Eye and Ear Conditions

Question 1

What questions do you need to ask further if patient tells you she has dry eyes and want eye drops?

Hint: What do each question mean given the response?

Answer 1

1. When do you experience these symptoms? (Tease out aggravating factors like contact lens, computer use, aging)
2. Have you tried any eye care products to help with the symptoms? (Eye ointments can cause blurriness)
3. Any medications, medical conditions, allergies? (Tease out the causes)
4. Any other symptoms experienced? (Rule out self-care)

Question 2

What 9 eye symptoms warrant a referral to the doctor and why (4 reasons)?

Answer 2

Symptoms:
1. Eye pain
2. Blurred vision not due to eye ointment
3. Light sensitive
4. Blunt trauma
5. Chemical / heat exposure
6. Eye operation
7. Persisting symptoms for 72 hours
8. Sticky discharge
9. Prescription Medications with this side effect

Reasons:
1. Infection need prescription of antibiotic
2. Need to assess for serious underlying conditions (e.g. neuropathy)
3. Blindness and injury are serious issue, not to play
4. Self-treat but no use means it doesn’t work

Question 3

What medications cause dry eyes? (2 most common, 5 suggestive)

Answer 3

Most common:
- Antihistamines
- Hormone replacement

Suggestive:
- TCAs, SSRIs
- Diuretics
- Beta blockers
- Isotretinoin
- Chemotherapy (Systemic)

Question 4

What 5 conditions can cause the patient to have dry eyes? (May be medical procedure, daily use of some things, patient profile related etc.)

Answer 4

• Old age = Less production of lacrimal fluid
• LASIK / refractive surgery = Disrupt the lacrimal reflex arc
• Long term contact lens wearer
• Computer use
• Smoking / Low humidity

Question 5

Product considerations for Dry Eye

Answer 5

1. Viscous or not? Depends on severity of Dry Eye
2. Preservatives or not? Should be free of preservative if:
   - Frequent eye drop user (4-6 times a day)
   - Recent eye surgery
   - Allergy to preservative
3. Single or multi-dose? Depends on storage vs frequency of use vs need for preservative-free

Question 6

Name the common preservatives in eye drops and list in descending order of toxicity.

Explain what is toxic about it

Answer 6

BAK > Sodium Perborate > Polyquad > EDTA > Stabilized Oxychloro Complex

Toxicity:
- May breakdown corneal epithelium and disrupt lipid component of tear film
- Irritation in severe dry eye

Question 7

Name the products containing preservatives

Answer 7

BAK: Hialid, Rinz, Optrex, Eyemo

Sodium Perborate: Genteal, TheraTears

Polyquad: Tears Naturale, Systane

EDTA: Rohto

Oxychloro: Refresh, Blink

Question 8

What other contents can help with recovery and protection of corneal epithelium?

Answer 8

• Electrolyte: Potassium
• Bicarbonate (TheraTears)
• Osmolarity (Glycerin, glycol found in Optive, Refresh)
• Viscosity for retention (CMC, HPMC, PVA)
• Wound healing (Hyaluronic acid)

Question 9

Which hydrogels has the longest retention time (brand and ingredient)?

Answer 9

Visidic Gel (Carbomer)

GenTeal (Hypromellose and carbomer)

Question 10

What should you know about all eyedrops? Which is better?

Answer 10

No clinical efficacy differences

Discard within 30 days of opening for eyedrop bottles and discard after one time use for eyedrop vials

Only Hylo-comod has 6 months use due to mechanism of bottle preventing air from getting in contact with liquid

Question 11

Name 2 oil containing eye ointments. What is good about them?

Answer 11

Duratears (White petrolatum)

Cationorm (Mineral oil)

Good:
- Viscosity retention for severe discomfort
- No preservatives

Question 12

What supplements can help with dry eye?

Answer 12

1. EPA (Omega-3)
   - TheraTears Capsules
2. Arachidonic acid (Omega-6)
3. Vitamin A

Question 13

Why do dry eyes produce poor quality tears?

Answer 13

When oil glands (Meibomian) do not produce sufficient oily layer, your tear film does not work properly and evaporates quickly (Evaporative dry eye)