Common Conditions of the Eyes and Ears

Eye drops and ear drops can be use interchangeably. T/F

False, eyes are more sensitive so they can be used in the ears but ear drops can NOT be used in the eyes

What are considerations for compounds made for eyes?

pH, tonicity (isotonic), sterility

SIG code for right hear

ad

SIG code for left ear

as

SIG code for each/both ears

au

SIG code for right eye

od

SIG code for left eye

os

SIG code for each/both eyes

ou

How many mL in 1 drop of ear/eye solution?

0.05 mL

Counseling points for ear/eye suspensions

shake well

Counseling points for ear/eye ointments

can make vision blurry (do not use with contact lenses)

Counseling points for ear/eye gels

invert and shake once (to get the medication into the tip before instilling into the eye)

Glaucoma Pathopsyiology

high aqueous humor --> increased intraocular pressure (IOA) --> damage to the eye ad loss of visual field

What IOP indicated glaucoma>

>22 mmHg

Wha is the normal IOP range?

12-22 mmHg

Open angle glaucoma vs closed angle

open - common, prevents without symptoms, treatd with eye drops of surgery

closed - sudden increase in IOP considered a medical emergency, treated surgically

Glaucoma Drug Tx goal

decreased IOP

Drugs that can increased IOP

- anticholinergics

- decongestants

- chronic steroids esp eye drops

- topiramate

Glaucoma Treatment Summary

reduce aqueous humor production

- beta blockers (timolol)

- carbonic anhydrase inhibitors (dorzolamide)

increase aqueous humor outflow

- alpha-2-agonists (brimonidine)

Both

- PG analoges (latanoprost)

When is a ophthalmic beta blocker preferable?

When IOP only raised in one eye (b/c eye changes with PG analogues)

What is the first-line tx of glaucoma?

PG analogues

PG analogues: MOA

increase aqueous humor outflow

What is the brand name for bimatoprost for glaucoma?

Lumigan

What is the brand name for bimatopros for inadequate eyelash growth?

Latisse

What are the brand names for latanoprost?

Xalatan, Xelpros

What is the brand name for travoprost?

Travatan Z

What are the PG analogues?

bimatoprost, latanoprost, travoprost

PG analogues: Warnings

darkening of the iris, eyelash length and number growth

PG analogues: SEs

blurred vision, stinging, increased pigmentation of the iris/eyeladh, eyelash growth

Latanoprost storage

refrigerator before opening after can keep at RT (up to 6 weeks)

Topical Beta Blockers: MOA

reduce aqueous humor production

What are the brand names for ophthalmic timolol?

Timoptic, Istalol

Topical Beta Blocker: SEs

burning, stinging, bradycardia/fatigue, bronchospasm

Which topical beta blocker used for glaucoma is non-selective?

betaxolol

recommended for pt with respiratory issues like asthma, COPD, chronic bronchitis, emphesyma

What is a topical cholinergic used for glaucoma?

pilocarpine

What is an important side effect of pilocarpine?

poor vision at night due to pupil constriction

What is the brand name for timolol + dorzolamide?

Cosopt

What are some carbonic anhydrase inhibitors used for glaucoma?

dorzolamide, acetazolamide

Carbonic Anhydrase Inhibitors: MOA

reduce aqueous humor production

Carbonic Anhydrase Inhibitors: Warnings

Sulfonamide allergy

What is acetazolamide mainly used for?

prevention and treatment of altitude sickness

What is an alpha-2 agonist used for glaucoma?

brimonidine

Alpha-2 Agonists: MOA

increase aqueous humor outflow; reduce aqueous humor production

What is a mother name for conjunctivitis?

pink eye

Conjuntivitis: Etiology

can be caused by viruses (usually), bacteria, or allergens/ocular irritants

What are the most contagious forms of conjunctivitis?

viral and bacterial

In what population does viral/bacterial conjunctivitis easily spread?

young children

Conjunctivitis: Transmission Prevention

- avoid touching eyes

- proper hand hygiene (thoroughly and frequently)

- change towels and washcloths daily

- discard eye cosmetics

What commonly causes viral conjunctivitis?

Adenovirus

Viral Conjunctivitis: Tx

generally no topical tx and will run its course

What organisms commonly cause bacterial conjunctivitis?

Staphylococcus aureus

Severe: Neisseria gonorrhoeae, chlamydia

Bacterial Conjunctivitis: Tx

Moxifloxacin (Vigamox)

Neomycin/Polymyxin B/Dexamethasone (Maxitrol)

Ofloxacin (Ocuflox)

Trimethoprim/Polymyxin B (Polytrim)

Azithromycin

What is the brand name for moxifloxacin for pink eye?

Vigamox

What is the brand name for Neomycin/Polymyxin B/Dexamethasone for pink eye?

Maxitrol

What is the brand name for ofloxacin for pink eye?

Ocuflox

What is the brand name for Trimethoprim/Polymyxin B for pink eye?

Polytrim

Describe storage for azithromycin for pink eye.

store in the fridge and is stable for 14d at RT

Allergic Conjunctivitis: Causes

common allergens like pollen, dust mites, animal dander

Why should steroids only be saved for severe eye inflammation/allergic conjunctivitis?

risk of increased IOP

Allergic Conjunctivitis: Tx

-cromolyn

- azelastine

- olopatadine (Pataday)

- ketotifen (Alaway, Zaditor)

What is the brand name for olopatadine for pink eye?

Pataday

What are the brand names for ketotifen for pink eye?

Alaway, Zaditor

What is blepharitis?

inflammation of the eyelid margins

Blepharitis: Tx

mainly a warm compress over the eye to loosen and wipe away debris

How can eye inflammation generally be treated?

- cold compress

- NSAID eye drop if mild

- steroid eye drop if severe

Eye inflammation: Tx

- prednisolone (Pred Forte, Pred Mild)

- ketorolac (Acular)

What are the brand names for prednisolone for eye inflammation?

Pred Forte, Pred Mild

What is the brand name for ketorolac for eye inflammation?

Acular

Eye Dryness: Tx

Artificial tears

What are examples of artificial tears used for eye dryness?

Refresh, Systane

What is used to treat chronic dry eye?

cyclosporine emulsion eye drops (Restasis)

What is the brand name for cyclosporine emulsion eye drops?

Restasis

Eye Redness: Tx

- nephazoline (Clear Eyes Redness Relief)

- nephazoline/pheniramine (Naphcon A, Visine A)

- tetrahydrozoline (Visine)

What is the brand name for nephazoline?

Clear Eyes Redness Relief

What is the brand name for nephazoline/pheniramine?

Naphcon A, Visine A

What is the brand name for tetrahydrozoline?

Visine

What medications can cause retinopathy?

- chloroquine

- hydroxychloroquine

What medications can cause optic neuropathy?

- amiodarone

- ethambutol

- linezolid

What medications can cause intraoperative floppy iris syndrome following cataract surgery?

alpha blockers like tamsulosin

What medication can cause yellow/green vision?

digoxin (with toxicity)

What medication can cause a visual greenish tinge around objects?

PDE-5 inhibitors like tadalafil & sildenafil

What medication can cause visual blurriness or halos?

digoxin (with toxicity)

What medications can cause vision loss in one or both eyes that can be permanant?

PDE-5 inhibitors like tadalafil & sildenafil

What medication can diminish vision at night, cause eye dryness, and irritate the eyes?

isotrentinoin

What medication can cause visual field defects?

topiramate

What medication has a high risk for causing permanent vision loss?

vigabatrin

What medication can cause abnormal vision and photophobia/sensitivity to light?

voriconazole

What can cause pain in the ear?

otitis externa or cerumen impaction

What is otitis externa?

swimmers ear or infection to ear

What is cerumen impaction?

when too much ear wax (aka cerumen) accumulated in the ear

Otitis externa tx

ciprofloxacin/dexamethasone (Ciprodex)

What is the brand name for otic ciprofloxacin/dexamethasone?

Ciprodex

Cerumen Impaction Tx

removal by irrigation or carbamide peroxide (Debrox)

What is the brand name for otic carbide peroxide?

Debrox

How are PG analogues given?

1 drop qHS

if pt wears them have them remove before admin and put back on in AM