eye & ear conditions

Can you use eye drops in the ear?

Yes

Can you use ear drops in the eye?

No

1 drop = ____ mL

0.05 mL

How many times should you shake gels?

Invert and shake once

Medications that can increase IOP (4)

• Anticholinergics (antihistamines, oxybutynin, tolterodine, benztropine, scopolamine, trihexypenidyl, TCA)

• Decongestants (pseudoephedrine)

• Chronic steroids (esp eye drops)

• Topiramate

Glaucoma TX

make less fluid

• Beta blockers (timolol)

• Carbonic anhydrase inhibitors (dorzolamide)

move fluid out

• Prostaglandin analog (latanoprost)

OR BOTH - often achieved with add on TX with alpha-2 agonist (brimonidine)

Prostaglandin analogs ("prost") MOA & options (3)

Increase aqueous humor outflow

• Bimatoprost (Lumigan)

• Latanoprost (Xalatan, Xelpros)

• Travoprost (Travatan Z)

What class can increase eyelashes?

Prostaglandin analogs like bimatoprost

Prostaglandin analogs (ex: bimatoprost) adverse effects (4)

• Blurred vision

• Stinging

• Increased pigmentation or iris/eyelashes

• Eyelash growth

Beta blockers MOA & options (1)

Reduce aqueous humor production

• Timolol 0.25% and 0.5% (Timoptic, Timoptic XE, Istalol): Non-selective

Timolol dosing (2)

• Timoptic: 1 drop daily or BID

• Timoptic-XE: daily

Timolol gel should be shaken once and then use ___ mins later

10

Timolol adverse effects (4)

• Burning

• Stinging

• Bradycardia/fatigue

• Bronchospasm

Timolol/dorzolamide brand

Cosopt PF, Cosopt

Dorzolamide MOA

Carbonic anhydrase inhibitor that reduces aqueous humor production

Dorzolamide: avoid in patients with ____ allergy

Sulfonamide

What medication is used for acute mountain altitude sickness?

Acetazolamide

Brimonidine MOA

Adrenergic alpha-2 agonist that increases aqueous humor outflow and reduces aqueous humor production

Prevention of pink eye (4)

• Avoid touching eyes

• Proper hand hygiene

• Change towels & washcloths daily

• Discard eye cosmetics

VIRAL PINK EYE

• Adenovirus

• No topical TX

BACTERIAL PINK EYE causes and tx

• Staph aureus or more severe cases by N gonorrhoe or Chlamydia

TX: topical eye drops & ointments

• Moxifloxacin (Vigamox)

• Neomycin/polymyxin B/dexamethasone (Maxitrol)

• Ofloxacin (Ocuflox)

• Trimethoprim/polymyxin B (Poytrim)

Azithromycin eye drops (AzaSite) is stored in the fridge or stable at room temp for ___ days

14

ALLERGEN PINK EYE tx

• Pollen, dust, molds

TX:

• Mast cell stabilizers

• Antihistamines: azelastine, olopatadine (pataday)

• Antihistamine/mast cell stabilzer: Ketotifen (Alaway, Zaditor)

What is blepharitis & what is the treatment?

Eyelid inflammation

• Warm, moist washcloth

What preservative is commonly added to eye drop? (studygal)

BAK (Benzalkonium chloride)

Eye drop administration if you have contacts

Take out contacts before using eye drops and wait 15 mins after administration before inserting back in

Eye inflammation TX (2)

Steroid

• Prednisolone (pred forte, pred mild)

NSAID

• Ketorlolac (acular)

Steroid eye drops should be used short term due to risk of increased ____

IOP

Eye dryness TX (2)

• Refresh

• Systane

Chronic dry eye dx TX (1)

• Cyclosporine emulsion eye drops (restasis)

Eye redness TX (3)

• Naphazoline (Clear Eyes Redness Relief)

• Naphazoline/Pheniramine (Naphcon A, Visine A)

• Tetrahydrozoline (Visine)

What RX can cause intraoperative floppy iris syndrome and therefore difficulty in cataract surgery?

Alpha-blockers (tamsulosin)

What RX can cause yellow/green vision?

Digoxin

What RX can cause greenish tinge around objects?

PDE-5 Inhibitors

What RX can cause optic neuropathy? (3)

• Amiodarone

• Ethambutol

• Linezolid

What RX can cause retinal changes/retinopathy? (2)

• Chloroquine

• Hydroxychloroquine

What RX can cause decrease night vision, dryness, & irritation?

Isotretinoin

What can you use to treat ear wax blockage?

Carbamide peroxide (debrox) limited to 3-5 days

TX of otitis externa (2)

• Acetic acid/glucocorticoid (VoSol HCl) ear drops

• Ciprofloxacin and dexamethasone (Ciprodex) ear drops

How long should you want between eye drops of different drugs?

5-10 mins

Where do you apply opthalmic ointments?

Space inside the lower eyelid

AD

right ear

AS

left ear

AU

both ears

OD

right eye

OS

left eye

OU

both eyes

Which is treated with drugs and which is treated with surgery pen angle glaucoma or closed angle glaucoma

Open angle: drugs (timolol)

Closed angle: Medical emergency that is treated surgically

Prostaglandin analogues warnings

Darkening of iris and eyelash

Increased length and number of eyelashes

Which prostaglandin analogue must be refrigerated after opening

Latanoprost

Cholinergic eyedrop for glaucoma that can cause poor night vision

Pilocarpine

Drug that causes visual field defects

topiramate

Drug that causes permanent vision loss

Vigabatrin

Drug that causes abnormal vision

Voriconazole