eye lecture

what is the cornea

primary absorptive site

what is the conjunctiva

thin mucus membrane that covers sclera

what is a ciliary body

make aqueous humor

what is the nasolacrimal

drug can drain from eye to nasal cavity

what is the primary route of aqueous humor drainage

filtration through trabecular meshwork of the schlemm’s canal

what is the secondary route of aqueous humor drainage

absorption into the iris blood vessels

what are risk factors for open angle glaucoma

increasing age, family history, African American or Latino decent, corneal thinning, corticosteroids, elevated IOP, and type 2 diabetes

what is goal of treatment for glaucoma

lower IOP by 25-30%

what is first line treatment for glaucoma

prostaglandin or beta blocker or brimonidine or carbonic anhydrase inhibitor

what are prostaglandins

drugs than end in prost, first line glaucoma, most effective lower IOP 25-20%, once at bedtime, increase aqueous humor outflow via uveoscleral pathway, has irreversible eye pigmentation,

what are beta blockers for glaucoma

Timolol, alt first line, lower IOP 20-30%, block ciliary production of aqueous humor, if systemic can cause bradycardia, heart block or bronchospasms

what are alpha adrenergic agents for glaucoma

reduce aqueous humor production lowers IOP 18-27% at peak, causes mydriasis, brimonidine may have neuroprotective effect, BID or TID

what are opthalmic CAIs

lower IOP 15-26% precaution with sulfa allergy, systemic lowers IOP more but lot of side effects, Dorzolamide, brinzolamide, acetazolamide and methazolamide

what are rock inhibitors

increase out flow of aqueous humor, lower IOP 18%, (when IOP <27mmHg), works both daytime and night, causes red eyes, netarsudil

what are direct acting cholinergic agents

lowers IOP 20-30%, 1 drop 4-6 hours, pilocarpine solutions, side effects, increase outflow

what drugs causes open angle glaucoma

corticosteroids, and anticholinergic agents

what are angle closure glaucoma causing meds

anticholinergic, SSRIs, venlafaxine, topiramate, sulfa containing drugs

how does viral conjunctivitis present

clear discharge typically bilateral caused mainly by adenovirus

what is self treatment for viral conjunctivitis

self limiting 10-14 days, avoid ocular corticosteroid, cold compress artificial tears and ocular antihistamines

how does bacterial conjunctivitis present

purulent discharge usually unilateral

what is first line for bacterial conjunctivitis

polymyxin ointment and drops, sulfa medications ointments and drops

what is aminoglycosides

gentamicin, and tobramycin ointment and drops less wide spectrum as not as effective against gram + streptococci

what are macrolides

azithromycin drops and erythromycin ointment (can be first line erythromycin)

what is fluroquinolones

all end in ofloxacin effective against pseudomonas aeruginosa second line poor streptococcus coverage,

what are antihistamines with mast cell stabilizing properties

olopatadine (pataday), and ketotifen 1BID

what are anithistamine decongestant

phernirmaine/naphazoline (naphcon, opcon, visine) 1-2 drops 4 times a day up to 3 days

what are corticosteroids for allergic conjunctiva

loteprednol, cataract formation, secondary infection, increase intraocular pressure

what are mast cell stabilizers

cromolyn sodium, nedocromil

what are treatment for annual or perennial allergic conjunctiva

topical antihistamine with mast cell stabilizer, ocular steroid, and intranasal steroids (flonase)

what are treatment for acute allergic conjunctiva

non-medicated artificial tears, ocular antihistamine/decongestant, ocular antihistamine with mast cell stabilizer

what is clinical presentation of dry eyes

white/mild redness of eye, sandy/gritty feeling, excessive tear production

what causes dry eyes

aging, decreased androgen hormones, sjogren syndrome, anticholinergic, antihistamine, diuretics, decongestants, estrogen, and environment

what is treatment of dry eyes

increasing blinking, scheduled breaks from computer, stop smoking, humidifiers, protective eye wear, drink water

what are eye lubricatns

artificial tears start 1-2 times a day then 3-4 times a day should with to preservative free or if allergic, ointments use at night cause blurry vision

what is cyclosporine

inhibition production and release of interleukin II and inhibits interleukin II induced action of resting T lymphocytes, onset 4 weeks and full effect 3-6 months wait 15 min

what is Xiidra

may inhibit T cell migration, T cell activation and secretion of pro inflammatory cytokines, onset 2 weeks full effect at 6-12 weeks, may cause taste sense alteration

what is eysuvis

corticosteroid for dry eye, shake 1-2 drops 4 times a day up to two weeks, wait 15 minutes after giving drop