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CDM 3 Exam 1 > Lecture 2 - Ophthalmic Disorders > Flashcards

Lecture 2 - Ophthalmic Disorders Flashcards

1
Q

Acute angle closure glaucoma

A

occurring suddenly due to mechanical blockage of trabecular meshwork** usually medical emergency

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2
Q

Primary open angle glaucoma

A

occurring slowly due to decreased drainage of aqueous humor through trabecular meshwork

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3
Q

Keratoconjuncitivitis sicca

A

Dry eye

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4
Q

Hordeolum

A

Stye

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5
Q

Blepharitis

A

infection of lid margins and meibomian gland openings

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6
Q

Cap colors

A

cap colors on cap correspond to what the MOA of eye drops

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7
Q

exclusions for eye self care

A
  1. pain
  2. Blurred vision not associated w/ us of ointments
  3. Sensitivity to light
  4. H/x of contact lens wearing..poor hygiene
  5. Blunt trauma to eye
  6. Chemical exposure to eye
  7. eye exposure to heat…not sun
  8. > 72hrs S/x
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8
Q

Gritty sensation but no foreign material could be….

A

dry eye

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9
Q

H/x of “pink eye” exposure, cold, or flu could be….

A

Viral conjunctivitis

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10
Q

H/x of allergies could be….

A

Allergic conjunctivitis

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11
Q

Mucous discharge could be….

A

Bacterial conjunctivitis

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12
Q

Starburst/Halos could be….

A

Corneal edema

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13
Q

Tear volume determined by…

A

Tear production
Tear outflow
Evaporation on surface

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14
Q

Signs/Symptoms of dry eye

A

Slight redness
Watering
Sensation of something in the eye

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15
Q

Risk factors for dry eye

A

Meds
Older age
Women>men
Dry environment
H/x of LASIK/cornea surgery
Cornea/eyelid disorders
Medical conditions
Irritants/Allergies

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16
Q

T/x for Dry eye

A

Artificial tears: used throughout day, 2-4times, can be used every 30-60min

Lubricant ointments: used at night due to blurry vision

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17
Q

T/x goal for dry eye

A

prevent corneal scarring and perforation

Choose therapy based on frequency of use, preservatives, allergies, lvl of discomfort and cost

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18
Q

Preservative vs Preservative Free drops

A

Preservative free = $$$$, inc infection but sometimes better tolerated and unit dosed

Preservative = cheaper, dec infection but possible inc irritation

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19
Q

Restasis info

A

Reduce inflam = inc tear production

takes months to work

AE: burning
0.05% cyclosporine

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20
Q

Cequa info

A

Reduce inflam = inc tear production
Better eye pen

AE: eye pain, redness
0.09% cyclosporine

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21
Q

Xiidra info

A

AE: Blurry vision, irritation, altered taste

Blocks T-cell activation

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22
Q

How to use meds for dry eyes

A

Try OTCs first, and if that doesn’t work you can bridge with a steroid towards one of the others like Cyclosporine or Xiidra

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23
Q

Non-pharm treatment for Dry eyes

A
  1. avoid dry environments
  2. wear sunglasses outside
  3. wear goggles if windy
  4. Avoid prolonged periods of not blinking
  5. Screen breaks
  6. Omega-3-fatty acid sup
  7. surgery - perm tear duct occlusion
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24
Q

Stye treatment

A

Warm compress for ~ 10min has needed throughout the day

Dont press/squeeze to drain

If doesn’t improve in 2-3 days, contact provider

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25
Stye prevention
1. Clear contacts 2. Dont leave makeup on overnight 3. Dont use old/expired cosmetics
26
Belpharitis treatment
1. warm compresses 2. lid scrub with gentle shampoo 3. artificial tears 4. can use antibiotics, use topical 1st (bacitracin/erythromycin) 5. can use oral for resistant cases 6. refractory can req topical steroid or cyclosporine
27
Belpharitis info
usually improper hygiene older adults at risk due to dec tear production/defense mechanisms can lead to corneal scarring, and infections
28
Corneal edema info
fluid in/around cornea caused by those who dont take their contacts out
29
Signs and symptoms of corneal edema
Halo effect in vision vision may or may not be limited diagnosed by eye care provider
30
Corneal edema treatments
1. topical hyperosmotic agents = draw water out (Muro 128) 2. start eye drops, then go to ointment and then inc % if nothing gets better
31
Age-related macular degeneration info
Most occurs in women and is genetic
32
Risk factors for macular degeneration
Genetic: White> non-white Women>men Positive family history Modifiable: Smoking Excess body weight Antioxidant, vitamin, zinc deficiency
33
Non-exudative vs Exudative
Non = non-neovascular or dry AMD, early stages..85% Exudative = neovascular or wet AMD, later stages...15% no cure for either
34
Clinical presentation of AMD
blurred vision plagues form in the back of eye (dry) big loss of vision, macular area surrounded with fluid of blood (wet)
35
Tx to slow progression of Non-neovascular AMD
Vitamins smokers = formulation w/o beta-carotene****
36
Tx for neovascular AMD
Verteporfin photodynamic therapy VEGF antagonists
37
AMD Monitoring
Vision loss progression of disease Quality of life eval
38
Allergic conjunctivitis
1. usually seasonal 2. often in both eyes
39
Bacterial conjunctivitis
Often associated with some sticky/yellow discharge starts in one eye and then spread to other eye Highly contagious can be acute + chronic Self-limiting, most resolve 2-5 days
40
Viral conjunctivitis
Most common one usually effects one eye first and then spreads to other eye, very contagious No crusting usually ie. Pink eye
41
Allergic conjunctivitis prevention + general tx
avoid allergens Tx: dont rub eyes + cold compress 3-4 times/day
42
Allergic conjunctivitis tx
1.Vasoconstrictor/antihistamine(3-4/day) 2. Antihistamine/mast cell stabilizers (most BID) 3. Mast cell stabilizers (usually Rx, QID so not used much..have to use for awhile)
43
Hyperacute bacterial conjunctivitis
1. usually caused by N.gonorrhoeae 2. tx with ceftriaxone IM, Azimuth/doxy PO
44
Acute bacterial conjunctivitis
1. caused by skin flora 2. 3-4 weeks full resolution
45
Bacterial conjunctivitis info
1. contagious about 7 days after "2nd eye" 2. consider delayed therapy if symptoms resolve themselves 3. Azithromycin PO or Erythromycin ointment Tx choice
46
Antibiotic choice for Bacterial conjunctivitis
Azithromycin- Cipro- Oflo- all more expensive than other options
47
Viral conjunctivitis info
Commonly adenovirus Tx:: cold compress, artificial tears and ophthalmic decongestants usually resolves in 1-2 weeks
48
HSV conjunctivitis info
topical: Ganciclovir Trifluridine Acyclovir Systemic: Acyclovir Valacyclovir Famciclovir start with topicals, move to systemic usually taper, and then Long term for suppressive therapy
49
Normal IOP
10-20mmHG
50
Occular hypertension
IOP > 21mmHG no optic disk changes
51
Normal tension Glaucoma
IOP < 21mmHG + optic disk changes and visual field loss 20-30% pts
52
Primary Open-Angle Glaucoma
Normal/elevated IOP Optic disk changes/visual deficits Majority of glaucomas usually peripheral vision, late stage can be central vision
53
Acute angle-closure glaucoma
acute, painful attack Elevated IOP w/ visual field loss 5-10% of primary glaucomas rapid onset, medical emergency
54
Glaucoma risk factors
Inc age FH Congential abnormalities Increased IOP Comorbidities Trauma Med induced
55
Treatment goals for glaucoma
reduce IOP prevent further loss + angle closure Strategies: start tx in 1 eye, determine drug and takes 4-6wks for response
56
Prostaglandin analogs MOA
1. increase outflow of aqueous humor 2. Decreases IOP by 25/30%
57
PGA dosing
usually qHS, can be qAM BID decreases IOP lowering effect
58
PGA drugs
Latanoprost (Xalatan, Xelpros) - F2 agonist Latanoprostene bunod (Vyzulta) - F2 agonist Tafluprost (Zioptan) - F2 agonist Travoprost (Travatan Z)- F2 agonist Bimatoprost (Lumigan) - Prostamide analog
59
PGA Side effects:
1. increase brown iris pigmentation = irreversible 2. Eyelash lengthening 3. eyelid skin darkening 4. local reactions
60
Beta-blocker MOA
act on beta-receptor in ciliary epithelium dec aqueous humor production Lowers IOP 20-25%
61
Beta-blocker AE
Local-dry eye, blurred vision, infection, local reaction Systemic- bradycardia, hypotension,etc ** Caution in HF, COPD, bradycardia, asthma **
62
Beta-blocker dosing
Typically BID or TID
63
Beta-blocker drugs
Non-selective: Timolol (Timoptic, Betimol) Carteolol (Ocupress)(ISA) Levobunolol (Betagan) Metipranolol (OptiPranolol) Selective: Betaxolol (Betopic S, Betopic)
64
Alpha Agonists MOA
1. Dec production of aqueous humor and increase outflow 2. Dec IOP by 20-25% at peak, ~10% after 8-12hrs
65
Alpha Agonists AE
Concern for tachyphylaxis burning, stinging, blurring, etc dizziness, fatigue,somnolencedry mouth etc
66
Caution Alpha-agonists in patients with...
CVD renal/hepatic dysfunction depression eye disease caused by diabetes
67
Drugs in Alpha-agonist class
Apraclonidine Brimonidine (Alphagan) w/ preservative = Alphagan -P ocular redness = Lumify
68
Carbonic Anhydrase Inhibitors MOA
Dec flow of bicarb, water and sodium into posterior chamber Dec in IOP by 15-25% Contains sulfonamides - allergies
69
Drugs in CAI class
Brinzolamide (Azopt) Dorzolamide (Trusopt) Oral = Acetazolamide (Diamox)
70
Caution CAI in....
renal/hepatic dysfunction can cause Kidney stones**** sickle cell disease respiratory alkalosis pulmonary disorders
71
Example of OA treatment algo
1. Monotherapy = PGA 2. If AE, try BB,CAI or AA 3. if no response, add 2nd drug trio different class 4. if no response, surgical procedure assess responses 2-4wks
72
Proper Eye drop instillation
1. wash/dry hands 2. shake bottle if suspension 3. tilt head back, pull down outer portion of lower eyelid 4. 1 drop into eye at time, close lid for 30-60sec 5. dont rub or blink 6. recap and store as instructed 7. wait 1 min between drops, 5min if dif meds
73
Nasolacrimal occlusion (NLO)
press finger against inner eye, hold for 1-3 min after instilling drop don use more than 1 drop separate by 3-5min if multiple drops

CDM 3 Exam 1 (10 decks)

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