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tough, collagenous layer of the eye
aspherical, avascular tissue of the eye
What part of the eye is the rate limiting step of drug absorption?
What part of the eye maintains normal intraocular pressure?
Do lighter or darker irides have more drug absorption?
What part of the eye produces the aqueous humor?
If a patient is complaining about floating spots, what part of the eye is being affected and what should you do?
Exclusions for self treatment of the eye?
- eye pain
- sensitivity to light
- blunt trauma to eye
- chemical exposure to eye
- wears contacts
- sun or heat exposure
- blurred vision not caused by ointment
- sensitivity to light
- more than 72 hours
What is most common disorder affecting the anterior eye?
What drugs can cause dry eye?
- beta blockers
What are the symptoms of dry eye?
- white or mildly red eye
- sandy, gritty feel
- excessive tearing
What eye condition is linked to a T-cell mediated inflammatory process or abnormalities in the tear layer?
How do we primarily treat dry eye?
artificial tears (ocular lubricants)
What are some non-pharmalogic txts for dry eye?
- avoid allergens
- avoid heaters, fans, or dry, dusty places
- change environment
When would you recommend GenTeal or Tears Again (contain HPMC and CMC)?
for dry eye
What is GenTeal?
a gel for dry eye txt
What are the common vehicles found in artificial tears?
- PVA (polyvinyl alcohol)
What are the two types of ophthalmic lubricants?
- cellulose ethers
- PVAs and povidone
What is the MOA of the cellulose ether lubricants?
- stabilizes tear film
- slows tear evaporation
- increases viscosity (increases bioavailability of drug)
What is the MOA of PVA and povidone lubricants?
- enhance stability of tear film
- form hydrophilic layer on corneal surface (mucomimetic so provides mucin)
This is a special formulation that supplements the lipid component in tears, is long-acting, and can be given in addition to artificial tears?
Refresh Eye Drops
Which special formulation lubricant contains a lipid restorative layer?
Which special formulation lubricant helps protect the corneal epithelium through an osmotic effect?
This special formulation contains hydroxypropyl guar and binds to hydrophobic corneal surface and forms glycocalyx . It creates an ocular shield for epithelial repair and is a gelling and polymer system?
When would you recommend preservative free eye drops?
when they have severe dry eye and are dosing every hour
What are the dosing schedules for mild, moderate and severe dry eye?
- mild: 1-2 times daily
- moderate: 3-4 times daily
- severe: every hour
How long should you let drops sit in your eye before adding more?
If your patient needs ointment and drops, what do you tell them?
Tell them to place drops 10 minutes before ointment
What is the MOA of eye ointments?
- enhance retention time in the eye
- increase tear film integrity
When should we tell patients is the best time to use eye ointment?
What are the 3 ingredients in eye ointments?
- white petrolatum
- mineral oil
How do we dose eye ointments?
What does the combo of mineral oil, lanolin and white petrolatum in eye ointments allow for?
allows water and water-soluble drugs to be delivered
How much ointment should you place on the lower eyelid?
1/4 to 1/2 inch
What is an advantage of preservative free eye ointment?
What should you counsel a patient about if they are going to use a preser-free eye ointment?
- refrigerate it
- don't contaminate it
- watch expiration date
What strengths of NaCl eye products are considered to be isotonic?
What can we tell patients when one dry eye txt fails?
- try a different one with a different polymer or preservative in it
- use more drops
- add ointment at night
- then refer if alse else fails
If you get allergic conjuctivitis, is it ok to wear your contacts?
What is the hallmark symptom of allergic conjunctivitis?
What are some non-pharm txts for allergic conjunctivitis?
- use air conditioning
- new air filters
- keep windows closed
- avoid allergens
- watch pollen counts
- use a cold compress 3-4 x day
- similasan eye drops #2 (not proven though)
When do you refer with allergic conjunctivitis?
if symptoms are not better after 72 hours
What is the first line txt for allergic conjunctivitis?
What is the second line txt for allergic conjunctivitis?
- ophthalmic mast cell stabilizer antihistamine drops
- ophthalmic/decongestant product
- oral antihistamine
What is the max time to use ophthalmic decongestants?
72 hours max
What are some ophthalmic decongestants?
- oxymetazoline (imidazoles)
What are some adverse effects of ophthalmic decongestants?
- angle closure glaucoma
- abnormal drying
- rebound hyperemia
- allergic blepharitis
- blah blah blah
What are the advantages of ketotifen (mast cell stabilizer eye drops)? (Zatador and Alaway)
- quick relief
- lasts longer (12 hours)
- no vasoconstriction
- can give to children over 3
How does Ketotifen (Alaway, Zatador) work?
- potent inhibitor of H1 receptors
- inhibits eosinophils
- blocks mast cell degranulation
What are the 2 decongestant/antihistamine combo eye products?
What is the only eye product that be used for longer than 72 hours?
Is pink eye a viral or bacterial infection?
What is the most common type of conjunctivitis?
What is hyperemia?
engorgement with blood
What is the non-pharm txt for pink eye?
- cold compress
- lots of hand washing
- no sharing of towels or anything really
What is the first line pharm txt for pink eye?
- artificial tears + decongestant
- then antibiotics
How do we tell the difference b/w a viral and a bacterial conjunctivitis?
- bacterial = discharge from the eye, especially upon wakening
- eyes stuck together
What is the symptom of corneal edema?
starbursts or halos around lights
What is the first line txt for corneal edema?
- sodium chloride only thing available
- hyperosmotic stuff
What does a "physiologically balanced" eye solution look like?
pH and osmolality are normal
Why can't we wear our contacts when putting stuff in our eyes?
they will absorb the preservatives and could become toxic or harm the corneal epithelium
What can you use zinc sulfate for?
- minor eye irritation
- a mild astringent
What is punctate keratitis?
small pinpoint loss of epithelial cells in the cornea
What are the hardest chemical burns to the eye to treat?
Can we self treat chemical burns to the eye?
What can we tell a patient who comes in with a chemical burn to the eye?
irrigate it with saline or tap water until they can get to the doctor (for 10 minutes)
What are the two types of AMD?
- neovascular (wet or bleeding)
- atrophic (dry)
What is the leading cause of blindness in the US?
What is AREDS?
age related eye disease study
What type of AREDS should smokers take?
without beta carotene, but with zinc
Can you take AREDS eye vitamins along with your daily vitamins?
no, or else you'll get hypervitaminosis
What is in the AREDS eye vitamins?
- vitamin C
- beta carotene (can risk for lung cancer)
- cupric oxide
What are the 3 disorders of the eyelid that need to be referred and are exclusions for self txt?
This eye disorder involves both eyelids and includes swelling, redness, intense itching, and scaling?
How do we treat contact dermatitis of the eye?
- oral antihistamines
- cold compress 3-4 times daily
- avoid offending agent
Red, scaly, thickened eyelids are a sign of what eye problem?
How do you treat lice infestation of the eye?
- wash eyes with mild soap and water 4-5x daily
- apply ointment to suffocate out the lice
What is the non-infectious, not tender to the touch eye disorder?
What is an eye disorder that is an infection of the glands in the eye and is tender to the touch?