Pharmaceutical care of Ocular Conditions

Question 1

Who do you refer?

Answer 1

Babies >2 years
Babies with sicky eyes from birth
Patients undergone ophthalmic/laser surgery

Question 2

What are the 5 symptoms to look for?
5 P’s

Answer 2

Pain
Photosensitivity
Pupils
Problems
Pus

Question 3

What are the possible causes of red eye?

Answer 3

Conjunctivitis
Subconjunctival haemorrhage
Inflamed

Question 4

What are the different types of conjunctivitis?

Answer 4

Viral
Bacterial
Allergic

Question 5

What should you do for allergic conjunctivitis?

Answer 5

Resolve within 7-10 days once exposure has stopped

Question 6

What should you do for bacterial conjunctivitis?

Answer 6

Resolves within 7-10 days
Can give chloramphenicol

Question 7

What is the course for chloramphenicol?

Answer 7

MAX 5 days
BUT take for 2 days after symptoms

Question 8

What can chloramphenicol also do?

Answer 8

Help loosen hardened discharge on lids

Question 9

What are the antiseptics available?

Answer 9

Propamidine isetionate drops
Dibromopropamidine isetionate eye ointment

Question 10

What is the antibacterial available?

Answer 10

Chloramphenicol drops + ointment

Question 11

What is chloramphenicol?

Answer 11

Topical treatment of acute bacterial conjunctivitis in adults + children over 2

Question 12

What must contact lens users do whilst using chloramphenicol?

Answer 12

Stop using them

Question 13

What is the dose regime for chloramphenicol?

Answer 13

1 drop every 2hrs for first 48hrs
And every 4hrs thereafter
Ointment = 3-4x/day

Question 14

When do you refer to GP with chloramphenicol?

Answer 14

If no improvement within 48hrs

Question 15

What must you do with chloramphenicol after 5 days?

Answer 15

THROW IT AWAY

Question 16

What is the eye hygiene for conjunctivitis chloramphenicol?

Answer 16

Don’t touch eye/lashes with nozzle
Wash hands
Don’t share bottle with anyone

Question 17

What are the side effects of chloramphenicol?

Answer 17

Transient stinging/burning
Blurred vision

Question 18

What does chlamydial conjunctivitis require?

Answer 18

Urgent referral

Question 19

How do you treat allergic conjunctivitis?

Answer 19

Avoid/minimise exposure to trigger
Oral histamines
Cold compress for eyes
Sodium cromoglicate (long-term)

Question 20

When do you refer someone with subconjunctival haemorrhage?

Answer 20

If on warfarin

Question 21

How do you treat subconjunctival haemorrhage?

Answer 21

Resolves spontaneously 7-14 days

Question 22

What are the cause of inflamed eyes?

Answer 22

Tired/irritated
Overworking
Over-exposure to smoky/dusty air

Question 23

What is the treatment for inflamed eyes?

Answer 23

Eye lotions/drops

Question 24

What is the treatment for styes?

Answer 24

Apply hot compress
Refer if not resolved within 7 days
May remove eyelash

Question 25

What is the treatment for chalazion?

Answer 25

Resolve spontaneously Treat same as styes May require surgery to drain

Question 26

What is marginal blepharitis?

Answer 26

Inflammation of margin of eyelid

Question 27

What is the treatment for marginal blepharitis?

Answer 27

Lid hygiene Contact lenses not worn

Question 28

What are included in lid hygiene?

Answer 28

Warm compress Massage eyelid Clean eyelid 2x a day Lid wipes Stop with eye makeup

Question 29

What can be used to treat bacterial blepharitis?

Answer 29

Antibacterial ointment rubbed into eyelashes 2-3x/day for 7 days Systemic = oral antibiotics

Question 30

What may cause watering eyes?

Answer 30

Interrupted drainage of tear film due to blockage of nasolacrimal duct

Question 31

What can watering eye be a symptom of?

Answer 31

Dry eyes

Question 32

What is watering eye often as a result of in older people?

Answer 32

Ectropion/entropion conditions

Question 33

How do you treat dry eye?

Answer 33

Eye drops with preservative Preservative free eye drops

Question 34

What is the problem with preservatives?

Answer 34

Can cause eye irritation = NOT to be used more than 4x/day

Question 35

What can early cataracts cause?

Answer 35

Myopic shift = see optometrist to change glasses prescription

Question 36

What may be used to treat glaucoma?

Answer 36

Parasympathomimetic drops Sympathomimetic drops Beta-blockers Prostaglandins analogues + prostamides Carbonic anhydrase inhibitors

Question 37

What is the screening for glaucoma?

Answer 37

Diabetics >40 years 1st degree relatives of glaucoma

Question 38

What is diabetic retinopathy?

Answer 38

Damage to retina due to increased sugar in eye

Question 39

How is the proliferative stage of diabetic retinopathy treated?

Answer 39

With surgery = scatter laser to shrink abnormal blood vessels

Question 40

What are eye drop dispensers suitable for?

Answer 40

People with impaired sight/shaky hands

Question 41

How is macular oedema treated?

Answer 41

With focal laser treatment

Question 42

How often does patients >40 with a family history of glaucoma/ocular hypertension who are not part of a monitoring scheme?

Answer 42

Every year

Question 43

How often does patients with diabetes who are not part of a diabetic retinopathy monitoring scheme?

Answer 43

Every year

Question 44

Describe rigid gas permeable contact lens

Answer 44

Smaller Take longer to get used to More durable

Question 45

Describe soft contact lens

Answer 45

Larger + cover cornea Replacement daily Daily-wear Incorporate water to stop drying out

Question 46

What is involved soft contact lens care?

Answer 46

Daily cleaning Disinfection Protein removal

Question 47

What is involved in hard contact lens care?

Answer 47

Wetting solutions

Question 48

Describe contact lens care for all

Answer 48

Reduction in tear flow = lens discomfort Lens intolerance = hormone preparations Lens discolouration = sulfasalazine

Question 49

When are you advised not to wear contact lens?

Answer 49

Dry eyes Blurred vision Cold sores Eye infections