Eye Disease Flashcards by Sara Fieger

highlights of eyedrops administration

contacts must be removed

pull eyelid back to form pocket

don’t touch eye with dropper

keep eye closed 1-3 min following administration

wait 10 minutes between administration of multiple drugs

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nasal lacrimal occlusion

essential part of eye drop administration

cover the nasal lacrimal duct with index finger to prevent systemic absorption

decreases side effects and dose, allows for better drug potency

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eye ointment administration highlights

warm ointment in hand 1-2 minutes

discard first .25 in of medication

close eye and don’t rub for 1-2 minutes

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eye diseases

cataracts
macular degeneration
retinopathy
glaucoma

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leading cause of blindness around the world

cataracts

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cause of cataracts

aging **

also sunlight, smoking, family history, trauma, DM and steroid use

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clinical features of cataracts

yellowing of the lens

myopic shift (brief improvement in near vision)

lost color discrimination and distant vision

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cataracts pathophys

as lens ages, new layers are added

these layers compress lens nucleus and it becomes harder

yellowing of lens

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cataracts dx and treatment

opthalmic exam (slit lamp, direct light) and decreased visual acuity

treatment: surgery (lens implant)

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2 blood supplies to retina

choroidal blood vessels (outer retina, photoreceptors -75%)

central retinal artery (supplies central portion of retina)

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retinopathy risk factors

HTN

smoking

hyper cholesteremia

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diabetic retinopathy (clinical features)

asymptomatic finding

loss of vision

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diabetic retinopathy fundus exam findings

cotton wool patches

neovascularization

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cotton wool patches

diabetic retinopathy

caused by infarcted nerve fibers

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neovascularization

diabetic retinopathy

hypoxia of retina causes formation of new blood vessels in the eye

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hypertensive retinopathy

asymptomatic but can have decreased vision

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hypertensive retinopathy fundoscopic exam findings

papilledema
AV nicking
Retinal hemorrhages

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AV nicking

hypertensive retinopathy

indentation in veins where there are arteries that cross

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macular degeneration

degenerative changes to central retina

causes loss of central vision

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macular degeneration risk factors

age
family history 
female 
caucasian 
smoking

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macular degeneration exam

ophthalmic exam shows scattered pale yellow spots

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pharmacologic treatment of macular degeneration

ranibizumab/Lucentis

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ranibizumab/Lucentis

Indication

neovascular macular degeneration

improves remaining vision, may preserve vision

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ranibizumab/Lucentis

MOA

inhibits VEGF so REDUCES new blood vessel growth

via monthly eye injections

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ranibizumab/Lucentis | ADR

increased IOP Traumatic cataract detached retina

vitamins used in macular degeneration

``` ascorbic acid vitamin E beta carotene Zinc Oxide Cupric oxide ```

Open angle glaucoma

pathophysiology not understood BUT decreased aqueous humor outflow and increased aqueous production

clinical features of open angle glaucoma

asymptomatic slow loss of vision (peripheral first then central) optic neuritis

testing for open angle glaucoma

peripheral and central field examination measure IOP

OAG goals of therapy

prevent further loss of visual function minimize adverse effects of therapy maintain IOP below pressure at which further optic nerve damage is unlikely

which agents increase aqueous humor outflow

prostaglandin analogs a-adrenergic agonists cholinergics

classes of agents that decrease aqueous humor production

b-adrenergic antagonists a-adrenergic agonists carbonic anhydrase

first line agents in OAG

b-blockers prostaglandin inhibitor

second line agents in OAG

selective a-2 receptor agents cholinergic agents

third line agents in OAG

topical carbonic anhydrase

b-blockers

traditional first line for both open and closed angle glaucoma decrease IOP by reducing formation of aqueous humor

b-blokcers list

timolol (Timoptic) levobunolol (betagan) betaxolol (Betoptic)

B-blockers adr (systemic)

bronchospasm pulmonary edema respiratory arrest bradycardia

CIs to beta blockers

COPD Asthma CHF PE betazolol is less likely to cause some of these diseases

prostaglandin

1B agent in treating OAG better compliance but more expensive $$$

prostaglandin local ADR

increased iris pigmentation hypertrichosis (excessive hair growth) darkening of eyelashes

A-2 adrenergic agonists (list)

bromonidine/Alphagen combination w/t 1st line agents

A-2 adrenergic agonists MOA

decreases IOP by increasing humor outflow

carbonic anhydrase inhibitors route + indication

brinzolamide/Azopt (Topical/DROPS) - open angle acetazolamide/Diamox (systemic) - closed angle

carbonic anhydrase inhibitors CI

SULFA ALLERGIES

cholinergic lis and MOA

pilocarpine soln/isopto carpine increase outflow by pulling open trabecular meshwork

cholinergic and angle closer glaucoma treatment

pilocarpine doesn't work until we already get the pressure reduced

Pinguecula

yellow-white, flat/raised lesions over the sclera doesn't involved cornea slit lamp exam protect eyes, moisture, topical steroid or NSAIDS

Pterygium

fold of fibrovascular tissue that extends onto cornea slit lamp dx topical steroid or NSAID, surgical exception if in visual access

ophthalmic lubricants indicaitons and MOA

relief of eye irritation and dry eyes tonicity, adjust pH, increase eye contact time OTC

Opthalmic NSAIDs list of drugs (2)

Ketoralac (Acular) | Diclofenac (Voltaren)

ophthalmic NSAID indications (4)

post operative inflammation after cataract surgery ocular itching Pingueceula pterygium

ophthalmic NSAID MOA

reduce prostaglandin E2 production minimal systemic absorption

ophthalmic corticosteroids

prenisolone (Pred-Forte) Triamcinolone (Triesence) Tobamycin/Dexamethasone (tobraDex)

ophthalmic corticosteroids indications

ocular inflammatory conditions

ophthalmic corticosteroids ADRS

can cause glaucoma

ophthalmic corticosteroids | CIs

pts w/herpes keratitis pts w/problems of elevated IOP

blepharitis | clinical features

crusty, thick eyelid margins itching, burning, foreign body sensation, tearing

blepharitis treatment

scrub margins with baby shampoo warm compress if severe can add ABX

Dacryoadentitis

inflammation of lacrimal gland pain, swelling, redness over outer one third of upper eyelid must rule out cellulitis

dacryoadentitis treatment

mild cases treat augmenting or kelfex severe- admit with IV ABX

chalazion clinical features

sub acute non tender papule on inner surface of eyelid cause: blocking meibomian gland

chalazion treatment

warm compress refers if not relieved

hordeolum

"sty: rapid onset painful, tender, erythematous pustule on lid of margin commonly caused by staph aureus