11.0 - Miscellaneous Primary Care Of Eyes

Front 1

How do you do an eye exam in the pharmacy?

Back 1

1. need good light
2. wash your hands
3. ask patient to look straight ahead: look at pupil, cornea and sclera
4. pull down lower lid and ask patient to look left and right - look at conjunctiva
5. examine reaction of pupils to light (penlight, or look at a brightlight and then back)
6. assess visual acuity - read small print, etc.

Front 2

Blocked tear ducts
(a) AKA?
(b) who?
(c) symptoms
(d) treatment

Back 2

(a) Dacryocystitis OR EPIPHORA (WATERY EYE)
(b) mostly babies - a thin tissue fails to open at birth, which usually unblocks by 9-12 months; sometimes also when there is trauma to the nose or infection
(c)starts days to weeks after birth: watery eye, tears running down face, discharge of pus, crusty eye lashes, increases susceptability to eye infections
(d) nothing. if neccessary, a small operation UNDER GA, sometimes massage which is difficult to do well

Front 3

Dry eyes
- causes

Back 3

- age (hormonal changes?)
- menopause
- keratoconjunctivitis sicca (KCS)
- Sjorgren's syndrome
- post herpes zoster
- thyroid conditions
- PD
- Vitamin A insufficiency
- anticholinergics, diuretics, ISOTRETINOIN
- lack of blinking (e.g. extended computing or reading, Bell's [facial] palsy = exposure keratitis)
- ectropion
- Environmental: air conditioning, smoke
- Contact lenses

Front 4

Dry eyes
- Sjorgren vs KCS?

Back 4

Same population group (rheumatic conditions) but KCS is chronic and Sjorgan's syndrome is recurrent and associated with dry mouth.

Front 5

Dry eyes
- symptoms

Back 5

dry
gritty
tired
WATERY

Front 6

When do you refer dry eyes?

Back 6

1. ectropion
2. sjorgran's syndrome (dry mouth)
3. children - dry eye is rare

Front 7

Examples of some eye drops for dry eyes (4 types)

Back 7

1. Systane (PEG and propylene glycol) is slightly more viscous and "aids in the healing process"
2. Polytears and Genteal (hypromellose) have the least irritant preservative
3. Refresh Contacts (bottle, preserved) and Bion Tears (single use) are suitable for contacts
4. Genteal gel, Viscotears Liquid Gel for night time use

Front 8

How do you use tear substitutes? Any cautions?

Back 8

as often as needed
any body

Front 9

PBS listing of artificial tears?

Back 9

PBS-R for severe dry eye syndrome including sjorgran's syndrome & single use only if can't tolerate preservatives
Includes Viscotears, Genteal gel, Systane, Refresh Tears Plus, and single use Bion Tears

Front 10

What else can people do for dry eyes (besides artificial tears and treating the cause)

Back 10

- humidifiers
- avoid air conditioning and hair dryers
- wrap around sunglasses

Front 11

Types of contact lenses

Back 11

1. hard lenses - <10%, corrects severe astigmatism and better corrects other visual problems, initially uncomforatble for 1-2 weeks, are now permiable to oxygen, replace every 1-2 years
2. soft lenses - less durable, contains water and hydrogel
(a) Wear time: daily or overnight from 6-30 nights
(b) Replacement: daily to yearly

Front 12

Contact lenses and make-up

Back 12

Always put the contact lenses on first & use non-allergenic make-up such as clinique
Never apply eye liner between eye lash and eye
Remove contact before removing make-up

Front 13

Taking contact lenses out
- is it possible to lose a contact lens at the back of your eye?

Back 13

No

Front 14

Taking contact lense out - how (soft lenses)

Back 14

Use clean hands, and do it away from a drain!
To remove soft contact lenses, look upward or sideways while you pull down on your lower eyelid. With a finger, gently maneuver the lens onto the white of your eye. There, you can very gently pinch the lens together with your index finger and thumb and lift it off the eye. Until you master contact lens removal, you might consider keeping your fingernails clipped to avoid accidentally scratching and damaging your eye.

Front 15

Putting contacts in -

Back 15

1. wash hands - avoid overly scented or oily soaps and lanolin
2. Shake your lens case in the storage solution to loosen contacts if stuck
3. Dont mix up left and right contacts
4. cover in contact lens solution
5. Place lens on tip of index finger (right side up!)
6. pull up eyelids and look up or forward, and place lens on white of eye nearer to ear
7. Roll your eyes and then blink

Front 16

Contact lens care - TO AVOID CORNEAL INFECTION - what's that?

Back 16

1. Contact lens solution should be effective against bacteria, fungi, viruses and amoeba.
2. Contact lense solution should never be topped up or re-used. Similarly, never re-use bottles for solution holding.
3. Hydrogen peroxide is considered to be very safe. However, wearers should rinse lenses in saline solution prior to wearing lenses.
4. Handle with clean and dry hands - dry with a lint free cloth
5. Clean whenever removed from eye
6. store in a case, which is cleaned after each opening, and is disposed of frequently, e.g. with each new bottle of solution

Front 17

What other elements are there to lens care besides lens solution?
**Guidelines for the safe and effective use of contact lenses (Contact Lens Care Summit, 2007)

Back 17

1. Have a travel kit
2. Avoid other waters: never use tap water, close eyes in the shower, firmly close eyes when swimming or use goggles

Front 18

Shelf life of eye drops

Back 18

28 days - hospitals may have an earlier discard policy

Front 19

Design of eye drops: comment on
1. penetration
2. volume

Back 19

1. Drops may need to act topically or intraocular-ly
: if inside the eye: need a balance of lipid and water solubility to penetrate tear film, conjunctiva, cornea and aqueous humor
2. Excess mostly runs through tear duct to the nasal mucosa, where it can be absorbed systemically WITHOUT first pass effects

Front 20

1. Counselling on eye drops
2. What if you can't tell if it went in your eye?

Back 20

1. write date of opening and throw out after 28 days
2. wash your hands & dont touch dropper to eye or skin
** Shake cloudy suspensions before use
3. gently pull lower eyelid to make a pouch & put in 1 drop. Try not to blnk. hold tear ducts for at least 3 mins to increase effectiveness and prevent yucky tastes
4. wait 5 mins before next drop
** If you're not sure if it went it, try using refrigerated drops

Front 21

Counselling on eye ointments

Back 21

1. clean hands and don't contaminate tube opening
2. put 1cm on lower pouch
3. blink several times to spread it around
** use after eye drops
*** Don't use contacts

Front 22

Eye drops and children

Back 22

Hold the child's eyelids open or put drops at the corner of eyes and wait for eyes to open
If you need to, swaddle the child with a sheet and put their head between your knees!

Front 23

Eye drops & ointments and contacts

Back 23

1. Remove soft contact lense before using an eye drop, then reinserted after a period of at least 15 minutes. If drops are used twice daily you can insert the lens after putting in the morning drop and remove the lens before the evening drop.

If drops are used accidentally while lenses are in, remove them and rinse well with an appropriate solution before reinsertion.

Soft (hydrogel) lenses can be stained by some drugs (check with your pharmacist). Disposable lenses can still be worn.

Some drugs may make your eyes feel dry.

Do not wear contact lenses when using eye ointments.

Front 24

Eye infections and contacts

Back 24

Don't wear them until 24hrs after resolution

Front 25

Cataracts
- definition
- cause
- treatment
- prevention

Back 25

clouding in the cornea
smoking, diabetes, uv light, short sightedness
Treat with laser eye surgery; 85% or people recover vision well enough to drive
We don't know if they can be prevented but not smoking and eye protection may help