(10) Ophthalmic and Contact Lens Disorders | Otic Disorders

Part 1 - 👁 OPHTHALMIC DISORDERS

topics covered

• Exclusions for eye self-care

• Eye Disorders

• Eye-drop counseling

• Contact lenses

Exclusions for eye self-care

REFER:

• ⭐ Photophobia (light sensitivity).

• Symptoms lasting >72 hours despite treatment.

• Eye pain or blurred vision (unless caused by ointment).

• Trauma, chemicals, heat injury.

• Contact lenses → Remove until eye condition resolves.

Identify the eye disorder

Condition	Hallmark / treatment
Dry eye	Gritty/sandy ± tearing → Artificial tears
Allergic conjunctivitis	ITCHING + watery/red → Artificial tears → antihistamine drops
Corneal edema	Halos/starbursts around lights. → Refer FIRST: Must rule out angle-closure glaucoma.
Foreign substance	Dust/eyelash → Irrigate with water
Minor irritation	Red after wind/chlorine → Artificial tears
Contact dermatitis	New makeup + itchy swollen lids → Stop product + cold compress

Other conditions:

• Bacterial conjunctivitis

  • → Purulent yellow/green discharge.

• Viral conjunctivitis

  • → Watery discharge, typically no prominent itching.

• Stye (hordeolum)

  • → Infected gland → Warm soaks; refer if recurrent.

• Chalazion

  • → Blocked gland → Refer.

• Blepharitis → Eyelid inflammation

  • → Lid hygiene + warm soaks; refer if recurrent.

Dry eye

topics overview

1. Causes

   • Drugs that cause dry eye

2. Treatment

   • Facts

   • Treatment progression

   • Non-drug treatments:

Dry eye

Causes

Causes:

• ↓ tears OR ↑ evaporation (meibomian gland dysfunction).

• Drugs causing dry eye:

  • Antihistamines, antidepressants, decongestants, diuretics.

Dry eye

Treatment facts

• High viscosity = Thicker → lasts longer.

• Preservative-free = Less irritation with frequent use.

• Ointment = Blurs vision → bedtime.

Dry eye

Treatment progression

• Low-viscosity tears → 1–2×/day

• Preservative-free tears → 3–4×/day OR high-viscosity drops

• Preservative-free tears hourly + bedtime ointment

🧠 Thin → Thick → Night.

Dry eye

Non-drug treatments:

• Warm compress, humidifier, avoid vents/screens.

• ⭐ Omega-3 → EPA:DHA = 4:1, ≥2,000 mg discussed; evidence limited.

Allergic conjunctivitis

topics overview

1. Treatment

   • Types

   • Drugs

     • Allergy drugs

     • Ophthalmic decongestants

     • Homeopathic allergic-eye product → Similasan Eye Drops #2 (not FDA-approved).

Allergic conjunctivitis

Treatment Types

• 1st line: Artificial tears → wash allergens away.

• 2nd line: Ophthalmic antihistamine ± Allergy drugs (mast-cell stabilizer)

• Nonpharm: COLD compress 3–4×/day; avoid allergens.

  • ⭐ RAT: Pollen exposure at golf meet → Keep windows/doors closed.

Allergic conjunctivitis

Allergy drugs

Drug	Dosing	Age
Olopatadine (Pataday)	0.1% BID; 0.2%, 0.7% daily (Extra Strength)	≥2
Ketotifen (Zaditor/Alaway)	0.025% BID	≥3
Alcaftadine (Lastacaft)	0.25% daily	≥2

• Olopatadine → H1 blocker

• Ketotifen/Alcaftadine → H1 blocker + mast-cell stabilizer.

Allergic conjunctivitis

Allergy drugs All three →

• no decongestant; may cause burning/stinging.

Allergic conjunctivitis

Ophthalmic decongestants

• Drugs: Naphazoline, tetrahydrozoline, brimonidine 0.025%.

• Mechanism: α-agonists → Vasoconstriction → ↓ redness ONLY.

• Safety:

  • Rebound redness → Limit to 72 hours (except brimonidine).

  • Avoid in angle-closure glaucoma.

  • Dangerous if swallowed by children.

• Combo: Pheniramine + naphazoline → Allergy + redness.

Corneal edema

1. Drug

   • Hypertonic NaCl (Muro 128).

2. MOA

   • Draws fluid from cornea → tear film.

3. Treatment Progression

   • After specialist diagnosis,

     • 2% solution QID

     • add 5% ointment HS

     • switch to 5% solution QID (4 times a day)+ 5% ointment HS (bedtime)

   • Each stage ~1–2 weeks with provider follow-up.

4. AE: Burning/stinging (↑ concentration → ↑ stinging).

Eye-drop counseling

• wash hands; Remove contacts; don't touch tip.

• Professor taught discard opened multiuse drops after 30 days (follow actual product label in practice).

• 5 min between different drops.

• Drops → wait ≥10 min → ointment.

• Suspension → Shake; use after solutions.

• Press tear duct → ↓ systemic absorption.

Contact lenses

chart

Product	Purpose
Surface-active cleaner	Removes lipids
Enzymatic cleaner	Removes proteins
Saline	Rinses ONLY
Multipurpose	Rub → Rinse → Soak
Rewetting drops	Lubricate contacts
Hydrogen peroxide	Disinfect; neutralize 6 hours NEVER directly into eye; if exposed, remove lenses + flush.

Contact lenses

fun facts

• Rub 20–30 seconds, back-and-forth.

• ⭐ Rifampin changes soft contact lens color.

• Soft vs gas-permeable solutions → Not interchangeable.

• Most serious complication → Microbial keratitis → corneal ulceration.

PART 2 — 👂 OTIC DISORDERS

topics covered

• Ear self-care exclusions

• ear disorder

• Ear drops + irrigation admin

• OTC hearing aids

Ear self-care exclusions

REFER:

• Ruptured eardrum or ear tubes.

• Unable to follow instructions.

• trauma., Infection, discharge, bleeding,

Important differences:

• Earwax → Under 12 years = REFER.

• Water-clogged → Dizziness = REFER (not age alone).

• Symptoms not improving after 4 days → PCP.

• Ear surgery within 6 weeks.

 ear disorder

Condition	Hallmark → Action
Impacted cerumen (wax)	Fullness + gradual hearing loss → Carbamide peroxide (Debrox)
Water-clogged ears	Wet/full after swimming, little pain → Isopropyl alcohol 95% + glycerin 5% (Drying drops)
Otitis externa	PAIN moving outer ear + itching → REFER (No FDA-approved OTC medication to treat/prevent otitis externa)
Otitis media	Steady/sharp pain after URI → REFER
Ruptured eardrum	Severe brief pain + sudden hearing loss → REFER
Foreign object	Fullness/pressure when chewing → REFER

Impacted cerumen (wax)

1. MOA

   • Softens + loosens wax.

   • Debrox treats WAX, not WATER

2. Dose

   •  5–10 drops, 1–2×/day; retain up to 15 min; MAX 4 consecutive days.

3. NonPharm

   • Washcloth on outer ear

   • curette only at canal entrance in adults

   • NO deep Q-tips.

4. Causes

   1. Q-tips

   2. narrow canal, hair

   3. age-related gland changes, hearing aids/earplugs.

Water-clogged ears

1. MOA

   • Alcohol dries trapped water; glycerin prevents overdrying.

2. Dose

   • 4–5 drops, retain 1–2 min.

3. NonPharm

   1. Remove trapped water

      • Tilt ear downward

      • low-heat hair dryer at a distance

   2. Prevent water from entering with earplugs or petroleum-jelly cotton ball.

   3. ClearEars

      • Absorbs water (does not prevent entry)

      • MAX 10 min

      • supervise <11

      • expands if swallowed → choking risk.

4. Cautions (Drug Warning)

   •  Flammable

   • lecture did not specify minimum age

   • Do not use with eardrum perforation/tubes or other exclusions.

 Ear drops + irrigation administration

Ear drops

• Warm drops in hands; affected ear facing UP; avoid touching dropper tip to ear.

• Age ≥3 → pull BACK & UP. Age <3 → BACK & DOWN.

• Press tragus gently; remain positioned.

Irrigation

•  Warm water aimed toward canal WALL, not eardrum; drain well.

• STOP for pain/dizziness; do not irrigate if perforation/tubes suspected.

OTC hearing aids

1. Who can use them?

   • Age ≥18 with mild-to-moderate hearing loss.

   • No prescription/hearing test required for purchase

   • user handles fitting/setup.

2. When to REFER?

   • Severe hearing loss → audiologist

   • ear pain, dizziness, sudden hearing loss → ENT.

3. Counseling:

   •  hearing test

   • return policy, insurance

   • battery, smartphone compatibility