1
Q
What eye services is covered by AB Health Care?
A
- annual complete eye exams for children 18 and younger and seniors 65 and older
- Medically necessary or urgent care eye visits are also covered for everyone regardless of age
- Examples
- Sudden changes in vision
- Annual exams for diabetics
- Removing foreign objects from the eye
- pre/post op care for cataract pts
- Examples
2
Q
How do other individuals pay for eye care?
A
- indiv. b/w 19 and 64 may qualify for full or partial coverage if they have private insurance such as through an employer
- ABC, Manulife, Assure
- pt may hesitate to have their eyes looked at as it may be costly. optometrists have ability to triage pts and then treat or refer them to a specialist if needed
3
Q
define red flags
A
signs and symptoms that found in pt’s history or clinical exam that are alarming and can indicate something more serious and may warrant immediate referral
4
Q
What are the red flags for eye problems? (9)
A
- pain - assess pain on a scale
- severe headache
- excessive tearing - tearing can be indication of a viral infection
- Vision disturbance, spotted, blurry
- Contact lens - greater long-term consequences or severity
- Photophobia - light sensitivity
- Exposure to heat or chemicals (workplace)
- Blunt trauma/imbedded foreign body/protrusion
- No improvement with recommended self care can signify other issues
5
Q
What questions should you ask for self-care assessment?
A
- SCHOLAR-E, onset, freq, duration of symptoms
- What area is involved
- One or both eyes, eye, eyelid or both?
- Is there discharge
- A little or a lot? Can you describe it
- Redness or inflammation?
- Aggravating, remitting
- Recurrence of symptoms
- Any attempted treatments?
6
Q
What is dry eye disease?
A
- one of the most common eye problems
- multifactorial disease of ocular surface, loss of homeostasis of tear film and with symptoms of tear film instability, hyperosmolarity, ocular surface inflammation and damage, neurosensory abnormalities
- tear composition off balance
- may lead to discomfort, eye surface damage, visual disturbances, neg impact on quality of life and psychological health
7
Q
DED symptoms?
- what happens in severe cases?
-
A
- burning
- stinging
- gritiness
- scratchiness
- foreign-body sensation
- transient changes in vision
- severe: blurred vision, photophobia, excess tear production
- usually bilateral
- can develop over days, months, years
8
Q
DED pathophys
What are the parts of Lacrimal Functional Unit
A
- cornea, conjunctiva, accessory lacrimal glands, meibomian glands, nervous system - connected to endocrine system and NS and control tear production
- If a component is not working properly inflammation cascade
9
Q
Name and describe 3 tear components
A
- Innermost mucus (mucin layer): coats eye and allows aqueous layer to stick to the cornea which is water repellent and helps remove waste from eyes
- Aqueous later: supplies oxygen and electrolytes to the eye
- Lipid layer: acts as a lubricant b/w eyelid and eyeball creating a smooth surface
- Tear quality can lead to DED (not quantity if tears are present)
10
Q
DED Classification - what are the 2 types?
A
Aqueous Deficient Dry Eye (2 types): aq or mucus layers are deficient
Evaporative Dry Eye (2 types)
11
Q
what are the 2 types of aqueous deficient dry eye?
difference in characteristics?
A
Sjogren-type (autoimmune) - pt may have dry eye and mouth
- primary ~10% of pt w/ aq deficient dry eye have Sjorgen syndrome which affects exocrine glands
- secondarily - rest are due to other autoimmune diseases
Non-Sjogren-type (nonautoimmune)
- Lacrimal gland deficiency (age-related hepatitis)
- Lacrimal duct obstruction (injury, infections, scarring conditions)
- Reflex hyposecretion: sensation on cornea reduced so tear production is compromised (refractive surgery, diabetes, contact lenses)
12
Q
2 types of Sjogren-type
3 types of Non-Sjogren
A
primary and secondary
- Lacrimal gland deficiency (age-related hepatitis)
- Lacrimal duct obstruction (injury, infections, scarring conditions)
- Reflex hyposecretion: sensation on cornea reduced so tear production is compromised (refractive surgery, diabetes, contact lenses)
13
Q
Evaporative Dry Eye (2 types)
what are the factors of each one?
A
external factors
- low humidity
- high temp
- exposure to sun, dust, wind
internal factors
- Meibomian gland dysfunction (chronic inflamm leads to squamous cell debris leads to gland obstruction leads to changes in secretion)
- conditions compromising blinking/eyelid function (Parkinson’s, computer work, exophthalmos)
- hormones (oral contraceptives, menopause, low androgen levels)
14
Q
what are 2 types of risk factors for the eye?
what are some examples of each?
A
non-modifiable
- female sex
- increasing age
- Sjogren syndrome
- Meibomian gland dysfunc
- thyroid disease
- diabetes
- rosacea
modifiable
- androgen deficiency
- computer use
- environment
- eye surgery
- medications (anticholinergics, antidepressants, some NHPs, antihistamines, SSRIs)
15
Q
DED goals of therapy (3)
A
- Ease discomfort and minimize symptoms
- prevent/delay complications
- Educate patients about their condition and encourage adherence to therapy
16
Q
Non-pharm treatment for aq deficient dry eye?
A
- reassess current medications
- include omega-3 fatty acids in diet (fish/flax seed oil)
- punctal occlusion (temp or permanent plugs to stop tear drainage from nasolacrimal ducts)
17
Q
Non-pharm treatment for evaporative dry eye?
A
- apply a warm compress to the eyelids for a 5-10 mins at a time
- “LipiFlow” (a procedure which unblocks meibomian gland ducts)
18
Q
Non-pharm treatment with environmental/lifestyle management?
A
- lower temp/avoid extreme heat
- use humidifiers
- maintain hydration
- avoid smoking/smoke
- decrease screen time and make efforts to blink, look away every 10-20 mins
19
Q
Pharm treatment - artificial tears
- Start anywhere and do a trial and error for 1-2 weeks for a product (little evidence to support use of one over another)
Name 4 common ingredients in artificial tears
A
- viscosity agents
- electrolytes
- lipids
- preservatives
- preservatives free
20
Q
Pharm treatment - artificial tears
Name 4 viscosity agents
what is their purpose?
A
- carboxymethylcelluose
- hyaluronic acid
- polyethylene glycold
- petrolatum - is viscous and is a lipid (2 roles)
Determine length of action
- lower viscosity = shorter action, more frequent use, drops
- high viscosity = gels or ointments, longer duration of action, short term blurriness, before bedtime is more appropriate
21
Q
Pharm treatment - electrolytes
Name 2
what is their purpose?
A
- potassium chloride
- sodium bicarbonate
mimic composition of natural tears (salt content)
22
Q
Pharm treatment - lipids
Name 2
what is their purpose?
A
- castor oil
- mineral oil
prevent tear evaporation
23
Q
Pharm treatment - preservatives
purpose
name 3 common preservatives
name 3 safer preservatives
A
- Preservatives prevent microbial growth and increase shelf life - have side effects
- 4 times a day over weeks or months, consider other options maybe
- Preservative free - may be pricey lose adherence due to cost
common
- benzalkonium chloride (BAK)
- EDTA
- Lanolin
safer
- PolyQuad
- Purite
- Sodium perborate
- oxidative preservatives, safe alternatives
24
Q
Name 4 preservative free artificial tears
A
- Minums - single use system
- Tears Naturale
- Thera Tears
- Hylo
25
DED OTC Products
what are two types of pts
Artificial Tears
- Systane Ultra, Balance
- Refresh Tears, Optive Active
- Blink Eye Tears
Artificial Gels and Ointments
- Systane Gel Ointment
- Refresh PM
- Liposic
- Lacrilube
26
DED Rx Pdts
Topical corticosteroids
MOA?
AE
duration of use
```
- MOA
Inhibits inflamm processes/mediators
- Drugs
- Lotemax - loterprednol 0.5%
- FML - fluorometholone 0.1%
- Side Effects
blurred vision, photophobia, irritation
- Use
14-28 days
```
27
DED Rx Pdts
Restasis - cyclosporine
MOA?
AE
duration of use
```
- MOA
Unknown - increases globlet cell density to increase mucin or could be immunomodulator effect
- Side Effects
irritation
- Use
6-12 weeks; lifelong therapy
```
28
DED Rx Pdts
Xiidra - lifitegrast 5%
MOA?
AE
duration of use
```
- MOA
thought to inhibit inflamm markers
- Side Effects
dysguseia (altered taste), blurred vision, irritation
- Use
2-12 weeks; lifelong therapy
```
29
DED Monitoring
- what to monitor for
F/U time
- preservative toxicity (stinging) or conjunctival inflamm (worsening redness)
- 3-5 days
30
Contact Lens Care
How do contact lenses work? What are some advantages over trad glasses?
- Can correct near-sightedness, far-sightedness, astigmatism
- Sit on tear film
- Act as barrier b/w cornea and tear supply
- advantages: natural appearance, increased field of vision, no image size distortion, no fogging or reflections
31
What are 2 types of contact lenses
soft
- silicone hydrogens for short-term use (daily/weekly/monthly)
- increased comfort - increased risk of lens deposits and irritation
rigid, gas-permeable (RPG)
- uncommon
- intended for long term use ~5 years
- more difficult to adjust to, better visual acuity, few complications
combination RPG/soft
32
Contact Lens Care
what questions should you ask the contact lens wearer?
- symptoms (assess for red flags)
- what type of lenses do you wear?
- what is your replacement schdeule?
- how long have you used contact lenses
- what products do you use to clean them; how do you do so?
- what meds are you taking?
- cleaning procedures should not be changed w/o consultation with eye care provider
33
Contact Lens Care
red flags (4)
- pain
- poor vision
- fog or halos
- discharge
34
Contact Lens Care
What drugs affect lenses or the wearer?
oral contraceptives (Alesse): exacerbation of dry eye
antihistamines, sedatives, hypnotics (benadryl): decreased blink rate
muscle relaxants (Robax pdts, cyclobenzaprine): incomplete blinking
aspirin: ocular irritation, redness
antibiotics (nitrofurantoin, others): discoloration of lenses
ophthalmic products (BAK, decongestants like phenylephrine, tetrahydrozoline): concentrates in lenses and leads to irritation, dark discoloration with repeated use
ASA, anticholinergic drugs, isotretinoin
- Some drugs require taking lens off for 15 minutes
- Rewetting drops as artificial tears compatible with contact lenses
35
Contact Lens Care
| What is the purpose of cleaning solutions?
- enhance wettability and comfort
- disinfect/kill microorganisms
- denature protein deposits
- prevent lens deposits
- maintain optimal pH
36
Contact Lens Care
| What are the goals of therapy (3)?
- optimize vision
- optimize contact lens comfort
- minimize complications
- improper lens care may significantly affect vision, eye health, lens life
- irritation (discomfort, corneal ulcers)
- infections (microbial keratitis)
- intolerance to lenses
37
Lens Care Products
| What are the 2 types of cleaning solutions for soft lenses? For RGP lenses?
soft lenses
- saline-based
- hydrogen peroxide-based
RGP lenses
- multi-step solutions (enzymatic cleaners)
- one-step solutions (hydrogen peroxide)
- Multi-purpose are most common
- Allergies to preservatives - hydrogen peroxide - see eye care professional first
- Now - have platinum disk at bottom of contact lens to neutralize it
- If neutralization doesn’t happen fully - it can lead to corneal irritation
- Case needs to be replaced after some time
- RGP cleaners are more viscous
38
Contact Lens Care
| Monitoring
pt education for meds, contact lens care
39
Lens care procedures
multipurpose: rub lens w/ sltn on each side for 20 s, rinse with sltn, soak for 4-8 h, wash hands with soap and water before inserting lens, discard old sltn and let case air dry, replace every 3 months
hydrogen peroxide: rub lens w/ sltn on each side for 20 s, rinse with H2O2, soak for 4-6 h with case upright, wash hands with soap and water before inserting lens, discard old sltn and let case air dry (don't rinse with H2O2), replace every 3 months
Pharmacotherapy
flashcards
Decks in class (14)
# Cards
-
Eye39
-
Ear Conditions54
-
Dental Care and Mouth Conditions43
-
Dyspepsia + GERD49
-
Hemorrhoids and Gas37
-
Lice and Scabies45
-
Corns, Calluses, Bunions, Ingrown Nails, and Warts34
-
Dandruff & Seborrheic Dermatitis19
-
Acne48
-
Bites, Burns, Wounds47
-
Xerosis and Dermatitis 132
-
Xerosis and Dermatitis 232
-
Perspiration/Body Odour15
-
review91
