Self Care - Ophthalmic Disorders

Dry Eye Causes

aging process, anticholinergic medications, allergens or environmental factors (dry working conditions, air conditioning systems)

Medications that can cause dry eye

antihistamines, antidepressants, diuretics, beta blockers

Presentation of dry eye

mildly red sclera of eye, sandy/gritty feeling, dry feeling

Goals of treatment for dry eye

alleviate dryness and irritation, prevent ocular tissue damage

non-medicated ointments for dry eye

longer lubrication effect, more sticky, may advise to apply at night for morning dry eye relief

Common ingredients in non-medicated ointments for dry eye

white petroleum, mineral oil, lanolin

Artificial Tears

lubricates the eye to provide moisture

Common ingredients in Artificial Tears

carboxymethylcellulose (Refresh Tears, Thera Tears), polyethylene glycol (Systane), propylene glycol, glycerin

Dosing for Artificial Tears

product dependent, check back of box

Non-Pharmacologic strategies to relieve dry eye

avoid irritants, warm compresses, maintain good eye hygiene, avoid dusty or dry environments, avoid elongated screen usage

Common Causes of Allergic Conjunctivitis

Environmental antigens (pollen, animal dander, topical products such as cosmetics or OTCs)

Presentation of allergic conjunctivitis

red eyes with watery discharge, pruritus (itching), excessive tearing (blurred vision)

Goals of treatment for allergic conjunctivitis

reduce severity of allergic reaction, provide symptom relief, protect ocular surface

Pharmacologic treatment for allergic conjunctivitis

artificial tears, decongestants, alpha agonist, antihistamines

Use of Artificial Tears for allergic conjunctivitis

washout allergens

Use of Decongestant in allergic conjunctivitis

reduces eye redness

common ingredients in a decongestant

naphazoline, tetrahydrozoline, oxymetazoline

MOA of decongestant

reduces redness by causing vasoconstriction of vessels in eye

Risks of decongestants

risk of rebound redness after initial symptom improvement, may cause stinging or burning during administration

Avoid use of decongestants for patients with:

acute angle glaucoma, vascular comorbidities (hypertension, diabetes, cardiovascular disease)

Alpha agonist (brimonidine) use for allergic conjunctivitis

reduces eye redness

MOA of brimonidine

reduces redness by causing vasoconstriction of vessels in eye

Notes for brimonidine

does NOT cause rebound redness, safe for occasional use, NOT safe for daily use

Use of Antihistamines for allergic conjunctivitis

provides itch relief

Common ingredients for antihistamines

ketotifen fumarate, pheniramine

Duration of Action for antihistamines

relief within a few minutes, lasts up to 12 hours

Which two medications for allergic conjunctivitis are combined for relief in these products: Naphcan A, Opcon-A Eye Allergy Relief, and Visine-A Multi

antihistamines and decongestants

Example of ophthalmic antihistamine

Zaditor (ketotifen)

When should you refer a patient to a provider in regards to allergic conjunctivitis?

If symptoms do not resolve in 72 hours

Causes of Minor Eye Irritation

wind, sun/UV light, loose foreign material, chemical fumes

Presentation of minor eye irritation

pain and redness of the eye, feeling of “sand in the eye”

Pharmacologic Treatments for minor eye irritation

artificial tears, non-medicated ointments, mild-astringent drops

Mild-astringent drops active ingredient

zinc sulfate

Preservative containing products

may be used multiple times from the same bottle

preservative free products

must discard container directly after each use

How long does a bottle last after the seal is broken?

30 days; expiration date is voided

When to refer patients:

severe irritations or if symptoms will not resolve; green/yellow discharge

Dosing:

check each product label

Age-Related Macular Degeneration

over time, parts of the eye deteriorate, resulting in loss of the central field of vision (blurriness)

Common ingredients in eye vitamins

Vitamins A, C, and E, zinc, copper, lutein, omega-3 fatty acids, zeaxanthin

Treatment for age-related macular degeneration

Ocuvite Adult 50+ Age-Adjusted Formula and PreserVision Eye Vitamin Formula

Ocuvite Adult 50+ Age-Adjusted Formula Directions

1 soft gel by mouth every morning with food

Ocuvite Adult 50+ Age-Adjusted Formula side effects

upset stomach

PreserVision Eye Vitamin Formula Directions

2 soft gels daily; one in the morning and one in the evening with food

PreserVision Eye Vitamin Formula side effects

upset stomach

AREDS-1

contains beta-carotine

risk for AREDS-1

can increase risk of lung cancer in patients who smoke; up to 15 mg beta-carotene daily in non-smokers

AREDS-2

does NOT contain beta-carotene

Review Directions for:

eye drop and eye ointment administration

Soft contact lens

contains water, most common lens of choice, mass produced, flexible, replaced daily, weekly, or monthly

How to reduce infections or inflammation with soft lens:

replace frequently

Rigid contact lens

custom fit, uncomfortable at first, replace after several years

Lens Care

use container, follow directions provided with solutions, let contact lens set in solution for at least 6 hours

Most common used multi-purpose solutions for lenses

Biotrue, Renu, Opti-Free, Clear Care

How to clean lens:

rub in a back-and-forth pattern, inspect for chips, tears, or foreign bodies