chapter: EYE

Question 1

When to discard:
domicilliary use?
In hospital
surgery outpatient

Answer 1

Domicillary- home use 28 days
Hospital- 1 week
Surgery- single use, discard after use

Question 2

Advise a patient using 2 eye drops, ointment or gel?

Answer 2

2 eye drops wait 5 minutes apart

ointment and gels, wait longer, apply last

Question 3

What is the use of eye lotion/washes?

Answer 3

first aid treatment, sodium chloride 0.9% ir water in emergency

Question 4

what are opthalmic specials?

Answer 4

prepared aseptically, advised against unlicensed versions

Question 5

Phosphate-preservative safety alert?

Answer 5

rarely corneal calcification
have been reported with the use of phosphate-containing
eye drops in patients with significantly damaged corneas—
consult product literature for further information.

Question 6

Types of contact lenses

+ risks of wearing

Answer 6

hard 
soft lenses (silicone hydrogel)- 

risk- infectious and non-infectious keratitis
poor compliance, cleaning can cause this

Question 7

what is acanthamoeba keratitis?

Answer 7

painful and sight-threatening
condition, is associated with ineffective lens cleaning and
disinfection, the use of contaminated lens cases, or tap water
coming into contact with the lenses. The condition is
especially associated with the use of soft lenses (including
frequently replaced lenses) and should be treated by
specialists.

Question 8

contact lens and drug treatment advice

Answer 8

some drugs accumulate in the lenses
use P/f eye drops
ointment/oily drops avoided

Question 9

systemic drugs which have adverse effect on contact lens wear??

Answer 9

These include oral
contraceptives (particularly those with a higher oestrogen
content), drugs which reduce blink rate (e.g. anxiolytics,
hypnotics, antihistamines, and muscle relaxants), drugs
which reduce lacrimation (e.g. antihistamines,
antimuscarinics, phenothiazines and related drugs, some beta-blockers, diuretics, and tricyclic antidepressants), and
drugs which increase lacrimation (including ephedrine
hydrochloride p. 286 and hydralazine hydrochloride p. 192).
Other drugs that may affect contact lens wear are
isotretinoin p. 1337 (can cause conjunctival inflammation),
aspirin p. 130 (salicylic acid appears in tears and can be
absorbed by contact lenses—leading to irritation), and
rifampicin p. 615 and sulfasalazine p. 47 (can discolour
lenses).

Question 10

Name 3 main danger associated with corticosteroid use?

Answer 10

1. ‘red eye’, when diagnosis unconfirmed, may be due to herpes simplex virus (HSV). corticosteroid may aggravate the condition, leading to corneal ulceration, with possible damage to vision and even loss of the eye. Bacterial, fungal, and amoebic infections pose a similar hazard;
2. ‘steroid glaucoma’ - follow the use of corticosteroid eye preparations in susceptible individuals
3. a ‘steroid cataract’ can follow prolonged use- risk increases dose and duration corticosteroid

Question 11

Intravitreal corticosteroid

Answer 11

implant containing dexamethasone, licensed macular oedema

fluocinolone acetonide- licensed visual impairment associated chronic diabetic macular oedema

Question 12

allergic conjunctivitis treatment options

Answer 12

• antihistamine
• lodaxamide – includes seasonal allergies
• sodium cromoglicate
• Eye drop containing antihistamine: antazoline (xylometazoline hydrochloride (otrivine-anistin), azelastine, epinastine, ketotifen + oloptadine
• diclofenac- licensed seasonal allergies
• NSAID- prophylaxis and treatment inflammation of the eye following surgery or laser

Question 13

VERNAL KERACONJUNCTIVIITS + other forms allergic conjunctivitis:

Answer 13

• sodium cromoglicate
• nedocromil sodium
• ciclosporin- severe keratitis, patient dry eye disease not improved
• cenegermin- mod-severe neutropenic keratitis

Question 14

Dry eye summary

Answer 14

DRY EYE:

• tear deficiency replacement
• hypromellose- hourly
• carmellose- 4 x daily, reduced frequency
• moderate-severe dry eye (carbomer or sodium hyaluronate) treated 6-8 weeks