Eye drops and ointments from work book

Question 1

Reasons for instilling drops or applying ointments

Answer 1

therapeutic medication
to dilate the pupil prior to examination or surgery
to anaesthetise the eye prior to medical or nursing intervention
to lubricate the eye
to treat the lacrimal apparatus

Question 2

where might ointments be prescribed for application

Answer 2

eyelid margins
eyelid/eyebrow wound
instillation into the eye

Question 3

Common Mydriatics

Answer 3

topicamide
atropine
cyclopentolate (Mydrilate)
phenylephrine

Question 4

Mydriatics

Answer 4

A mydriatic is an agent that induces dilation of the pupil. Drugs such as tropicamide are used in medicine to permit examination of the retina and other deep structures of the eye, and also to reduce painful ciliary muscle spasm.

Question 5

Main reason why you would use topicamide?

Answer 5

to dilate the patient’s pupil in order for the doctor to examine the fundus. The wider the pupil the greater the area of the fundus will be seen on examination.

Question 6

What two strengths does Tropicamide come in?

Answer 6

0.5% and 1%

Question 7

Action of Tropicamide

Answer 7

stimulates the dilator muscles and also weakly paralyses (cycloplegic) the ciliary muscles

Question 8

Effect of tropicamide

Answer 8

is to dilate the pupil - mydriasis

Question 9

Side effects of Tropicamide

Answer 9

may cause an attack of acute glaucoma- in patients who are susceptible.
mydriatic drops sting
contact dermatitis - any patient with a known contact dermatitis should not have topicamide.

Question 10

What two strengths does Atropine come in?

Answer 10

1% or 2%

Question 11

Atropine

Answer 11

natural alkaloid of Belladonna, derived from deadly nightshade. It is an infrequently used mydriatic and produces mydriasis in half an hour and almost complete cyclopegia

Question 12

Is Atropine Long or Short acting?

Answer 12

Long its effects can last up to 14 days

Question 13

miotics and atropine

Answer 13

atropine’s action cannot be reversed bby miotics which is a great disadvantage.

Question 14

Side effects of atropine

Answer 14

raised intraocular pressure
raised blood pressure 
sensitivity 
psychotic disturbance and hallucinations 
contact dermatitis

Question 15

Cyclopentolate (Mydrilate)

Answer 15

Cyclopentolate is a medication commonly used during pediatric eye examinations that dilates the eye (mydriatic), prevents accommodation of the eye to different distances (cycloplegic), and blocks specific receptors called muscarinic receptors (muscarinic antagonist).

Question 16

how long does it take Cyclopentolate to produce cyclopegia and dilation? and how long will the effect last for?

Answer 16

produce cyclopegia and dilation within half an hour

effect lasts for 24 hour

Question 17

Where must Cyclopentolate be stored?

Answer 17

the fridge

Question 18

Cyclopentolate side effects:

Answer 18

Ocular side-effects of mydriatics and cycloplegics include transient stinging and raised intra-ocular pressure; on prolonged administration, local irritation, hyperaemia, oedema and conjunctivitis can occur. Contact dermatitis can occur with the antimuscarinic mydriatic drugs, especially atropine.

Systemic side-effects of atropine and cyclopentolate can occur, particularly in children and the elderly.

Question 19

Phenylephrine 2.5% or 10%

Answer 19

non-cyclopegic mydriatic 
pwerful mydriatic and is capable of breaking up adhesions (posterior synechiae). 
no effect on accommodation 
stings on instillation 
very irritant in the anterior chamber

Question 20

posterior synechia

Answer 20

adhesion of the iris to the capsule of the lens or to the surface of the vitreous body.

Question 21

annular synechia

Answer 21

adhesion of the whole rim of the iris to the lens.

Question 22

anterior synechia

Answer 22

adhesion of the iris to the cornea.

Question 23

total synechia

Answer 23

adhesion of the whole surface of the iris to the lens.

Question 24

adhesion

Answer 24

union of two surfaces that are normally separate, such as in wound healing or in some pathological process. Surgery within the abdomen sometimes results in adhesions from scar tissue; as an organ heals, fibrous scar tissue forms around the incision and may cling to the surface of adjoining organs. Adhesions are usually painless and cause no difficulties, but occasionally they produce pain, with or without obstruction or malfunction, by distorting the organ.

Question 25

non-cyclopegic mydriatic that is sometimes used in the treatment of Open Angle Glaucoma

Answer 25

phenylephrine because of its ability to lower intra-occular pressure.

Question 26

what could a darker iris indicate?

Answer 26

more resistance to the effect of mydriatics and caution should be exercised to avoid overdose.

Question 27

Common Miotics

Answer 27

Pilocarpine timoptol trusopt cospot

Question 28

Miotics

Answer 28

These medications reduce eye pressure by increasing the drainage of intraocular fluid through the trabecular meshwork.

Question 29

Preparations pilocarpine comes in

Answer 29

1%, 2%, 4% and occasionally 6%

Question 30

Pilocarpine

Answer 30

commonly used miotic can be used for long periods without causing irritation of the eye used in the treatment of open angle glaucoma

Question 31

Pilocarpine action

Answer 31

acts to contract the pupil and ciliary muscles miosis lasts up to four hours - therefore can be instilled sometimes four times per day. spasms of accommodation lasts about 2 hours

Question 32

Pilocarpine side effects

Answer 32

small pupil blurring of vision browache

Question 33

Timoptol

Answer 33

beta-blocker works by reducing the production rate of aqueous tumour use twice per day

Question 34

Timoptol side effects

Answer 34

can have systemic effects e.g. broncho constriction

Question 35

trusopt 2%

Answer 35

a buffered, slightly viscous, aqueous solution of dorozolamide when used alone may be instilled three times per day with adjunct treatment trusopt is instilled twice per day effective in the treatment of open angle glaucoma and ocular hypertension

Question 36

trusopt 2% side effects

Answer 36

ocular burning and stinging, blurred vision, itching, tearing, conjunctivitis, lid inflammation, irritation, redness. some patients complain of signs and symptoms including: headache, fatigue, dizziness, skin rash, bitter taste in mouth. USE IN CAUTION IN PATIENTS WITH HEPATIC DISEASE

Question 37

cospot

Answer 37

isotonic, slightly buffered, viscous aqueous solution contains 20mg dorzolomide and 5mg timolol used to treat intraocular pressure and open angle glaucoma

Question 38

corticosteriod drops

Answer 38

betamethasone | dexamethasone

Question 39

betamethasone 0.1% supplied as betnesol or | betnesol-N - containing antibiotic Neomycin sulphate 0.5%

Answer 39

indicated for use in the short term treatment of inflammation. should not be used in the treatment of undiagnosed red eye- because if the red eye is caused by a virus the corticosteriods could aggravate the condition and cause blindness prolonged treatment could result in the condition steroid glaucoma in patients predisposed to this condition.

Question 40

Dexamethasone supplied as maxidex 0.1% or | Maxitrol 0.1% which contains 0.35% Neomycin

Answer 40

used in the short term local treatment of inflammation

Question 41

Local anaesthetics

Answer 41

Minims Benoxinate Lignocaine fluorescein

Question 42

minims benoxinate

Answer 42

oxybuprocaine 0.4% widely used topical local anaesthetic

Question 43

Lignocaine and fluorescein

Answer 43

lignocaine 4% and fluorescein 0.25% | topical local anaesthetic combined with fluorescein both of which are necessery for tonometry.

Question 44

Diagnostic drops

Answer 44

fluorescein | rose bengal

Question 45

Fluorescein 2%

Answer 45

orange coloured dye does not penetrate, intact cell membranes if there is damage to the epithelial layer, it gains access to the bowmans membrane, the stroma and the aqueous.

Question 46

what colour is damaged tissue visualised as with fluorescein

Answer 46

green fluorescence

Question 47

alternative uses for fluorescein | other than diagnosis of abraded, broken surface of the cornea

Answer 47

contact lens fitting goldman applanation tonometry siedel's test for leaking cornea-scleral wound test for patency of lacrimanl drainage system fundu photography

Question 48

goldman applanation tonometry

Answer 48

Applanation tonometry: measures IOP by providing force which flattens the cornea. Variable force applanation tonometers (Goldmann, Perkins, Draeger, MacKay-Marg, and Tono-Pen and Pneumatonometer): area of the cornea being applanated held constant, variable for applied.

Question 49

siedel's test for leaking cornea-scleral wound

Answer 49

the test used to reveal ocular leaks from the cornea, sclera or conjunctiva following injury or surgery and sometimes disease is called Seidel test.

Question 50

fundu photography

Answer 50

Fundus photography documents the retina, the neurosensory tissue in our eyes which translates the optical images we see into the electrical impulses our brain understands. The retina can be photographed directly as the pupil is used as both an entrance and exit for the fundus camera's illuminating and imaging light rays. The patient sits at the fundus camera with their chin in a chin rest and their forehead against the bar. An ophthalmic photographer focuses and aligns the fundus camera. A flash fires as the photographer presses the shutter release, creating a fundus photograph like the picture above. Ophthalmologists use these retinal photographs to follow, diagnose, and treat eye diseases.

Question 51

Rose Bengal

Answer 51

dye selectively stains all devitalised corneal and conjunctival cells a readily visible red colour. More effective than flourescein and is considered a more sensitive test for keratoconjunctivitis sicca - sjorgen's syndrome. discomfort and irritation

Question 52

eye drop antibiotics

Answer 52

``` chloramphenicol ciprofloxacin gentamicin fucithalmic floxacin ```

Question 53

chloramphenicol

Answer 53

in drop and ointment form when used systemically can cause blood dyscrasions penetrates the cornea

Question 54

ciprofloxacin

Answer 54

broad spectrum antibiotic used to treat superficial bacterial infections especially useful in the treatment of bacterial ulcers

Question 55

ciprofloxacin side effects

Answer 55

local burning and itching crusting on the lid margins not recommended for children under 12 and should be used in caution with those pregnant of breast feeding.

Question 56

Gentamicin 0.3%

Answer 56

broad spectrum antibiotic particulary useful in infections caused by pseudomonas auruginosa toxic if used for long term therapy

Question 57

fucithalmic 1%

Answer 57

useful for treating staphylococcal infections. presents as eyedrops in a gel base.

Question 58

floxacin 0.3%

Answer 58

broad spectrum antibiotic side effects local irritation, photophobia, dizziness, nausea and vomiting, headache.

Question 59

antivirals | acyclovir 1%

Answer 59

herpes simplex