there is no colour contrast
  • Unable to determine traffic light changes
  • Difficulty reading, with blurred words and letters running together
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24
Q

What is a cataract?

A

A cataract is the clouding of the lens inside the eye. With a cataract, light is scattered as it enters the eye, causing blurred vision; gradual deterioration of lens.

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25
Q

What does early cataract do in spectacle prescription?

A

Myopic shift so see an optometrist to change glasses prescription

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26
Q

What are the 3 types of cataract?

A

Congenital, senile and secondary

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27
Q

What part of the eye does cataract affect?

A

The lens

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28
Q

What can increase the risk of cataract? (3)

A
  • Long term use of corticosteroids can increase risk of cataracts
  • Exposure to UV light can also increase the risk
  • Ageing, smoking and having diabetes can increase the risk of developing cataract.
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29
Q

How does cataract affect the vision?

A

Foggy images and the changes in colour perception, yellowing.

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30
Q

Functional implications of cataract

A
  • Blurred vision
  • Reduced contrast
  • Having difficulty judging depth
  • Seeing a halo or double vision around lights at night
  • Seeing images as if through a veil/smoke
  • Being particularly sensitive to glare and light
  • Having dulled colour vision.
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31
Q

What is diabetic retinopathy?

A

It affects the small blood vessels of the retina. Blood vessels begin to leak and bleed inside the eye

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32
Q

What percentage of people with type 2 diabetes will develop retinopathy?

A

22%

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33
Q

What to things to do with diabetes, can increase the risk of diabetic retinopathy?

A

Diabetic kidney disease and type 1 diabetes

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34
Q

How does diabetic retinopathy affect the vision?

A

The appearance of “clouds” moving in the vision which obstruct a person’s sight.

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35
Q

What part of the eye is affected with diabetic retinopathy?

A

Leaking blood vessels in the retina

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36
Q

Functional implications of diabetic retinopathy

A
  • Difficulty with fine details (e.g. when reading or watching television)
  • Fluctuations in vision from hour to hour or day to day
  • Blurred, hazy or double vision
  • Difficulty seeing at night or in low light
  • Being particularly sensitive to glare and light
  • Having difficulty focusing
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37
Q

What are the 4 stages of diabetic retinopathy?

A

Mild non proliferative

Moderate non proliferative

Sever non proliferative

Proliferative

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38
Q

What treatment is needed during the first 3 stages of diabetic retinopathy?

A

No treatment unless muscular oedema.

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39
Q

What is proliferative in diabetic retinopathy treated?

A

Surgery, scatter laser treatment to shrink abnormal blood vessels.

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40
Q

What are some of the complications with scatter laser treatment?

A

Some loss of vison, but saves the rest of sight

Might slightly reduce colour and night vision

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41
Q

How is macular oedema treated?

A

Focal laser treatment. Stabilises vision and can reduce risk of vision loss by 50%.

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42
Q

What is glaucoma?

A

It is a disease that affects the optic nerve at the back of the eye.
Increased intraocular pressure due to a malfunction in eyes aqueous humor drainage system - can lead to optic nerve damage.

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43
Q

What reduces progression of glaucoma?

A

Relieving pressure on the nerve reduces progression of the disease.

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44
Q

What happens with glaucoma over time?

A

Gradual loss of peripheral vision.

If untreated - eventually complete vision loss.

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45
Q

What can early detection of glaucoma do?

A

Early detection and treatment can slow the vision loss.

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46
Q

What part of the eye is affected by glaucoma?

A

Optic nerve at the back of the eye

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47
Q

How does glaucoma affect the vision?

A

Peripherally vison so dark around the edges

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48
Q

Where does the fluid flow in glaucoma?

A

Behind the iris, through the pupil, into the aqueous part, then out though trabecular meshwork.

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49
Q

What is closed angled glaucoma?

A

The iris blocking the trabecular meshwork

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50
Q

What is opened angled glaucoma?

A

The iris NOT blocking the trabecular meshwork

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51
Q

What type of glaucoma is more common?

A

Opened angled glaucoma

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52
Q

What is the treatment aim for glaucoma?

A

Inhibition or decrease in the aqueous formation. And an increase of uveoscleral outflow.

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53
Q

Risk factors for glaucoma

A
  • Extreme refractive error
  • Diabetes
  • Migraine
  • Cataracts
  • Previous eye injuries
  • Sleep apnoea
  • Gender, males higher risk
  • Corticosteroids can increase the risk of developing glaucoma
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54
Q

Functional implications of glaucoma

A
  • No functional implications in early stages, silent disease
  • Difficulty adjusting to lighting changes (e.g. between indoors and outdoors)
  • Occasional blurred vision
  • Seeing a halo around lights (angle closure)
  • Increased sensitivity to glare and light
  • Difficulty identifying the edge of steps or road
  • Tripping over or bumping into objects
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55
Q

What is refractive error?

A

Refractive error is a focusing disorder of the eye.

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56
Q

How can refractive error be corrected?

A

It is correctable by wearing glasses or contact lenses or refractive laser surgery (selected cases)

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57
Q

4 types of refractive error?

A
  1. HYPEROPIA
  2. MYOPIA
  3. ASTIGMATISM
  4. PRESBYOPIA
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58
Q

How does refractive error affect the vision?

A

Blurred vision

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59
Q

What is hyperopi?

A

Far, long sightedness

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60
Q

Hyperopia mechanism

A
  • object focuses behind the retina

- able to see only far objects

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61
Q

What is myopia?

A

Near, short sightedness

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62
Q

Myopia mechanism

A
  • object focuses in front of the retina

- able to see only close objects

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63
Q

What is astigmatism?

A

Change in the shape of the lens

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64
Q

Astigmatism mechanism

A
  • abnormal shaped cornea (egg shape instead of spherical)

- object is partially clear and other blurred

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65
Q

What is presbyopia?

A

The lens not functioning properly

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66
Q

Presbyopia mechanism

A
  • Rigidity of the lens (old age)

- unable to focus

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67
Q

Functional implications of refractive error: long-sightedness (hyperopia)

A

difficulty seeing near objects

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68
Q

Functional implications of refractive error: short-sightedness (myopia)

A

difficulty seeing things in the distance

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69
Q

Functional implications of refractive error: astigmatism

A

blurred vision

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70
Q

Functional implications of refractive error: presbyopia (age focus difficulty)

A

difficulty seeing near objects occurs from 40 and onwards

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71
Q

Hordeolum (stye)

A

Inflammatory infection of the hair follicle of the eye lid

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72
Q

Chalazion (meibomian cyst)

A

Collection of fluid or soft mass cyst

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73
Q

Blepharitis

A

Inflammation of the margins of the eye lids

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74
Q

Entropion

A

Inversion of eye lid into eye

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75
Q

Ectropion

A

Outurned eye lids

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76
Q

Conjunctivitis

A

Pink eye

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77
Q

Conjunctivitis mechanism

A

Inflammation of the conjunctiva

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78
Q

Conjunctivitis etiology

A
  1. Viral / bacterial

2. Irritants (allergies, chemicals, UV light)

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79
Q

Conjunctivitis symptoms and signs

A
  • Redness / swelling / itching
  • tearing when exposed to light
  • pus if infectious
  • “contagious” with contaminated hands, washcloths
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80
Q

4 types of conjunctivitis

A

Bacterial, viral, chlamydial, allergic

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81
Q

Treatment for bacterial conjunctivitis

A

Chloramphenicol

Lid hygiene

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82
Q

Treatment for viral conjunctivitis

A

Lubricants

Steroids if keratitis

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83
Q

Treatment for chlamydial conjunctivitis

A

GUM clinic

Azithromycin

Erythromycin

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84
Q

Treatment for allergic conjunctivitis

A

Lid hygiene,

mast cell stabiliser,

antihistamine,

steroid

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85
Q

Ocular inflammation treatment (4)

A
  • Corticosteroids
  • Steroid-Antibiotic Combinations
  • Non-Steroidal Anti-inflammatory Drugs (NSAIDS)
  • Oral Analgesics
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86
Q

Ocular infection treatment (4)

A
  • Topical Antibiotics
  • Oral Antibiotics
  • Anti-Viral
  • Analgesics
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87
Q

What are mydriatics?

A

Cause pupil dilation

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88
Q

What are mydriatics used for?

A

Examine fundus (can see more of retina)

Used as pain relief

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89
Q

Example of mydriatic

A

Mydriacyl (Tropicamide)

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90
Q

Mydriatics onset

A

15 mins can last for 3-6 hours

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91
Q

What affect does mydriatics have on vision?

A

Blurs

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92
Q

What are cycloplegics?

A

Cause mydriasis and cycloplegia

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93
Q

What is mydriasis?

A

Dilation of the pupil

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94
Q

What is cycloplegia?

A

Paralysis of the ciliary muscle that controls focusing of the light rays entering the eye by changing the shape of the crystalline lens.

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95
Q

What are miotics?

A

Causes pupil constriction

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96
Q

What are miotics used for?

A

Treatment of glaucoma

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97
Q

Side effects of miotics

A
  • Night blindness
  • Stinging on instillation
  • Brown ache or spasm
98
Q

What is miosis?

A

Constriction of the pupil

99
Q

What can happen with long term use of pilocarpine (miotic) cause?

A

Difficulty to dilate pupil

100
Q

Example of miotic

A

Pilocarpine

101
Q

What to do:

Babies

A

REFER

Can’t really diagnose

Not much OTC

Cannot use Chloramphenicol for under 2 years

102
Q

What to do:

Babies with sticky eyes from birth

A

REFER

Could be indication of blockage in tear duct

Infection going though birth canal

103
Q

What to do:

Patients who have undergone ophthalmic surgery or eye laser treatment

A

REFER

Not sure about surgery implications

104
Q

What to do:

For chloramphenicol –personal or family history of bone marrow problems

A

REFER

Contraindication for it to be used in these patients

105
Q

What to do:

Associated pain or swelling around the eye or face

A

REFER

106
Q

What to do:

Photophobia (Sensitivity to light)

A

REFER

Cannot really give any treatment

107
Q

What to do:

Unusual appearance, e.g. cloudiness

A

REFER

New presentation would require examination

108
Q

What to do:

Restricted eye movement

A

REFER

109
Q

What to do:

Pain inside the eye

A

REFER

110
Q

What to do:

Visual disturbance

A

REFER

111
Q

What to do:

Foreign bodies in the eye

A

REFER

Needs to be removed appropriately

112
Q

What to do:

Reported trauma to the eye

A

REFER

Needs to get checked out

113
Q

What to do:

Presence of systemic symptoms, e.g. headache

A

REFER

114
Q

What to do:

Unusual appearance of the eye, e.g. irregular shaped pupil –a feature of acute angle closure glaucoma

A

REFER

115
Q

What to do:

Recurring problems

A

REFER

116
Q

What to do:

Any occurring after trauma to the eye

A

REFER

117
Q

What to do:

If already seen the doctor

A

REFER

118
Q

What to do:

If tried another remedy

A

REFER

119
Q

What to do:

On any other medicines

A

REFER

120
Q

What is the basis of referral?

A

Required further examination and specialist treatment

121
Q

What to do:

Drug induced eye conditions

A

REFER

122
Q

Eye complaints in community pharmacy?

A
  • Red eye
  • Disorders of eyelid
  • Bacterial conjunctivitis
  • Tear disorders
123
Q

Red eye presentation may be more serious when…

A

With pain and or visual loss

124
Q

Possible cause of red eye

A

Conjunctivitis (allergic or infective)

Subconjunctival haemorrhage

‘inflamed’ eyes

125
Q

Difference between allergic and infective

A

Infective starts in one then goes to other. Allergic both at the same time.

126
Q

When does allergic conjunctivitis usually resolve?

A

7-10 days once exposure has stopped

127
Q

What does it mean when conjunctivitis is self-limiting?

A

It will go by itself with body defence mechanisms.

128
Q

Which conjunctivitis takes considerably longer to heal?

A

Adenoviral

129
Q

When does bacterial conjunctivitis usually resolve?

A

7-10 days even without treatment

130
Q

What type of OTC treatment can be used for conjunctivitis?

A

Antibiotic or help loosed hardened discharge on lids

131
Q

Antiseptics for conjunctivitis

A

Propamidine isetionate drops

Dibromopropamidine isetionate eye ointment

132
Q

Antibacterial for conjunctivitis

A

Chloramphenicol drops and ointment

133
Q

How is chloramphenicol drops used?

A

Every 2 hours for first 2 days

Every 4 hours there after

134
Q

How is chloramphenicol ointment used?

A

3-4 times a day but generally Used on bottom waterline at night.

135
Q

What do antiseptics do?

A

More for cleaning the eye and prevent further infection.

136
Q

Chloramphenicol and contact lens user?

A

Stop wearing contacts (preservatives can form deposits on lens and lens can get contaminated) or refer.

137
Q

What may contact lenses users use instead of chloramphenicol?

A

Signal use vial as it has not got preservatives.

138
Q

What is the usual course for chloramphenicol?

A

5 days. Should discard after this.

139
Q

What to do if chloramphenicol shows no improvement after 2 days?

A

If not improvement after 48 hours then referred (resistance or viral)

140
Q

Can you share bottles of chloramphenicol?

A

No, usually get bottle for each eye

141
Q

How you use eye drops?

A

Pull lower lid and drop into pocket, without touching eyes and eyelashes.

142
Q

Side effects of eye drops like chloramphenicol?

A

Transient stinging, burning and blurring of vision.

143
Q

How is chloramphenicol drops stored?

A

In the fridge

144
Q

If your not sure if its conjunctivitis what should you do?

A

Not give chloramphenicol due to antibiotic resistance. REFER

145
Q

What to do with chlamydial conjunctivitis?

A

More serious so required REFFERAL.

146
Q

What treatment is used in chlamydial conjunctivitis?

A

Oral macrolide or tetracycline (antibiotic given by doc)

147
Q

Allergic conjunctivitis advice

A

Avoid/minimise exposure to trigger

Cold compress for eyes

148
Q

Allergic conjunctivitis treatment

A

Oral antihistamines

Antihistaminic eye drop with a vasoconstrictor Sodium cromoglicate

149
Q

When do you use Sodium cromoglicate in allergic conjunctivitis?

A

More suitable for long-term: fast and effective and safe for prolonged periods?

150
Q

When do you use Antihistaminic eye drop with a vasoconstrictor in allergic conjunctivitis?

A

Short-term or intermittent use

151
Q

Why should steroid use be avoided for allergic conjunctivitis?

A

Can cause cataract, glaucoma or severe infection. (Only available on prescription)

152
Q

What is Subconjunctival haemorrhage?

A

Small vessel burst

153
Q

How is Subconjunctival haemorrhage treated?

A

Resolves spontaneously in 7-14 days

154
Q

When do you refer Subconjunctival haemorrhage?

A

If recurring or on warfarin

155
Q

What can cause inflamed eyes?

A
  1. Tired/irritated
  2. Over-exposure to smoky/dusty air, or regular rubbing
  3. Overworking: reduction in blink frequency and poor corneal wetting
156
Q

What can be used for inflamed eyes?

A

Eye lotions or drops containing astringents, such as witch hazel or lubricants as short-term measure: soothing

157
Q

What to do it dry eye persist?

A

REFER Maybe dry eye condition

158
Q

Why would you refer is Subconjunctival haemorrhage is recurring?

A

It may be undiagnosed hypertension.

159
Q

Why would you refer is Subconjunctival haemorrhage if on warfarin?

A

Indication of bleeding time, anticoagulation not working so well.

160
Q

What is a stye?

A

Acute localised abscess usually caused by Staphylococcal infection

161
Q

How to treat stye?

A

Resolves spontaneously

162
Q

How to speed up stye healing?

A

With hot compress to closed lid for several mins each day.

163
Q

How does applying a warm compress speed healing of the stye?

A

It brings up and puss building up in the absence to the surface more quickly allowing is seep out and/or heal.

164
Q

When to refer stye to GP?

A

If not resolved after 7 days

165
Q

What may happen if not resolved?

A

Surgical treatment, often removing an eyelash

166
Q

What is a Chalazion?

A

Cyst of meibomian gland that secretes fluid to stop eyes sticking together

167
Q

How do you treat a chalazion?

A

Resolves spontaneously but may take few weeks

Treat same as styes

168
Q

What would happen if the chalazion (cyst) doesn’t heal?

A

Cysts that don’t resolve may require surgery to drain swelling

169
Q

What is Marginal blepharitis?

A

Chronic condition inflammation of the margin of the eyelid

170
Q

Can Marginal blepharitis be cured?

A

Symptoms can be improved but may not be cured permanently

171
Q

What is important for Marginal blepharitis treatment?

A

Compliance to treatment is important and lid hygiene

172
Q

Is sight affected with Marginal blepharitis?

A

Sight rarely affected as it is on the outside of the eye.

173
Q

Can you wear contacts with Marginal blepharitis?

A

Contact lenses should not be worn during any eye infection as it will cause increased inflammation and sensitivity.

174
Q

Eyelid hygiene: warm compress

A

Warm compress to lids and eye margins to loosen crusts and cleans more effectively and comfortably

175
Q

Eyelid hygiene: Massage eyelids

A

Gently roll first finger on lids to help push out any oily fluid from eyelid gland

176
Q

Eyelid hygiene: Cleaning of eyelids

A

Mix of 2 parts baby shampoo with 10 parts warm water. Applied with a clean cloth or cotton bud and rubbed along the margins

Or lid wipes

177
Q

Eyelid hygiene: How often should you cleanse eyes?

A

Twice daily for several weeks.

Once improved reduce to 1 times daily.

178
Q

Eyelid hygiene: Eye makeup

A

Especially eye liner can contribute to infection. Should discard in eye infection as it will be contaminated.

179
Q

Eyelid hygiene: When to refer to GP?

A

Symptoms not resolved in 7 days

180
Q

How is Bacterial blepharitis treated?

A

With antibacterial ointment rubbed into eyelashes and at base of lashes 2-3 times a day for 7 days.

181
Q

Is OTC chloramphenicol licenced for bacterial blepharitis?

A

No- only licensed for conjunctivitis

182
Q

What medication can be used for bacterial blepharitis?

A

Fusidic acid viscous drops. But POM.

183
Q

When is Systemic treatment (e.g. oral tablets) occasionally required for bacterial blepharitis?

A

Usually undertaken after culturing organisms (swab) from the eye lid margins and determining antibiotic sensitivity

184
Q

How long are oral antibiotics for bacterial blepharitis given for?

A

Oral antibiotics such as tetracyclines given for 3 months or longer may be required

185
Q

Why do oral antibiotics need to be given for 3 months or longer?

A

For something taken orally to have an effect on a superficial part of the body is going to take longer to take action.

186
Q

Watering eyes

A

Excessive lacrimation

187
Q

Watering eyes with no other symptoms

A

May be associated with interrupted drainage of tear film often as a result of blockage of nasolacrimal duct

188
Q

What do 20% of infants develop during the first month of life?

A

Congenital lacrimation obstruction, but usually resolves spontaneously.

189
Q

What may GPs do if a infant has Congenital lacrimation obstruction?

A

Apply pressure with a finger to the lacrimal sac at the internal corner of the eye and lightly massage the duct beneath.

190
Q

What can happen if the fluid is not released in the Congenital lacrimation obstruction?

A

Pressure may increase.

191
Q

What would happen to and adult with Congenital lacrimation obstruction?

A

Messaging usually ineffective. Requires specialist and may need surgery.

192
Q

How may watering eyes be due to dry eyes?

A

Part of the inflammatory process.

193
Q

What can a reason for watering eyes particularly found in older people?

A

Ectropion or Entropin conditions.

194
Q

What to do: Ectropion or Entropin conditions.

A

REFER

Minor surgical procedure can correct the problem.

195
Q

What is Ectropion or Entropin?

A

Where the eyelid turns in or out

196
Q

Dry eyes

A

The loss of the ability to produce tears. This is usually lifelong.

197
Q

Who are more prone to dry eyes?

A

Contact lens wearers.

198
Q

When may dry eyes be acute and temporary?

A

Dry eyes with an infection

199
Q

What to do: dry eyes

A

REFER

To eliminate associated problems such as corneal ulceration.

200
Q

Treatment for dry eyes

A

Lubrication, to allow inflammation of eye surface to subside and then maintain lubrication so patient is symptom free.

Tear substitutes are recommended as they have prolonged retention time.

201
Q

What is the issue with less thick dry eye drops?

A

Need to be applied more often.

202
Q

What is the issue with more thick dry eye drops?

A

Greasy

Stickiness

sometimes crystallisation on the lid

Blurring vision

203
Q

What is recommended for a patient that needs to use dry eye drops for more than 6 times a day?

A

Preservative free, to reduce damage by benzalkonium chloride which disrupts tear film.

204
Q

What drops can be used for glaucoma? (3)

A

Parasympathomimetic drops

Sympathomimetic drops

Beta-blocker drops

205
Q

How to use eye drops for glaucoma

A

Use of punctual occlusion or simply shutting eyes for several mins after application can reduce drug entry into lachrymal ducts and subsequently systemic circulation

206
Q

Prostaglandin analogues and prostamides advantage

A

Have advantage of once daily application. Warn patients that may increase brown pigmentation in iris

207
Q

Carbonic anhydrase inhibitors

A

2 available: dorzolamide and brinzolamide. The latter is more comfortable because of neutral pH

208
Q

Screening for glaucoma

A

> 40 years encouraged for check-up and 1st degree relatives can get free eye tests.

209
Q

Side effects caused by ocular products

A

Typical local side effects: transient stinging,

burning, itching or irritation

210
Q

Difficulties with eye drop adherence

A

Difficulty aiming bottle

Shaky hands

Reflex blinking

211
Q

Where can eye drop be put?

A

In temporal corner of lower conjunctival sac.

212
Q

How can you stop getting the taste of the drops?

A

Press a finger against the inner corner of the eye by the nose for approx. min. after using drops may help to stop drops draining into nose and throat.

213
Q

Advice for using eye drops (4)

A
  • Tilt head back
  • Lower lid pulled down
  • Patient looking towards nose
  • Wash hands before and after
214
Q

What does looking at your nose do when using eye drops?

A

Won’t see drop descending.

215
Q

Rigid gas permeable contacts

A

Smaller than soft lenses and rest within corneal area

216
Q

What is rigid gas permeable contacts good for?

A

Thought to be better at correcting irregularly shaped eyes (takes longer to get used to).

217
Q

How often are rigid permeable contacts replaced?

A

More durable so replaced every 6-12months

218
Q

Soft contact lenses

A

Like thick cling-film

Larger and cover cornea so lens can be seen on sclera

219
Q

How often do you replace soft contact lenses?

A

Replacement may be daily, 2-weekly, monthly or 3monthly

May be daily-wear or 30 days continuous wear

220
Q

How do you prevent drying of soft contact lenses?

A

Incorporate water to prevent drying out

221
Q

Problems that can occur with contact lenses?

A
  • Inappropriate fit, prescription or extended wear
  • aged contact lenses
  • Inherent patient problem with tear film, lids or lashes
  • Immunological factors
  • Microbial keratitis
222
Q

What is Microbial keratitis?

A

Type of bacterial infections

  • Pseudomonas aeruginosa
  • Acanthamoeba
223
Q

Soft and hard contact lens care: Daily cleaning

A

Daily use of surfactant to remove mucins, lipids, eye cosmetics and dirt

224
Q

Soft and hard contact lens care: Disinfection

A

Daily with either hot/cold disinfectant

225
Q

Soft and hard contact lens care: Protein removal

A

Usually once a week to remove tear proteins

226
Q

Soft contact lens care: Saline solutions

A

Used for rinsing or as medium for protein-removing tablets

227
Q

Soft and hard contact lens care: Multipurpose solutions

A

Combine functions of cleansing, rinsing and disinfection

228
Q

Soft and hard contact lens care: Lubricant or comfort drops

A

May require especially when they are getting used to this.

229
Q

Hard contact lens care: Wetting solutions

A

Need to ensure lenses come into complete contact with tear film. Improve comfort on insertion, provide buffer between lens and finger during insertion and prevent contamination and facilitate even spread of tears over lens surface. Usually same solution used for soaking and wetting

230
Q

Rigid gas permeable lenses care

A

Deposits may be more difficult to remove than hard lenses.

Same care as hard lenses

231
Q

Reduction in tear flow (Contact lens issues)

A

Can cause lens discomfort can follow drugs with antimuscarinic side effects

232
Q

What can be signs of deposits on lenses?

A

Discolouration, visions issues or irritation

233
Q

Which lenses can be used with OTC eye preps?

A

Hard and rigid gas permeable.

234
Q

Why are soft lenses less recommended to use with OTC eye preps?

A

Potential to absorb comportment particularly the preservative benzalkonium chloride.

235
Q

Which drops can be used with soft lenses?

A

With chlorhexidine

236
Q

How may they use contacts when using eye preps?

A

Wait 15 mins after treatment.

237
Q

Lens intolerance (Contact lens issues)

A

Can be caused by hormone preparations

238
Q

Lens discolouration (Contact lens issues)

A

Can occur after oral administration of beta blockers, nitrofurantoin, rifampicin, sulfasalazine and tetracyclines

239
Q

Hormonal changes and contact lenses

A

Problems such as dry eyes and blurred vision can result from hormonal changes: thought to be deficiencies in lipid component of tear film, resulting in increased tear evaporation and reduction in aqueous and mucin layers.

240
Q

What can be used for someone with poor manual dexterity for eye drops?

A

OptiCare universal: handheld reusable plastic dispenser

241
Q

What is good about the eye drop dispenser?

A

It allows for accurate positioning of the eye and only requires 25% of force of squeezing.

242
Q

Cold sores and contact lenses

A

Not to wear during infection to avoid spread. This is because it affect mucosal membranes.

Stage 3 Case 3 (8 decks)

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