1
Q
Dry Eye Causes
A
- Aging
- Various disease (RA, Bells Palsy)
- Eye anatomy defects
- Medications (anticholinergic, decongestants, diuretics, beta blockers)
- Environmental conditions
2
Q
Dry Eyes Clinical Presentation
A
- White/mild red eye
- sandy/gritty feeling
- initial presentation with excessive tearing
- “feels like something is in my eye”
3
Q
Nonpharmacologic Treatment for Dry Eyes
A
- • Cold compress
- • Omega 3 FA, flax seed oil (oral)
- • Avoidance of environments that increase tear evaporation
- • Avoid computer strain
4
Q
Pharmacologic Therapy For Dry Eyes
A
- Nonmedicated Ointments are mainstay of treatment
- Blurred vision
- Artificial tears – stabilize the tear film, protect, decrease tear evaporation, enhance wound healing; provide lubrication
- Lubricants and vehicles
- Vehicles they increase drug action by decreasing drainage due to increase viscosity to increase contact time
- Cellulose esters (hydroxypropyl methylcellulose)
- Polyvinyl alcohol (PVA)
- Povidine
5
Q
Artificial Tears
A
- Systane
- Refresh
- Optive, Clear Eyes for dry eyes
- GenTeal
- Less Preservatives is better
6
Q
Systane
A
- Polyethylene glycol + propylene glycol
- gelling and polymer system lubricant eye drop; creates and ocular shield
- Promotes comfort and relief of symptoms
7
Q
Refresh
A
- CMC sodium 0.5% and 1%
- Glycerin, polysorbate 80, & castor oil
- Oil-in-water emulsion; prolonged lubrication
- bid-tid; can use with artificial tears
- vehicle in Restasis
8
Q
Optive, Clear Eyes for dry eyes
A
CMC sodium + glycerin
9
Q
GenTeal
A
- CMC sodium + hypromellose
- Moderate to severe dry eye
10
Q
Refresh Optive Advanced Lubricant
A
- Components: glycerin (0.9%), polysorbate 80 (0.5%), CMC 0.5%, boric acid, castor oil, erythritol, levocarnitine, and carbomer copolymer type A
- Lipid-based, triple-action preparation that helps lubricate and hydrate dry eyes and protects against evaporation of natural tears
11
Q
Nonmedicated Ophthalmic Ointments
A
- White petrolatum(lubricant and ointment base); mineral oil (helps ointment melt at body temperature); lanolin (facilitates incorporation of water soluble medication and prevents evaporation)
- Advantage – enhance retention time in eye
- BID dosing (Qhs mostly)
- SE: Blurred vision
12
Q
Preservatives
A
- Surfactants – bactericidal (disrupt bacterial membrane)
- Mercury metals (thimerosal); iodine; EtOH
- Benzalkonium chloride (BAK)
- Long term use can cause damage to conjunctival and corneal epithelium
- Sodium perborate – dissociates upon contact on eye to form hydrogen peroxide (small amt)
- Purite (oxychloro complex) – dissociates after long wave UV light to form water and sodium
13
Q
Excipients
A
- Antioxidants – prevent/delay deteriation of products exposed to oxygen
- Wetting agents – decrease surface tension and low drug to spread easily
- Buffers – maintain pH between 6-8 (decrease ocular discomfort)
- Tonicity adjusters – helps medications to be isotonic with physiologic tear film
14
Q
Allergic Conjunctivitis
A
- Type I IgE-mediated hypersensitivity reaction
- Immediate Response – predominately by mast cells -> histamine is the main mediator w/ H1 and H2 receptors involvement
- Late phase – mast cells release other cytokines and chemokines causing continuation of inflammation -> eosinophils, basophils, and neutrophils appear in 6-10 hrs after exposure followed by others
15
Q
Exclusions to Self-Care for Allergic Conjunctivitis
A
- } Eye pain
- } Blurred vision not associated with use of ophthalmic ointments
- } Sensitivity to light
- } History of contact lens wear
- } Blunt trauma to the eye
- } Chemical exposure to the eye
- } Symptoms that have persisted >72 hours
16
Q
Pharmacologic for Allergic Conjuntivitis
A
- Artificial tears
- Ophthalmic decongestants
- Ophthalmic antihistamine/mast cell stabilizer
- Antihistamine/decongestants
- Oral antihistamines
17
Q
Ophthalmic Decongestants
A
- MOA: primarily on α-adrenergic receptors to constrict conjunctival vessels and decrease eye redness
- Duration of use is 72 hours
- Can produce rebound conjunctival hyperemia
