Self Care II IE1 Material SHARMA

3 layers of tear film

• lipid layer (outermost)

  • oily layer prevents evaporation of tears

• aqueous layer (middle)

  • thickest watery layer provides hydration, O2, nutrients to cornea

• mucous layer (innermost)

  • helps aqueous later spread evenly over surface and adhere to cornea

lipid layer secreted by (glands)

• meibomian glands

  • inside eyelid

• glands of zeiss and moll

  • at base of each eyelash

aqeuous layer secreted by (glands)

• lacrimal glands

  • above each eyeball

• glands of Krause and wolfring

  • under eyelids

mucous layer secreted by (cells)

• goblet cells

  • in conjunctiva

• corneal and conjunctival epithelial cells

symptoms of dry eye

• what happens untreated

• itching, burning, scratchy

• foreign body sensation

• redness

• difficulty wearing contact lenses

• excessive tearing (inital stage)

• stringy mucous

• untreated → corneal ulceration, scarring, vision loss

non-pharm approaches in dry eye

• adequate water intake

• frequent blinking

• position screens below eye level → minimize tear evaporation

• consider warp around glasses → protect from wind and dust

• hairdryers and car ac away from eyes

• use humidifier

• stop smoking and dusty environments

• do not sleep under fan

active ingredients in artificial tears

• demulcents

  • cellulose derivatives

  • polyols

  • alcohols

• water-soluble polymers that lubricate and protect eye surface

  • CMC, HPMC
    propylene glycol, PEG, glycerin

  • PVA, Povidone

Inactive ingredients in artificial tears

• NaCl, KCl, MgCl2, CaCl2, Phosphate/Bicarbonate based buffer

• osmoprotectants

  • protect from damage

  • Trehalose, Carnitine

• humectants

  • absorb + retain water

    • sodium hyaluronate

  • oils

    • prevent water reabsorption

    • castor, mineral oil

Preservatives in artificial tears

• vanishing preservatives

  • break down components upon contact w/ light/eye

  • gentle

  • Purite, Sodium peroborate

• quaternary ammonium compounds

  • polyquaternium-1: safe + effective w/ low toxicity

  • BAK: toxic to corneal epithelial cells

mild case selection

• single active ingredient tear

  • CMC or HPMC

• lifestyle modifications

increased frequency selection

• if using preservative-containing drop more than 4- 6x day → switch to preservative free formula

multiple ingredient selection

• contains a lipid component (oils) to prevent evaporation

• for more relief

gel based tears selection

• for severe symptoms

• longer lasting relief

• consider referral

supplement w/ nighttime ointments

• used at night because they interfere w/ vision

• consider referral

what is prescription required artifical tear insert?

• Lacrisert

what is not recommended

vasoconstrictor containing eye drops

• “zoline” and phenylephrine

Perfluorohexyl octane (Meibo)

• MOA

• counseling

• form non-aqueous barrier on top of tears to prevent evaporation

• 1drop 4x daily, remove contact lens, reinsert after 30mins

• non-aqueous non-preservative multi-dose vial

Cyclosporine 3 meds

• MOA

• SE

• Counseling

• storage

• restasis

• cequa

• veyve

• MOA

  • calcineurin inhibitor that inhibits T lymphocyte activation → decrease inflammation and increase tears

• SE

  • burning sensation, eye pain, discharge, foreign body sensation

• Counseling

  • invert, wait 15 mins, remove contact lenses

• room temp 15 - 25 C

Restasis 0.05%

• cyclosporine emulsion in single dose unit or multidose vial

Cequa 0.09%

cyclosporine nanosphere solution in single unit dose

Veyve 0.1%

• semi-fluorinated alkane solvent in multi dose vial

• non-aqueous and preservative free

Lifitegrast (Xiidra)

• percentage and vial type

• MOA

• SE

• Counseling

• storage

• 5% single unit vial

• LFA-1antagonist that blocks T cell adhesion and activation → decrease inflammation

• blurred vision, eye discomfort, increased tearing

• wait 15 mins, remove contact lenses , 1 drop 2x daily

• room temp 20 - 25C

drugs that stimuate tear secretion

• Acoltremon (Trpytyr)

  • 0.003% single unit preservative free

  • 1 drop 2x daily

  • fridge

  • stimulate TRMP8 receptors

• Varenicline (Tyrvaya)

  • nasal spray 0.03mg

  • stimulate nicotinic cholinergic receptors

  • sneezing, coughing, nose throat irritation

  • prime pump 7 sprays

  • room temp

  • do not shake or freeze

anterior blepharitis

caused by lid colonization w/ staph bacteria and/or infestation w/ demodex mites

posterior blepharitis (MGD)

• dyfunction of meibomian gland related to staph infection

• bacterial lipase digests meibum, form fatty acids, clog glands, prevent release of oily tear layer → cause dry eye

anterior blepharitis symptoms

• staph

• seborrheic

• hard scales and crusting around eyelashes called collarettes

• greasy lid margins w/ soft scales causing lashes to stick

posterior blepharitis symptoms

swollen eye lids, capping of meibomian glands w/ oil causing dry eye

self care approaches of blepharitis

• good eyelid hygiene

  • remove crusts 1-2x day w/ cotton tip dipped in baby shampoo

• facilitate meibomian gland secretions

  • warm compress for 10 mins 2x day

  • massage

• eliminate demodex

  • tea tree oil scrubs - active 4-terpineol

  • Lotilaner (Xdemvy)

    • 1 drop 2x daily for 6 weeks

    • GABA channel inhibitor

pharm management of blepharitis

• topical antibiotics

  • “mycin”

• oral antibiotics for MGD

  • “cycline”

  • inhibition of microbial lipase

• alternative for children and pregnant women

  • azitrhtomycin, erythromycin

hordelolum (sty)

• acute staph infection of glands in eyelin

• external

  • zeiss or moll

  • warm compress, epilation of eye lash, incision, bacitracin, tobramycin

• internal

  • meibomian gland

  • warm compress

  • oral antibiotics (large) - dicloxacillin 1 - 2 weeks

• symptoms

  • painful, tender, red swelling

Chalazion

• chronic sterile lipogranulomatous inflammation

• hard, painless, non-red growth

• management

  • warm compress and massage 2 - 4 weeks

  • injection of triamcinolone acetonide max 2 injections; 1- 2 weeks resolved

  • surgical intervention