Self-Care 2025: Eye and Ear

Clinical Presentation of Dry Eyes

Normal-appearing white sclera or mildly red eye, often associated with patient complaints of a sandy, gritty feeling or a sensation that something is in the eye

What eye disorder is often associated with that aging process?

Dry eyes

Dry eyes manifests with what initially?

Excessive tearing

-Abnormalities in the tear layer cause less-than-optimal lubrication of the ocular surface, with subsequent inadequate tear production and initiation of a vicious circle.

What are the exclusion factors for eye surface disorders?

Eye pain

Blurred vision not associated with ophthalmic ointments

Sensitivity to light

History of contact lens wear

Blunt trauma to the eye

Chemical exposure affecting eye

Eye exposure to heat excluding sun exposure

Symptoms that have persisted for > 72 hours

Dry eye treatment goal

Alleviate surface dryness (thereby relieving symptoms of irritation and preventing damage)

Artificial Tears: OTC Dry Eye Therapies

Refresh Relieva: Carboxymethylcellulose sodium 0.5%, Glycerin 0.9%

Refresh Optive Advanced: Glycerin (0.9%), polysorbate 80 (0.5%), CMC 0.5%, boric acid, castor oil, erythritol, levocarnitine, carbomer copolymer type A

Systane: Polyethylene Glycol 400 0.4%, Propylene Glycol 0.3%

SootheXP: Light mineral oil (1.0%), Mineral oil (4.5%)

What does it mean if a product has a higher viscosity?

Higher viscosity = prolonged eye contact

Solution < Gel < Ointment

What formulations may be less likely to cause irritation?

preservative-free

Counseling for Eye Drops

1.Wash hands

2.Remove contact lenses, if applicable

3.Inspect expiration date

4.If the eye drops are a suspension, shake well.

5.Remove cap.

6.Tilt head back.

7.Pull down on the lower lid to create a well or pouch.

8.Apply 1 drop of solution. Do NOT touch the tip of the dropper to the eye

9.Gently close the eye.

10.Gently apply pressure to the tear duct with your finger.

11.Repeat steps 6-10 if more than 1 drop of solution needs to be used.

12.Blot excess solution from around the eyes with a tissue.

13.Wait 5 minutes to administer other drops. Administer drops 10 minutes prior to eye ointments/gels.

Eye Drops and Kids

Demonstrate:

-Put a drop into your own hand

-Let your child put a drop into your hand

-Put a drop into child's hand

Next, have your child lie down flat on the floor, looking straight up.

If you have a second person to help, have them gently hold the sides of the child's face so they don't turn away.

Issues with Eye Drops and Kids

Not easy to keep eyes open

-Can place the drops within the inner corner of each eye

-With practice, you may be able to place a drop in each eye in quick succession.

Which eye problem is caused by allergens such as pollen, pet dander, and topical eye preparations?

allergic conjunctivitis

Characteristics of Allergic Conjunctivitis

-Red eye with watery discharge

-Hallmark symptom of ocular allergy is pruritus (itching)

-Vision usually is not impaired but may be blurred because of excessive tearing

Goals of treatment of allergic conjunctivitis

Remove/avoid allergen

Limit/reduce severity of reaction

Provide symptomatic relief

Protect ocular surface

Non-Pharm Therapy for Allergic Conjunctivitis

Remove/avoid exposure to offending allergen by:

-Check pollen count

-Keeping doors and windows closed

-Use hypoallergenic bedding

-Washing clothes frequently

-Bathing or showering just before bedtime

-Running the air conditioning system

Apply cold compress to the eyes 3-4 times per day

Treatment exclusions for Allergic Conjunctivitis

-S/s of infection of eyelids (red, thickened lids, scaling)

-Blunt trauma to eye

-Exposure of eye to chemical

-Head lice

-Macular degeneration

-Hordeolum, chalazion, blepharitis

Antihistamine AND Mast Cell Stabilizer Products

-Olopatadine: 0.2% Once daily, 0.1% Twice daily

-Ketitofen: One drop in each eye Q12H

Antihistamine AND Decongestant combination Products

-Pheniramine & Naphazoline

-Antazoline & Naphazoline

Decongestant Products

-Oxymetazoline

-Brimonidine

-Tetrahydrozoline

Which eye disorder must be diagnosed by an eye care specialist before self-treatment is attempted?

corneal edema

Which eye problem can be caused by overwear of contacts, surgical damage, or inherited corneal dystrophies?

corneal edema

Corneal Edema Hallmark Symptom

Perceptions of halos or starbursts around lights

Treatment goal for corneal edema

Draw fluid from cornea (thereby relieving symptoms)

First-line self-treatment of corneal edema is:

2% sodium chloride solution 4 times per day

If symptoms of corneal edema persist for more than 1-2 weeks...

Nighttime use of 5% hyperosmotic ointment should be added to the regimen

If symptoms of corneal edema persist for more than 1-2 weeks after adding the nighttime ointment...

Switch to 5% hyperosmotic solution and continue use of nighttime ointment

If symptoms keep happening without relief from previous regimen for another 1-2 weeks...

Medical referral is necessary.

How much time should patients wait between administering multiple drops to the same eye?

5 minutes

How much time should patients wait to apply eye ointments/gels after administering eye drops?

10 minutes

Sensations of ear fullness, dull pain, itching, and hearing loss are symptoms of

impacted cerumen

Treatment goals for impacted cerumen

Remove the cerumen while preventing adverse events

Treatment Exclusions for Impacted Cerumen

-Signs of infection (irritation, rash)

-Pain associated with ear discharge

-Bleeding or signs of trauma

-Ruptured tympanic membrane

-Ear surgery in past 6 weeks

-Tympanostomy tubes present

-Incapable of following proper instructions

-Hypersensitivity to available OTC agents

-<12 years old

-Condition worsening after attempted self-treatment

Nonpharmacologic therapies for impacted cerumen

Use of ear-cleaning tool to remove wax in the outermost portion of ear canal;

Warm water irrigation with a bulb syringe

What are appropriate options to clean ears?

Cloth with warm water and soap to clean outside;

Warm water irrigation with bulb syringe

(DON'T use q-tips)

What is the most appropriate recommendation for pharmacologic treatment of impacted cerumen?

Carbamide Peroxide

-Can be used alone or in conjugation with warm water irrigation to remove loosened cerumen

Use of Carbamide Peroxide

Can be used in children +12 yrs and adults

Use in patients younger than 12 yrs should be directed by the advice of a primary care provider.

Steps for appropriate administration of carbamide peroxide into ear

-Tilt head to the side

-Place 5-10 drops in ear, wait several minutes, keeping head tilted

-Repeat last step 2x daily for up to 4 days if needed or as directed by doctor

-Gently flush with warm water, using soft rubber blue syringe to remove any wax

Presentation of Water-Clogged Ears

The presence of water in the ears can cause transient hearing impairment or a sensation of localized discomfort or fullness

Water-Clogged ears vs Swimmer's Ear

Water clogged: Excessive moisture in EAC

Swimmer's Ear: Local trauma to EAC caused by excessive moisture or abrasions; subsequent fungal/bacterial infections.

What are the goals of treatment of water-clogged ears?

Dry the external auditory canal,

Prevent recurrences

Treatment Exclusions for Water Clogged Ears

-Signs of infection (irritation, rash)

-Pain associated with ear discharge

-Dizziness

-Bleeding or signs of trauma

-Presence of ruptured tympanic membrane

-Ear surgery in past 6 weeks

-Tympanostomy tubes present

-Incapable of following proper instructions

-Hypersensitivity to available OTC agents

-Condition worsening after attempted self-treatment

What are the nonpharmacologic treatment recommendations for water-clogged ears?

Prevent exposure to moisture by using earplugs or bathing cap;

Pull earlobe gently while tilting head downward;

Use a blow dryer on the lowest heat setting

What is the principal OTC pharmacologic therapy for water-clogged ears?

Isopropyl alcohol in anhydrous glycerin

-Instill 4 or 5 drops in the affected ear