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Pharm301 Topics > Topic 3: eyes and ears > Flashcards

Topic 3: eyes and ears Flashcards

1
Q

What is infective conjunctivitis?

A

inflammation of conjunctiva due to infection

caused by bacteria or viruses

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2
Q

How common in infective conjunctivitis?

A

most common in children and elderly

with recent studies suggesting 33% and 78% of cases are bacterial

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3
Q

What is the prognosis of viral conjunctivitis?

A

generally self limiting illness that resolves spontaneously

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4
Q

What is the prognosis of acute bacterial conjunctivitis?

A

resolves spontaneously in most people without topical ocular antibiotic treatment, usually within 7 days of onset.

involvement of the cornea, presenting as keratitis can occur but is uncommon

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5
Q

What are the complications with infective conjunctivitis?

A
  • significant complications are rare following bacterial conjunctivitis
  • otitis media may develop in 25% of children with H influenzae conjunctivitis
  • punctate epithelial keratits may occurr following infective conjunctivitis
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6
Q

How is bacteria conjunctivitis diagnosed from viral conjunctivitis?

A

bacteria: usually affects both eyes but often starts in one eye before moving to other eye
- discharge is mucupurulent with eyes stuck together on waking

viral: usually both eyes affected
discharge is not as purulent as bacterial

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7
Q

When should infective conjunctivitis be referred?

A
  • pain going beyong discomfort
  • redness lasting longer than 1 week
  • changes in vision
  • redness localised around coloured part of eye
  • other symptoms like vomiting, sensitivity to light,
  • irregular shaped pupils,
  • cloudy cornea,
  • history of trauma to eye
  • redness/allergic conjunctivitis lasting longer than a week
  • OTC treatment without relief
  • history or family history of eye disease
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8
Q

What symptoms should be ruled out with infective conjunctivitis?

A

corneal ulcer (keratitis): main symptom being pain. Caused by abrasion (contats) or infection

Iritis: inflammation of iris. Pain is felt within the eye and there is no discharge. Eye is red and pupil may be irregular

Glaucoma: sudden onset (closed angle) assoc. with severe pain, possibly vomiting

Inflammatory conditions: episcleritis, scleririts, uveitis. Often with autoimmune disease

Subconjuntival haemorrhage

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9
Q

How is bacterial conjunctivitis managed?

A

anti bacterial drops and ointment:
Chloramphenicol - available as drops or ointment for acute bacterial infection

Sulfacetamide 10% (1-2 drops 2-4 hourly) Bleph 10 eye drops for acute bacterial infection

Propamidine 0.1% (1-2 drops 3-4 times daily) Brolene eye drops for mild acute conjunctivitis

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10
Q

How is viral conjunctivitis managed?

A

no OTC preparations available but antibacterial drops given to prevent secondary infection

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11
Q

What self care can we inform the patient about bacterial conjunctivitis?

A
  • use normal saline to wash away eye secretions
  • wash hands frequently
  • avoid touching eyes
  • use own face towel
  • wash hands before & after using eye preparations
  • avoid contact lens during infection
  • avoid contact lens use whilst using drops and for 48 hours afterwards
  • do not share eye medications
  • children should be excluded from school until discharge from eye has stopped
  • refer to Dr if no significant improvement after 2 days
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12
Q

What self care can we inform the patient about viral conjunctivitis?

A
  • wash hands frequently
  • avoid touching eyes
  • use own face towel
  • wash hands before & after using eye preparations
  • avoid contact lens use during infection
  • avoid contact lens use whilst using drops and for 48 hours after
  • do not share eye medications
  • children excl. from school until discharge from eye has stopped
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13
Q

What is allergic conjunctivitis?

A

inflammation of conjunctiva due to hypersensitivity reaction triggered by exposure to an allergen. Examples include seasonal and perennial allergic conjunctivitis

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14
Q

What is the prevalence of allergic conjunctivitis?

A
  • accounts for 15% of all eye presentations at GP

- seasonal allergic conjunctivitis accounts for half of all cases of allergic conjunctivitis

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15
Q

What are the complications of allergic conjunctivitis?

A
  • complications rare with both forms
  • chronic use of allergen that causes contact dermatoconjunctivitis can cause keratinisation of eyelid, leading to punctal oedema and stenosis
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16
Q

How is allergic conjunctivitis diagnosed?

A
  • both eyes affected
  • no gritty feeling
  • itchy eyes
  • discharge watery and clear
  • assoc with other allergic symptoms like sneezing, runny nose
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17
Q

How is allergic conjunctivitis treated?

A

Levocabastine (Livostin) antihistamine eye drops: 1 drop bd

Antazoline + Naphazoline (albalon-A) antihistamine + anticholinergic eye drops: 1-2 drops every 3-4 hours

Pheniramine maleate + Naphazoline (Naphcon-A, Visine Allergy) anithistamine + anticholinergic eye drops: 1-2 drops 3-4 times daily

Sodium cromoglycate (Optrex hayfever allergy, Oprticrom) mast cell stabilier eye drops: 1-2 drops qds

Lodoxamide trometamol (Lomide) mast cell stabiliser eye drops: 1 drop qds

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18
Q

What self care information can you advise the patient on allergic conjunctivitis?

A

-avoid rubbing eyes
-wash hands before & after using eye preparations
-avoid contact lens use during infection until symptoms and signs resolve
-avoid contact lens whilst using drops and for 48 hours afterward
-do not share eye medications
-place cool compresses such as flannel soaked in cold water on affected eyes to ease symptoms
-avoid known triggers where possible
(keep car windows closed especially on windy days, see pollen calender for more info, avoid freshly cut grass or mowing lawns, wear fitted sunglasses

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19
Q

What is contact lens and microbial keratitis?

A
  • a rare but severe complication of contact lens wear

- greater risk with overnight wear

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20
Q

What are the risk factors for CL & microbial keratitis?

A
  • poor CL hygeine
  • microbial contamination of CL case
  • greater risk of vision loss with overnight CL wear
  • sporadic overnight wear
  • smokers
  • shorter duration of wear
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21
Q

What are the referral points for CL and microbial keratitis?

A

patients who wear contacts must be referred!

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22
Q

What is red eye?

A

redness of eye and conjunctiva

  • this is a presenting symptom in both serious and non serious causes
  • can occur alone or with accompanying symptoms like discharge
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23
Q

What are the causes of red eye?

A
  • allergy
  • conjunctivitis
  • dryness
  • irritation (ffrom wind, dust, pool chlorine, smoke)
  • tiredness,
  • sleeplessness,
  • excess alcohol
  • excess sunlight
  • foreign body
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24
Q

When should red eye be treated?

A
  • if the eye was not scratched or the foreign body had not entered the eye mass
  • use washes like Optrex eye drops, sterile normal saline
25
Q

How is red eye managed?

A

Naphazoline 0.012% (clear eyes)
Naphazolne 0.1% (Albacon, Naphcon forte)
These are given as 1-2 drops every 3-4 hours

Phenylephrine 0.12% (Prefrin, Albalon relief) given as 1-2 drops every 3-4 hours

Tetrahydrozoline 0.01% (Visine) given as 1-2 drops up to qds

Naphazoline 0.01% + witch hazel 12.5% (Optrex Red eye relief- pharmacy only) given as 1-2 drops up to tds

Witch hazel 13$ (Optrex eye drops, Optrex eye lotion - general sale) given as 1-2 drops as needed. Use undiluted and bathe eyes

26
Q

Who is dry eyes more common in?

A

older patients, especially women

27
Q

What are the symptoms of dry eye?

A

eyes burn, feel tired, are itchy, irritated or gritty

-dry mouth is a more serious sign

28
Q

What is the typical history of dry eyes?

A

usually assoc with long history of irritated eyes

29
Q

What medication or medical conditions might precipitate dry eyes?

A

anticholinergic medicines, tricyclic antidepressants, antihistamines, isotretinoin, HRT

30
Q

What causes dry eyes?

A

Most patients have no measurable abnormality of tear production and no serious disease affecting tear composition, their symptoms are likely to be caused by one or more of

  • decreased tear production
  • increased evaporation of tears
31
Q

What is the prevalence of dry eyes?

A
  • common.
  • in 65 years and over, prevalence reports to be 15-33%
  • prevalence increases with age
  • about 50% more common in women
32
Q

How is dry eye managed?

A

Hypromellose 0.3% (Tears Naturelle, Genteal) given as 1-2 drops prn

Hypromellose 0.5% (Methopt) given as 1-2 drops prn

Hypromellos 1.0% (Methopt Forte) given as 1-2 drops prn

Hypromellose 0.3% + Dextran 70 0.1% (Poly-tears) given as 1-2 drops as needed

White soft paraffin 57.3% w/w + liquid paraffin 42.5% w/w (Lacrilube) given as apply 1cm at bedtime

Polyvinyl alcohol 1.4% (Liquifilm tears, Liquifilm forte) given as 1-2 drops prn

Polyvinyl alcohol 1.4% + Povidone 0.5% (Refresh, Tears plus) given as 1-2 drops prn

33
Q

What are styes?

A

swollen, painful eyelid on one side

34
Q

How are styes treated?

A

with warm compresses pressed against the stye
altho this might be painful, it brings the stye to a head.

Brolene ointment was used but have unproven benefit and no longer available

35
Q

What is Blepharitis?

A

caused by increased sebum production or staph infection

can be acute or chronic

36
Q

Who does blepharitis affect?

A

in patients usually affects both eyes:

  • majority of eyelid is inflammed (red eyelids)
  • irritation, burning, excess tears
  • skin flakes in eyelashes, eyelashes can be missing
37
Q

What is the typical history of a patient with blepharitis?

A
  • sore eyes, can have periods of remission
  • conjuntivitis can be a complication of blepharitis
  • recent changes to cosmetics as contact dermatitis can mimic blepharitis
38
Q

What other conditions does blepharitis usually present with?

A

can occur in patients with conditions like psoriasis or seborrhoeic dermatitis

39
Q

How is blepharitis managed?

A

improving lid hygiene

  • use mild baby shampoo and apply with cotton bud
  • apply warm compress for 10-20mn bd

(no evidence of more effect with anti dandruff shampoos)

40
Q

What are some general advise for eye treatments?

A
  • if using more than 1 drop, wait 5 minutes between drops but double check manufacturer instructions
  • eye ointments can cause temporary blurrienss
  • after instilling, patients may experience unusual taste
  • if there is irritation, burning or stinging that does not go away, stop the treatment
  • discard all eye preparations 30 days after opening
41
Q

What is earwax?

A
  • normal physiological substance that protects the ear canal
  • functions include removal of keratin from ear canal, cleans, lubricates and protects lining of ear canal by trapping dirt and repelling water
  • earwax is mildly acidic and has antibacterial properties
42
Q

What are the different types of ear wax?

A

wet and dry

43
Q

What is wet wax subdivided into?

A
  1. Hard: dry dessicated constituency and more common in adults. It is more likely to become impacted
  2. Soft: moist and sticky. It is more common in children
44
Q

What is dry earwax like?

A

dry, flaky and golden-yellow

45
Q

How can earwax be a problem?

A
  • excessive build up of earwax can occur in some people and earwax can be impacted
  • wax itself does not cause hearing impairment, unless it is impacted deeper into the canal
46
Q

How is earwax diagnosed?

A

mostly itching and discomfort, hearing may or may not be impaired

47
Q

When should earwax be referred?

A
  • assoc with trauma related conductive deafness
  • dizziness or tinnitus
  • fever and general malaise in children
  • foreign body in the EAM
  • non prescription medicine failure
  • pain originating from the middle ear
48
Q

What OTC treatment is available for ear wax?

A

Carbamide peroxide 65mg/mL (Ear Clear) given as 5-10 drops bd up to 4 days without plugging ear

Docusate sodium 0.5% (Waxsol) given a fill ear for not more than 2 consecutive nights

Chlorbutol5% + orthodichlorobenzene 14% + paradichlorobenzene 2% + arachis oil 57% (Cerumol) given as 2-3 drops bd for a few days

49
Q

What are ear candles?

A

a historical method for the treatment of ear wax originating from the Hopi Native American traditional healing. There is non objective evidence as to its efficacy, but the candle is hollow, lit an placed in the ear. The rising hot air is supposed to pull out toxins and wax

50
Q

What self care can we advise the patient on earwax?

A
  • warm the drops before use
  • incline head and instil drops
  • do not use cotton wool buds as they push the wax in and can damage the ear drum
51
Q

What is acute otitis media?

A
  • infection of the middle ear, characterised by the presence of middle ear effusion assoc with acute onset of symptoms and signs of middle ear inflammation
  • should be referred as antibiotics needed. can sell some pain relief.
52
Q

What is otitis externa?

A

inflammation of the external ear canal (passage leading from external ear to the ear drum)

  • can present as pain and discharge which are the same symptoms as otitis media
  • can present as dry skin on the pinna of the ear (eczema)
53
Q

Is pain a main feature of otitis externa?

A

No but it may be associated with a boil in the external ear canal

54
Q

What is otitis externa often associated with?

A

excess water - other name is swimmer’s ear)

55
Q

What is acute otitis externa caused by?

A

streptococcus, staphylococcus or pseudomonas

56
Q

What is chronic otitis externa caused by?

A

associated with ezcema

57
Q

How do the symptoms of otitis externa compare with otitis media?

A

externa: mainly itching and discomfort
media: pain, deafness and fever can present

58
Q

When sure ear pain be referred?

A
  • severe pain
  • n improvement after 48-72 hours
  • children under 6 years of age
  • generalised inflammation of the pinna
  • if symptoms persist for 7 days or longer after initiation of treatment
  • impaired hearing in children
  • ongoing deafness
  • mucopurulent discharge
  • vertigo longer than a few days
  • vertigo assoc with nausea, vomiting or tinnitus
  • pain on palipation of mastoid area
  • slow growing growths on pinna in elderly
  • unusual lesion on pinna e.g. blister, ulcer
  • lesion that is growing in size
  • pain rather than discomfort
59
Q

What are the OTC treatments for otitis externa?

A

Glacial acetic acid 17.3mg + isopropyl alcohol (Aquaear)

Phenazone 54mg/mL + benzoaine 14mg/mL + glycerol (Auralgan)

Propylene glycol diacetate 2.8% + acetic acid 2.2% (Vosol)

Pharm301 Topics (8 decks)

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