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PHAR154 > Ophthalmic > Flashcards

Ophthalmic Flashcards

(105 cards)

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1
Q

Describe the cornea.

A

transparent, anterior portion of the eye
pain receptors present
no blood vessels

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2
Q

Describe the sclera.

A

posterior aspect of the eyes outer surface
continuous with cornea
white, fibrous tissue

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3
Q

Describe the conjunctiva.

A

membrane covering the sclera and inside the eyelids
blood vessel supply

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4
Q

How cautious are we with eye conditions?

A

start to think referral if its been longer than 2 days

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5
Q

When is a black eye worrisome?

A

direct hit to the eye
swelling does not recede after a few days
changes in vision (especially double vision)
severe pain starts
signs of infection
behavioural changes, lethargy
nausea, vomiting, dizzy
inability to move eye
blood in eye itself
any laceration to the eye area

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6
Q

How long does it take for a black eye to heal?

A

1-2 weeks

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7
Q

What is the treatment for black eyes?

A

cold compress
-15 minutes every few hours
analgesics

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8
Q

What are the symptoms that occur immediately upon a foreign body entering the eye?

A

tearing
irritation/scratchy

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9
Q

True or false: rubbing your eye to try get rid of a foreign body is a good move

A

false
avoid rubbing when there is a foreign body in the eye

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10
Q

What can we do for a foreign body in the eye?

A

gentle rinsing with warm water
if object cant be removed, cover eye and get MD care
do not try to remove a foreign body with a Q-tip, match, etc

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11
Q

Regarding ophthalmics, what is a good item to add to your first aid kit?

A

saline solution

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12
Q

What is phantom movement?

A

when looking somewhere with one eye, the other eye follows
can be damaging if you have a patch over an eye

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13
Q

What do we do for chemical contact in the eyes?

A

flush eye, pull eyelids away from eye at times, at least 15min
transfer to MD
take offending chemical container with you if possible

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14
Q

What are the eye symptoms from radiant energy?

A

red eyes
itchy
foreign body sensation

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15
Q

What can we do for eye symptoms from radiant energy?

A

cool compresses
non-medicated eye drop (Murine or Systane)
sunglasses for few days
contact lenses can help people who have them (source of fluid)

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16
Q

What does Visine contain to make it medicated?

A

decongestant

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17
Q

Describe the layers of tear film.

A

outer surface is oily (prevents evaporation of middle layer)
middle layer is mainly aqueous
inner layer is mucoidal

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18
Q

What is the function of tears?

A

lubricating
protecting
nourishing

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19
Q

What can occur if tear film is compromised?

A

dry spots on eye surface

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20
Q

What is the etiology of dry eyes?

A

changes to any tear component
alteration in blink frequency/efficiency

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21
Q

What are the two main types of dry eyes?

A

evaporative dry eye
-eyes make tears but they dont last long
-blocked glands can contribute to lipid deficiency
-most common
aqueous deficient dry eye
-eyes dont make enough water

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22
Q

What percentage of patients benefit from artificial tears?

A

15%

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23
Q

What are the symptoms of dry eyes?

A

difficulty blinking
generally less tears produced
-can also see more tearing (ineffective tears)
light sensitivity
redness
blurry vision

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24
Q

True or false: stringy discharge is a common symptom of dry eyes

A

false
more so viral conjunctivitis

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25
Are drops a quick and easy fix for dry eyes?
no, we should be careful of using drops as a quick fix should be checked out by MD or optometrist
26
What are some factors that can contribute to dry eyes?
age blepharitis (oil glands can be compromised) medications (Acutane, anticholinergic drugs) Sjogren's syndrome menopause allergic conj rosacea computer use eyelid hygiene contacts arthritis lasik (cuts the nerves)
27
What are the symptoms of Sjogren's syndrome?
dry eyes dry mouth arthritic joint pain
28
What is an OTC treatment for dry eyes?
artificial tears
29
Do artificial tears actually mimic real tears?
no company can mimic all three layers of tears basically like putting a bandaid over it and adding some lipids
30
Do we care about the ingredients in artificial tears?
no check for: use with contact lenses, preservative
31
How should artificial tears be used?
use frequently, dont play catch up (they are very safe) trial and error until one works for the patient
32
What is a disappearing preservative?
preservative that dissociates in the eye
33
Which version of artificial tears is a good level to start at?
preserved artificial tears -most common solution -provide moisture and comfort -multi dose bottles
34
What are the LiquiGel artificial tears?
doesnt come viscous, forms a film over the eye better at bedtime as it can cause blurry vision
35
If someone were using ointment/gel formulations of artificial tears, when would be the best time to use them?
HS dosing -can cause blurry vision -recommended for more intense, dry sensitive eyes
36
How do preservative-free artificial tears come packaged?
single-use vials
37
True or false: there is no king of artificial tears, as in one is the best
true its all trial-and-error
38
What is Hylo?
was just another version of artificial tears super expensive ($55) used to be popular because its preservative free
39
What is Thealoz Dup?
just another version of artificial tears try out the simple versions before trying one like this
40
What is different about Clear Eyes Pure?
the bottle has a purifying filter to prevent stuff from getting in *other than that, its just another version of artificial tears*
41
True or false: artificial tears should be administered on a prn basis
false should be administered on a regular schedule
42
What are some other options for dry eyes, aside from artificial tears?
humidifier (if winter) lid margin hygiene plug the ducts cyclosporine drops (Restasis) omega-3 fatty acids lifitegrast drops heat at night
43
If someone is using Restasis for dry eyes, what is it very important you do as the pharmacist?
can take months to work, thus its important to handle patient expectations
44
What is the MOA of cyclosporine for dry eyes?
anti-inflammatory in eyes and tear ducts helps improve the bodys ability to make tears
45
Are omega-3 drops any different than other artificial tears?
not at all
46
What are the anti-inflammatory (Rx drugs) that can be used for dry eyes?
cyclosporine (Restasis) lifitegrast (Xiidra)
47
How does varenicline work for dry eyes?
activates the trigeminal nerve-->cholinergic stim-->increased tear film *comes as nasal spray*
48
What is the etiology of a stye?
staph aureus infection in an eyelash follicle
49
What are the symptoms of a stye?
swelling (can come to a head) tenderness *red bump on edge of eyelid*
50
What is the treatment of styes?
warm compresses no squeezing (esp if it hasnt come to a head)
51
Are topical antibiotics used for styes?
no not even the eye drops because the stye is on the eyelid
52
What is a chalazion?
obstruction of an oil gland can be painless or tender slow to develop *higher up than a stye*
53
What is the treatment of a chalazion?
warm compresses + massage
54
What do we do in most chalazion cases?
can speculate on cause but likely refer
55
What is a sub-conjunctival hemorrhage?
vessel under conjunctiva bursts ~7-10 days to clear
56
Can decongestants clear up a sub-conjunctival hemorrhage faster?
no decongestants need healthy vessels to work
57
What is the etitology of conjunctival hyperemia?
dust, smoke, chlorine low humidity eye strain symptom of ocular conditions (Blepharitis, Rosacea) contact lenses
58
What is the treatment for conjunctival hyperemia?
cool compress eye washes: -Murine (less viscous) -Optrex (99.9% saline, more volume)
59
What are the ingredients of Optrex?
99.9% normal saline boric acid witch hazel allantoin
60
What are examples of ophthalmic decongestants? Rank them from shortest acting to longest acting.
phenylephrine (shortest) naphazoline tetrahydrozoline oxymetazoline (longest) zinc sulfate (historical and not a decongestant)
61
What are the uses of ophthalmic decongestants for conjunctival hyperemia?
cosmetic reasons not for: seasonal allergies, chronic redness, contact lens problems
62
What is the concern with ophthalmic decongestants?
rebound redness
63
What is the agent that does not cause rebound redness?
brimodidine -QID for red eyes -alpha 2 agonist rather than alpha 1
64
What is blepharitis?
eyelid disorder can lead to problems with dry eye
65
What is the etiology of blepharitis?
disorder of the Meibomian gland bacterial (more so younger adults and children) seborrheic (more so adults) -combo of both types is common
66
What are the symptoms of blepharitis?
more noticeable in adults inflammation of eyelid margins -red, scaly, NO discharge -scales=yellowish, bit greasy if seborrheic eyes can become irritated, dryness vision normal (some blurring) *rarely disappears completely and is often chronic*
67
True or false: if you are unsure about a possible blepharitis case it would be wise to refer
true
68
What is the treatment for both forms of blepharitis?
bacterial: -eyelid hygiene -topical antibiotics -Blephamide (antibiotic+steroid) seborrheic: -eyelid hygiene -check/treat scalp-->antifungal -tx lasts 3 weeks and up to months
69
What are the different forms of conjunctivitis?
viral bacterial allergic *viral and bacterial are referred to as Pink eye*
70
What is our comfort in prescribing for each form of conjunctivitis? What about in regards to age groups?
most comfortable with allergic: -refer bacterial quicker than viral more comfortable with adults than paeds
71
True or false: perennial allergy sufferers are more likely to experience ocurlar symptoms
false seasonal is more likely
72
How many eyes are typically involved in allergic conjunctivitis?
both eyes
73
What are low-level non-pharm treatments for allergic conjunctivitis?
cool compress/non-medicated drops -flush out allergens allergen avoidance
74
What does the "A" stand for on a box of Naphcon A?
antihistamine -no "A" means its straight decongestant
75
Are OTC topical antihistamines good for allergic conjunctivitis?
no the antihistamines are garbage and theres a decongestant so theres worry about rebound redness
76
What are examples of OTC topical antihistamines? What about Rx?
OTC: pheniramine, pyrilamine, antazoline Rx: ketotifen, emedastine -MUCH BETTER
77
What is the drawback of OTC topical cromolyn?
frequency of dosing -QID or > -almost no systemic se
78
How does cromolyn work?
mast cell stabilizer
79
Describe Rx cromolyn-like products.
Alocril (nedrocomil) -mast cell stabilizer -BID Patanol (olopatadine) -mast cell stabilizer + antihistamine -BID (Pataday is OD) Alomide (lodoxamide) -mast cell stabilizer -QID
80
True or false: oral decongestants work for allergic conjunctivitis
no shot
81
Are topical ocular steroids good for allergic conjunctivitis?
would be great except for concern for increased IOP and cataracts
82
What is the topical ocular steroid associated with less steroid-induced side effects in allergic conjunctivitis?
loteprednol (Lotemax)
83
What are the symptoms of bacterial conjunctivitis?
exudate from eyelid exudate from lid margin (but blepharitis also does) both eyes
84
What are the symptoms of viral conjunctivitis?
starts in 1 eye, moves to 2nd eye in 1/3 of cases often follows a cold profuse tearing
85
What is the treatment of viral conjunctivitis?
symptomatic care -drops
86
What is the treatment of bacterial conjunctivitis?
topical antibiotics -3 day window or start using Polysporin more so 2nd line
87
Describe bacterial vs viral conjunctivitis in adults.
viral causes more common (7 days of symptoms) both are self-limiting if contact lenses involved: refer
88
What is the efficacy of antibiotics in bacterial conjunctivitis?
shorten course by 1-3 days decreases spreading should see improvement in 2 days
89
True or false: bacterial conjunctivitis is more common than viral conjunctivitis in kids
true
90
What are the symptoms in a kid <6 that tells you its likely bacterial conjunctivitis?
discharge eyes glued shut in AM eye pain *Refer to MD or prescribe*
91
Will Polysporin drops work for blepharitis or sties?
unlikely, how will the drop hit the site? can be used in bacterial conjunctivitis but not commonly done
92
What is the regimen of Polysporin drops for bacterial conjunctivitis?
QID x 7-10d + 2 days after symptoms clear
93
What can be done if instilling eye drops is an issue for children?
close eyes place drops in corner of eye open eyes
94
What is periorbital cellulitis?
infection of the skin around the eye
95
What are floaters?
little dot like things that appear in your vision could be normal in an older person if quick onset, could be more serious
96
What is blepharospasm?
benign twitches in eyelids
97
What are obstructed tear ducts?
tears do not drain away seen in newborns most clear on their own
98
What is the cause of bags under eyes?
thinning skin with age and genetics
99
Differentiate between dry type and wet type AMD.
dry type: -90% -fat deposits -stages: early-->intermediate-->advanced wet type: -10% -vascular issues -automatically advanced
100
What can we do for AMD at an OTC level?
*SECONDARY PREVENTION, not helpful for primary prevention* ARED vitamins: -25% reduction of intermediate-->advanced
101
What is the formulation of AREDS?
beta carotene (25,000IU) vitamin C (500mg) vitamin E (400 IU) zinc (80mg) copper (2mg)
102
What are the changes that got made to AREDS2?
omega 3 added (no value) beta carotene removed (did not reduce value) less zinc (just as effective) lutein and zeaxanthin added (not helpful)
103
Would taking lutein or omega-3 on their own be enough for AMD?
no give people the AREDS formula
104
What got removed from the AREDS formula for Vitalux S?
beta-carotene AREDS2 is practically Vitalux S
105
What are some miscellaneous ophthalmic agents?
topical NSAIDs -Acular/LS (ketorolac) -Voltaren Ophtha (diclofenac) -Ocufen (flurbiprofen) local anesthetics -Alcaine (proparacaine) -Pontocaine (tetracine) topical steroids -Maxidex (dexamethasone) -Flarex (fluorometholone) -FML (fluorometholone) -Pred Mild/Forte (prednisolone) -Vexol (rimexolone) -loteprednol (only one that doesnt increase IOP) combination products -Blephamide (sulfacet + pred) -Vasocidin (sulfacet + pred)

PHAR154 (18 decks)

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