1
Q
Reasons to refer opthalimic disorders
A
- Eye pain
- Blurred vision i.e. change in visual activity
- Sensitivity to light (photophobia)
- Contacts
- Blunt trauma to eye
- Chemical, heat, sun exposure to eyes
- Symptoms persist >72 hours
2
Q
Dry Eye: Symptoms
A
- may or maynot be mildly red
- sandy, gritty, foreign body sensation
- tearing
3
Q
Dry Eye: Causes
A
- poor tear quality
- decreased tear production
- menopause
- defects
- eyelid problems.
- collagen vascular disease (RA)
- Bell’s palsy
- drugs
- anticholinergics, beta-blocker, diuretic
- environment
- wind, air, high altitude
- LASIK
4
Q
Dry Eye: Treatment
A
- When using drops, only 1 drop because of limited eye volume
- Artificial tears: starting point
- 3-5 times a day, blink
- cellulose esthers: viscosity
- PVA: spreading agent
- povidone: preservative
- Non-medicated ointment at bedtime
- white petroleum
- Environmental strategies
- blink at computer
- move fans
- inserts/plugs
- Cyclosporine
- Restasis, immunosuppresent, anti-inflammation
5
Q
Allergic Conjunctivitis: Symptoms and Causes
A
- Sx:
- Red, watery, itchy eyes
- Causes:
- Allergens
- Pollen, dander, topical eye preps, etc.
6
Q
Allergic Conjuctivitis: Treatment
A
- Articifical tears (always helpful) then…
- Opthalmic antihistamine/descongestant
- DO NOT use
- pregnant, HT, diabetes, CV diseases
- Combo drug can be cheaper than singular antihistamine (ex: Napchon-A)
- Naphazoline/tetrahydrozoline won’t cause rebound and thus good combo
- Naphazoline/pheniramine
- Naphazoline/pheniramine
- Naphcon-A, Visine-A
- antihistamine/mast cell stabalizer
- alleviate watery eyes, itchiness
- use for long process
- prevents further redness
- Zaditor and Alaway: Ketotifen
- decongestant: reduce redness/tearing
- short term
- can get eye rebound
- quick/cheap
- Visine: Tetrahydrozoline
- Naphcon/Clear Eyes: Naphazoline
- Phenylephrine
- Oxymetazoline
- DO NOT use
7
Q
Viral Conjuctivitis: Symptoms
A
- Symptoms:
- red, watery discharge, with viral URI
- bacterial: not stringy/thick discharge, eyes stuck after nap. Need antibiotics
- red, watery discharge, with viral URI
- ”Pink Eye”
8
Q
Viral Conjunctivits: Treatment
A
- Self-limiting in 1-3 weeks
- Artificial tears and ocular decongestants
- Strict hygiene
9
Q
Foreign Bodies in Eye/Chemical burns
A
- Referral if corneal abraisons
- Irrigation
- A liter of saline
- Use isotonic solution
- See a physician for burns
10
Q
Preservatives in Optic Solutions
A
- Surfactants
- long half-life, stability, coverage
- long-term: toxic
- bactericidal
- BAK, benzathonium Cl
- Polyquad, chlorhexidine
- Metals (Hg/I), Alcohols
- allergic reactions
- Thimerosal: contact blepharitisk conjunctivitis
- **Chlorbutanol: **weak, disappears with time
- **Methylparaben: **unstable, allergic rxns, common in tears
- EDTA
- **Sodium Perborate: **dissociates on contact
11
Q
Blepharitis
A
- Chronic, common inflammation of eyelid margins
- Red, scaly, thickened eyelids, loss of eyelashes, itching and burning
- Treatment:
- Good hygiene
- Hot compress
- Lid scrubs
- Wash hair with Selsun blue, Head and Shoulders
12
Q
Hordeolum
A
- Stye
- Infection of gland of eyelid
- Swelling, palpable, tender
- Treatment:
- usually clear in 1 week
- if not, refer
- hot compress
- external/oral antibiotic
- usually clear in 1 week
13
Q
Chalazions
A
- Like stye, but not tender to touch
- “Sterile granuloma”
- may need to be drained, or else keep growing
14
Q
Otic Disorder: Exclusions
A
- Signs of infection
- Pain w/ discharge
- bleeding/signs of trauma
- Ruptured tympanic membrane
- Ear surgery within 6 months
- Tympanostomy tubes
- Clutz/unable to follow direction
- hypersensitivity to recommended agents
Self-treatment should be restricted to external ear disorders (water-clogged/cerumen)
15
Q
Cerumenosis: Etiology
A
- Narrow or mishapen EAC
- excessive hair growth
- overactive glands
- hearing aid use
- earplug use
- oldsters
16
Q
Cerumenosis: Symptoms
A
- Sense of fullness and/or ear pressure
- Gradual hearing loss
- Ocassional dull pain
- Vertigo
17
Q
Cerumenosis: Treatment
A
- Carbamide Peroxide
- softens wax
- 12 yo and older
- twice daily up to 4 days
- Glycerin, mineral oil, olive oil
- softens wax
- Docusate
- not very effective
- Dilute H2O2
- After softening wax, irrigate using otic bulb syringe filled with warm water
- use caution when recommending irrigation
- show patient how to do it
- Prevent with frequent removal/clearning or hearing aid
- Improper or excessive removal of cerumen can damage EAC
- Q-Tips/Fingernail: can push cerumen further in, abrade skin and allow pathogens in
18
Q
Water-Clogged Ears: Etiology
A
- Shape of EAC, cerumen, climate, swimming, bathing
- NOT the same as “swimmer’s ear” (otitis external)
- wiggle ear and hurts
- need steroid and antibiotics
19
Q
Water-Clogged Ears: Symptoms
A
- Feeling of fullness/wetness in ear
- Gradual hearing loss
- Can lead to tissue maceration
- itching, pain, inflammation, infection
20
Q
Water-Clogged Ears: Treatment
A
- Isopropyl alcohol
- Acetic acid (vinegar)
21
Q
Misc. Ear Problems
A
- Contact dermatitis
- earrings and eardrops
- Seborrhea, psoriasis
- skin cells plugging things up
- need same meds used on skin in eardrop formula
- Hearing loss
- Dizzines
- Tinnitus
22
Q
Teething
A
- No fever, V/D, nasal congestion, rash
- Symptoms:
- sleep disturbance, irritability, drooling
- Treatment:
- frozen pacifiers/washclothes
- Ibuprofen (baby Tylenol), APAP
- NO lidocaine
- NO benzocaine
- can bind hemoglobin and cause blue lips
- Methemoglobinemia
- blue lips, SOB, fatigue, confusion, tachycardia
- minutes to hours onset, 1st or several times after use
23
Q
Apthous Stomatitis: Etiology
A
- Canker Sore
- unknown
- Things to consider: smoking, stress, diet
- Precipitating factors: stress, trauma
- Smoking cessation
- Allergies
- Hormonal change
- Genetics
- Malnutrition
- HIV/AIDS
24
Q
Apthous Stomatitis: Symptoms
A
- ulceration on nonkeratinized mucosa
- lasts 5-14 days
- heal spontaneously with no scarring
- painful
25
Apthous Stomatitis: Treatment
* No cure, only relief
* Nonpharmacological
* increase iron, folate, Vit B12, avoid spicy/acidic food, apply ice
* NO HEAT, can spread infection
* Pharmacolgic
* Oral debriding/wound cleaning agents
* carbamide peroxide, H2O2, sodium bicarb, perborates
* Topical anesthetics
* not benzocaine
* butacaine
* Oral Protectants
* Orabase (mix with steroid and put it on), Zilactin
* Oral rinses
* Listerine to hasten healing
* Saline/baking soda to soothe
* Analgesic
26
Aphtous Stomatitis: When to refer
* Lesions with underlying pathology
* Lesions there for more than 2 weeks
* frequently reoccuring
* systemic illness
27
Leukoplakia
* white, flaky patches on tounge
* tobacco users
* referral, risk of oral cancer
28
Herpes Simplex Labialis/Virus: Trigger, Etiology
* Etiology
* lips/bordering mouth area
* painful/reoccurant lesion
* self-limiting, heals w/o scarring, 5-14 days
* Trigger
* hides in trigeminal ganglion
* reactivated by UV, stress, fatigue, cold, windburn
29
HSV: Symptoms
* Prodrome (warning sign)
* tingly, burning, numbness
* vesiculopapular eruption
* Other symptoms:
* fever, pain, bleeding, swollen lymph nodes, malaise
30
HSV: Treatment
* Avoid triggers
* Keep lesions clean
* Topical to prevent infection and relieve dryness
* DO NOT USE NEOSPORIN (for bacteria, not virus)
* Docosanol (Abreva)
* prevents viral replication
* shortens course
* Acyclovir
* Don't use good drugs if don't need them
* Can cause antibiotic resistance
* Refer if \>14 days, increased frequency, compromised immune, infection
31
Xerostomia: Etiology
* AKA: Dry mouth
* Sjorgens, DM, depression, Chron's
* Radiation
* Medication
32
Xerostomia: Symptoms
* From increased talking, swallowing,
* stomatitis (inflammation of mouth)
* burning tounge
* halitosis
* loss of apetitie
* dental decay
33
Xerostomia: Treatment
* Good dental care
* Avoiding:
* tobacco, alcohol, antihistamines, CNS stimulants, sugary/acidic food
* xylitol is okay
* Artifical saliva
* Flouride
* pilocarpine, cevimeline (prescription)
Pharm 558
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