Common Conditions of Ears and Ears

Yup!

How many mL are in one drop? And vice versa?

• 1 drop = 0.05 mL

• 1 mL = 20 drops

What is Latin for left?

• S = sinistra, latin for left. Left handed people are evil

What is Latin for right?

• D = Dextra

How is Glaucoma diagnosed?

• Intraocular pressure (IOP) and visual field test (losing peripheral vision)

What is normal IOP?

• 12-22 mmHg

Which drugs are known for risk to increase IOP?

• Anticholinergics (remembers TCAs are anticholinergic AF!)

• Cough/Cold/Motion Sickness medications

• Chronic steroid use

• Topiramate

Which drugs are MOST effective at reducing IOP? How much do they decrease IOP by? When should you use them? Weird side effects?

• Prostaglandin analogs (the “prosts”)

• Decrease IOP by ~30%

• Use at night

• WARNINGS for darkening of eye, skin, and lashes. Also can cause thick eyelashes

Which drugs are 2nd most effective at reducing IOP? How much do they decrease IOP by? Frequency? Weird side effects?

• Beta blockers

• Decrease IOP by ~22%

• Can be either once daily or BID (gels are generally once daily)

• WARNINGS in cardiac problems, pulmonary problems, and BAK warnings

If using a gel in your eyes, what do you need to do to prepare it? How long to wait before applying?

• Shake once before use do get the gel to the tip of the bottle

• Wait at least 10 minutes after other eye drops to apply gel. APPLY GEL LAST!!

Which classes of glaucoma meds make less fluid in eyes by reducing aqueous humor production?

• Beta blockers

• Carbonic anhydrase inhibitors (like Dorzalamide)

• Alpha 2 agonists (like Brimonidine)

Which classes of glaucoma meds move fluid out by increasing aqueous humor outflow?

• Prostaglandins

• Cholinergics (mitotic agents like Pilocarpine)

• Alpha 2 agonists (like Brimonidine)

• Rho kinase inhibitors (like Rhopressa)

What does ”PF” mean with regards to eye drops?

• “Preservative free”

If using different kinds of eye drops, how long do you have to wait between using them? How long if it the same drug but multiple drops?

• Between 2 drugs : wait at least 5-10 mins

• Between same drug: at least 5 minutes

In the case of bacterial pink eye, which bugs are usually responsible? Also, if it’s severe, which bugs, and what kind of treatment does that need?

• Staph aureus, Strep, H. influenzae, Moraxella catarrhalis

• If severe, could be from Neisseria or Chlamydia. Need SYSTEMIC treatment (IV or PO)

Which drugs to use to treat viral conjunctivitis?

• None! :)

Which drugs to use to treat bacterial conjunctivitis?

• Moxifloxacin (Vigamox)

• Neo/Poly/Dex (Maxitrol)

• Ofloxacin (Ocuflox)

• Trimethoprim/Polymyxin (Polytrim)

Which drugs to use to treat allergic conjunctivitis?

• Mast cell stabilizers like Cromolyn, Lodoxamide, Nedocromil

• Antihistamines like AZELASTINE, Olopatadine (Pataday) and Cetirizine

• Ketotifen (Alaway, Zaditor) is a combination of antihistamine/mast cell stabilizer

Which drugs can be used for eye inflammation?

• Steroids (prednisolone, dexamethasone)

• NSAIDS (ketorolac, bromfenac)

Which drugs can be used for eye dryness? What about chronic dry eye?

• Artificial tears like Refresh and Systane

• If chronic, Cyclosporine (Restasis) or Lifitegrast (Xiidra)

Why do we avoid long term use of steroid in eyes?

• Can increase IOP

What is Sjogren’s syndrome?

• A chronic autoimmune disease that primarily affects the moisture-producing glands, particularly those in the eyes and mouth, leading to dryness

Which drugs can be used for eye redness?

• Vasoconstrictors like..

  • Visine = Naphazoline/Pheniramine

  • Clear Eyes = Naphazoline

Which drugs have a known risk for retinopathy?

• Chloroquine

• Hydroxychloroquine

Which drugs have a known risk for optic neuropathy?

• Amiodarone (corneal deposits)

• Ethambutol

• Linezolid

Which drugs have a known risk of floppy iris syndrome?

• Alpha blockers (like Tamsulosin)

Which drugs have a known risk of changing color discrimination in eyes?

• Digoxin (with toxicity can cause red/green halos)

• PDE-5 inhibitors like Sildenafil

• Voriconazole

Which drugs have a known risk of causing vision loss/abnormal vision?

• Digoxin (with toxicity can cause red/green halos)

• PDE-5 inhibitors like Sildenafil

• Isotretinoin (can decrease night vision)

• Vigabatrin (strong seizure med in kids)

• Voriconazole

What are possible treatments for swimmers ear AKA otitis externa? How can you manage pain with swimmers ear?

• Ciprofloxacin + Dex (Ciprodex)

• Ciprofloxacin + Hydrocortisone (Cipro HC)

• If pain, can do PO Tylenol or ibuprofen. AVOID topical drops for pain in ear, you need to feel pain to know if your treatment is working

Treatment for ear wax (cerumen) blockage?

• Removal by medical professional

• Carbamide peroxide (Debrox)

Which way to pull earlobes for ear dops in those under 3 years old? and which way for those older?

• If UNDER 3 pull DOWN AND BACK

• If OVER pull UP AND BACK

What are generic names for the following:

• Lumigan

• Xalatan

• Xelpros

• Travatan Z

• Bimatoprost (Lumigan)

• Latanoprost (Xalatan, Xelpros)

• Travopost (Travatan Z)

What are the ingredients for the following combinations and also name their classes:

• Cosopt

• Combigan

• Cosopt = Dorzolamide / Timolol

  • Dorzolamide = Carbonic anhydrase inhibitors

  • Timolol = Beta blocker

• Combigan = Brimonidine / Timolol

  • Brimonidine = Alpha 2 agonist

Generic name for Rhopressa?

• Netasurdil

What are generic names for the following:

• Vigamox

• Maxitrol

• Ocuflox

• Polytrim

• Moxifloxacin (Vigamox)

• Neo/Poly/Dex (Maxitrol)

• Ofloxacin (Ocuflox)

• Trimethoprim/Polymyxin (Polytrim)

Generic name for the following:

• Lumify

• Visine

• Clear Eyes

• Brimonidine (Lumify)

• Visine (Naphazoline/Pheniramine)

• Clear Eyes (Naphazoline)

If using eye drops, how long should you wait before reinserting contacts?

• 15 minutes