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79 Cards in this Set
- Front
- Back
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Treatment for corneal edema
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Anti-osmotics
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Causes of corneal edema
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Birth trauma, corneal dystrophies, keratoconus, inflammation, increased IOP
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What does Sodium Chloride treat?
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Corneal edema
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Sodium Chloride
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Treats corneal edema
Works best if epithelia is intact |
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Sodium Chloride adverse effects
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Stinging on insertion
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What does Glycerin treat?
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Corneal edema
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Glycerin
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Treats corneal edema
Reduces edema in 2 minutes |
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Glycerin adverse effects
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VERY painful on insertion
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Cause of aqueous deficient dry eye
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Lacrimal dysfunction
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Aqueous deficient dry eye diagnostic tests
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Schirmer's test, TBUT, FL staining of surface, Biopsy of salivary gland, Biomarkers in tears/blood
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Sjogren's Syndrome
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Chronic autoimmune disease where patients white blood cells attack moisture producing glands
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Sjogren's Syndrom diagnostic tests
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Biopsy of salivary glands
Biomarkers in blood/tears |
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Aqueous deficient dry eye treatment
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Artificial tears, punctual plugs, goggles, low dose steroid (Alrex/lotemax), Restasis (Cyclosporine), autologues serum/ PRP
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Artificial tears
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Increase tear volume for 10 minutes
Requires frequent use |
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Low viscosity artificial tears
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Does not interrupt vision
Dosed often Often preservative free |
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Medium viscosity artificial tears
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Slightly thicker than low viscosity
Preservative free or naturalizable preservative |
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High viscosity artificial tears
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All preservative free
Gels take more time than a few blinks to clear vision |
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Bland Ointments
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Non-medicated petrolatum
Blurs vision so use at bedtime |
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Slow release inserts
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Contain hydroxypopylcellulose (HPC) without preservatives
Constant release of polymer, needing replaced every 24 hours |
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Cause of lid related dry eye
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Anterior or posterior blepharitis
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Blepharitis diagnostic tests
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TBUT, slit lamp examination, tear sampling, meibography, expressions of MG's
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Systemic oral antibiotics for treatment of blepharitis
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Tetracycline
Doxycycline Minocycline Erythromycin |
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Dosage of Tetracycline for treatment of blepharitis
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150 mg orally QID for 6 weeks
Taper to 250 mg daily for 3 months |
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Dosage of Doxycycline for treatment of blepharitis
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100 mg orally for several weeks
Taper to 50 mg BID for a few months |
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Dosage of Minocycline for treatment of blepharitis
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50 mg orally BID for 2 weeks
Taper 100 mg BID for 3 months |
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Dosage of Erythromycin for treatment of blepharitis
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250 mg orally QID for 4 weeks
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Lotemax, Alrex
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Treats inflammation and dry eye
Won't elevate IOP or induce IOP |
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Lotemax, Alrex dosage
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QID for 1 month then taper
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Restasis (Cyclosporine)
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Suppresses T-cell lymphocytes
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Restasis (cyclosporine) dosage
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BID
Takes 1-3 months to begin working |
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Restasis (cyclosporine) adverse effects
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Stinging
20% patients fail |
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Acetylcysteine
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Mucolytic
Treats filamentary keratitis by eliminating mucus filaments Dissolves in corneal filaments |
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Direct acting cholinergic agonist
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Act similar to ACh
Respond to muscarinic and nicotinic receptors involved in autonomic activity Parasympathomimetic |
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Direct acting cholinergic agonist effects
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Bronchi narrow
Bowels go Glands flow Heart slows down |
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What does pilocarpine treat?
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Angle closure glaucoma
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Pilocarpine
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Stimulates longitudinal muscle of ciliary body, causing scleral spur to widen trabecular meshwork and increase aqueous outflow
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Pilocarpine IOP reduction
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15-20%
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Pilocarpine Dosage
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QID
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Pilocarpine Adverse effects
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Miosis
Ciliary muscle spasms causing brow ache Retinal detachment Induced myopia |
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Pilocarpine Systemic effects
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Abdominal pain, diarrhea, nausea, bradycardia, hypertension, perspiration, bronchospasm
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What does Echothiophate treat?
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Glaucoma
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Echothiophate
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Indirect acting cholinergic agonist
Binds irreversibly to cholinesterase Lasts 1-4 weeks |
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Echothiophate adverse effects
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Cataracts
Iris cysts Upset GI |
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Beta 1
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Present in blood vessel walls and heart muscle
Stimulate tachycardia and increase cardiac output |
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Beta 2
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Present in bronchial vasculature causing bronchial dilation
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Beta Blockers effect on eyes
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Treat glaucoma
Reduce aqueous production |
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Beta blockers IOP reduction and dose
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25% with daily dose
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Beta blockers adverse effects
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Allergic reaction
Reduced TBUT and tear flow Bradycardia Hypotension Bronchospasm CNS effects |
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Alpha adrenergic agonist
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Act like catecholamines (epinephrine, norepinephrine)
Respond to alpha 1 and 2 receptors causing smooth muscle contraction Sympathomimetric |
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Apraclonidine
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Sympathomimetic
Alpha 2 adrenergic agonist Decreases aqueous production and enhances uveoscleral outflow |
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Apraclonidine IOP lowering
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20%
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Apraclonidine Adverse effects
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Conjunctival blanching
Eyelid retraction Mydriasis Allergy with long term use Dry mouth and nose |
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Brimonidine
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Sympathomimetic
Alpha 2 adrenergic agonist 30 times more selective than Apraclonidine Now uses Alphagan P as preservative to decrease allergy |
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Combigan
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Alpha agonist with beta blocker to decrease allergic response
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Carbonic Anhydrase inhibitors (CAI)
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Lower IOP by inhibition of aqueous production
Peak action in 2-4 hours |
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Topical CAI
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Dosed TID
Less effective than systemic CIA, but fewer systemic side effects |
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Topical CAI IOP lowering
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20-25%
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Topical CAI with beta blocker IOP lowering
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30%
Both adverse effects apply |
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CAI Ocular adverse effects
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Stinging
Ocular allergy Punctate Keratitis Reduced endothelial cell function |
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CAI CNS adverse effects
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Headaches
Nausea Fatigue |
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CAI Hematological adverse effects
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Blood dyscrasias
Electrolyte imbalance |
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CAI Immune and digestive adverse effects
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Sulfa allergy
Bitter taste Lost appetite |
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Prostaglandin F2-alpha
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Activates prostanoid selective FP receptors in the ciliary body and iris sphincter increasing the uveoscleral outflow
Peak concentrations at 2 hours Results in reduced collagen types 1,3,4 resulting unreduced IOP |
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Prostaglandin F2-alpha IOP lowering and dose
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30% dosed 1 time a day
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Prostaglandin F2-alpha adverse effects
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Eye reddening
Iris darkening |
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Xalatan
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Prostaglandin F2-alpha
Less likely to develop redness and irritation |
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Lumigan
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Prostaglandin F2-alpha
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Travatan
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Prostaglandin F2-alpha
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Zioptan
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Prostaglandin F2-alpha
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Zioptan IOP lowering
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28%
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Zioptan adverse effects
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Conjunctival hyperemia
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Bevacizumab
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Binds VEGF preventing its interaction with receptor on surface of endothelia cells
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Ranibizumab
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Monoclonal antibody fragment
Anti-angiogenic action by inhibiting VEGF |
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What does Ranibizumab treat?
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Wet ARMD
Diabetic macular edema Macular edema Retinal vein occlusion |
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Ranibizumab Dosage
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Injected intravitreally each month
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Ranibizumab adverse effects
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Conjunctival hemorrhage
Eye pain Vitreous floaters Increased IOP Intraocular inflammation |
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Pegaptanib
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Selective VEGF antagonist
NOT a monoclonal antibody |
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Botulinum toxin
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Blocks nerve impulses telling muscles to contract, temporarily weakening/paralyzing facial muscles
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Botulinum toxin approved treatments
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Eye muscle disorders, strabismus, abnormal neck and shoulder contractions
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