Week 8: Ophthalmic Flashcards
What are the common eye complaints?
- Dry eye
- Allergy eye
- Corneal edema
- Age related macular degenration
- Contact lens related problems
What are the exclusion of eye companies?
- Eye pain
- Blurred vision not associated with use of ophthalmic ointments
- Sensitivity to light
- Blunt trauma to eye
- History of contact lens wear
- Chemical exposure to eye
- Eye exposure to heat, excluding sun exposure
- Symptoms that have persisted for >72 hours
- Signs and symptoms of infection of the eyelids (e.g., red, thickened eyelids; scaling)
- Blunt trauma to eye
- Exposure of the eye to chemicals
- Head lice
- Macular degeneration
- Hordeolum, chalazion, blepharitis
What is dry eye?
May be the result of anything that disrupts healthy tear film
What are the symptoms of dry eye?
- Blurred vision
- Stinging
- Burning
- Sensitivity to light
- Difficulty wearing contact lenses
- Eye fatigue
What is dry eyes associated with?
- the aging process
- lid or corneal defects
- Sjögren syndrome
- Bell’s palsy
- thyroid disorder–related eye disease
- collagen diseases (e.g., rheumatoid arthritis)
- Medications
What are types of medication for dry eye?
- Anticholinergic drugs (e.g., antihistamines)
- Decongestants
- Diuretics
- Beta Blockers
What are the risk factors of dry eyes?
- AGE – increased risk among elderly
- SEX – increased risk among women
- DIET – especially diets low in fatty acids
- HISTORY OF SURGERY OR CONTACT USEOF CONTACT LENSES
How do you prevent dry eyes?
- Add moisture to the air especially during dry seasons
- Stop smoking and avoid smoke
- Avoid air blowing directly on the eyes (moisture chamber goggles)
- Add omega-3 rich foods to diet (in consultation with prescriber)*
- Take breaks during long tasks that require visual concentration
What are the treatment goals of dry eyes?
- Alleviate the dryness of the ocular surface
- Relieve the symptoms of irritation
- Prevent possible corneal and non corneal tissue damage
What are the non pharms for dry eyes?
- Avoid environments that increase evaporation of tear film
- Increasing humidity
- Avoiding prolonged use of computes
- Repositioning workstations
- Wearing eye protection
- Warm compresses
What are pham for dry eyes?
- Artificial tear solution (substituted cellulose ethers)
- non medicated ophthalmic ointments
Examples of artificial tear solution API?
- Hydroxypropyl Methylcellulose
- Carboxymethylcellulose
- Polyvinyl Alcohol
- Propylene Glycol
- Polyethylene Glycol
- Povidone
- Glycerin
What are the counseling points of viscosity of artificial tears?
- Greater viscosity = prolonged ocular contact time
- Mild dry eye may benefit from less viscous
- More severe may benefit from more viscous
What are the counseling points of types of artificial tears?
- Solution
- Gel
- Ointment (can cause blurred vision, for bedtime)
What are the counseling points of contact weares of artificial tears?
Some ingredients will interact with rewetting drops and other contact lens care products
What types of preservatives are preferred by manufacturers?
benzalkonium chloride and benzethonium chloride
Why is benzalkonium chloride and benzethonium chloride a good preservative for drops?
- Stability
- Antimicrobial activity
- Long shelf life
- Toxic effect on the the tear film and the corneal epithelium
What are the counseling points of suspensions of artificial tears?
- Shake before use
- If using a suspension and another dosage form, use the suspension last, because it has prolonged retention time in the tear film.
What are the counseling points of combo solutions products of artificial tears?
Wait at least 5 minutes before instilling the next drop to prevent the first drop from being flushed away by the second
What are the counseling points of combo drops and ointments products of artificial tears?
Instill the drops at least 10 minutes before the ointment so that the ointment does not become a barrier to the drops penetration of the tear film or cornea
What is the hallmark of allergic conjunctivitis?
Pruritus
What are the common allergens?
- Pollen
- Dander
- Topical eye preparation
What is allergic conjunctivitis?
- a red eye with watery discharge.
- not impaired but may be blurred because of excessive tearing
What are the treatment goals of allergic conjunctivitis?
- Remove or avoid the allergen
- Limit or reduce the severity of the reaction
- Provide symptomatic relief
- Protect the ocular surface
What are the non pharm for allergic conjunctivitis?
- cold compresses to the eyes 3–4 times per day for redness and itching.
- checking the pollen count
- keeping doors and windows closed
- hypoallergenic bedding
- bathing or showering just before bedtime
- Wearing sunglasses outdoors
What is the 1st line treatment for allergic conjunctivitis?
Artificial tears follow up with topical antihistime/mast cell stabilizers
What are the types of Antihistamine/Mast Cell Stabilizer Eye Drop?
- Zaditor
- Alaway
- Pataday twice daily relief
- Pataday one daily relief 0.2%
- Pataday once daily relief 0.7%
What Antihistamine/Mast Cell Stabilizer Eye Drop is for 2 and up?
- Pataday twice daily relief
- Pataday one daily relief 0.2%
- Pataday once daily relief 0.7%
What Antihistamine/Mast Cell Stabilizer Eye Drop is for 3 and up?
- Zaditor
- Alaway
What decongenstatnt can we use to treat redness and eyelid edema?
- Phenylephrine
- naphazoline
- tetrahydrozoline
- oxymetazoline
- brimonidine
What are combo products of allergic conjunctivitis?
Visine A, Naphcon A
What are the counseling points with decongestants?
- May cause angle-closure glaucoma
- Do not use for more than 72 hours due to risk of rebound congestion
What should decongestants not be used on?
- HTN
- CVD
- Diabetes
- Hyperthyroidism
What are the counseling points for antihistimine?
- May cause burning, stinging, and discomfort.
- May cause angle-closure glaucoma
What is the patho of corneal edema?
Accumulation of fluid in the cornea
What is the clinical presentation of corneal edema?
- Accumulation of fluid in the cornea distorts optical properties
- Subjective perception of halos and starbursts
What causes corneal edema?
occur due to overwearing contact lenses, surgical damage, inherited corneal abnormalities.
What is the treatment goal of corneal edema?
draw fluid from the cornea, thereby relieving the associated symptoms.
What are the treatments of coreal edema after diagnosis?
hyperosmotic formulations – only agents containing nacl are available otc
What is the first line treatment for corneal edema?
instillation of a 2% solution 4 times per day
What are the types of hyperosmotics?
- AK-NaCl Solution
- AK-NaCl Ointment
- Muro 128 Solution 2%
- Muro 128 Solution 5%
- Muro 128 Ointment
What are the types of age related muscular degeneration?
Dry and wet
What is dry AMD?
more common, accounting for approximately 80% of all cases
What is wet AMD?
more sight-threatening and often is responsible for 80%–90% of those cases involving vision loss.
What are types of corrective errors?
- Myopia (nearsightedness)
- Hyperopia (farsightedness)
- Astigmatism
What is a contact lens?
Therapeutic “bandage” for severe corneal abrasions
What are the contraindications of contacts?
- Presence of an active problems or infections of the eyelids, cornea, or conjunctiva.
- Presence of dry eye except when used as a “bandage” for protection
- Pregnancy or use of oral contraceptives
- Diabetes mellitus
- Eye medications requiring frequent dosing
- Personal, occupational, or environmental conditions that are not conductive to lens wear
- Medications that cause discoloration of bodily fluids
- Frequent change from low to high altitude
- Inability to properly care for or wear contact lens (e.g. pediatric patients and geriatric patients)
What are the types of lenses?
- Hydrophilic (soft)
- Rigid gas permeable (GP)
- Rigid Non-Gas Permeable (Polymethylmethylacrylate—PMMA)
Which is the most common type of sense?
Hydrophilic
What are the goals or cleaning contacts?
- Remove debris from surface
- Recent the accumulation of proteins from the tear layer on the lens
- Disinfect the lens of organisms that can cause infection
What are the types of lens care products?
- Surface Active Cleaning Solutions
- Combination Hydrogen Peroxide Disinfecting and Rising/Neutralizing Products
- Saline Solutions (for rinsing)
- Multipurpose Solutions
- Enzymatic Cleaners
- Rewetting/Lubricating Drops
How should contacts be cleaned?
surface active cleaner prior to using enzymatic cleaner because enzymatic cleaners remove proteins but not any other debris that may be on the lens
What are contacts adverse problems?
Itching
Blurred vision
Redness
Pain
Fogging
Photophobia
Excessive tearing
Flare
Lens falling out of the eye
Squinting
How do we asses the need for contacts?
- Old, chipped, scratched lens
- Vision changes
- Deep aching pain in the eyes
- > 1 year since last eye exam
- Drug-contact lens interaction
- Lens problems related to medical conditions
What are the products for thdecreasign tear production?
1.Anticholinergic drugs (e.g., amitriptyline)
2. Antihistamines (e.g., diphenhydramine)
4.Beta Blockers
What changes lens color?
Rifampin (ORANGE)
Nicotine in cigarette smoke (BROWN)
What causes eyelid or corneal edema?
- Oral contraceptives
- Conjugated estrogens
What are the counseling points contacts?
- Appropriate care and wear of contact lens
- Do NOT use any ophthalmic drops, gels or suspensions while the contact lens is in place unless the product is specially formulated for use with contact lens
- Appropriate selection and use of cosmetics and aerosol products – USE WATER BASED PRODUCTS.
