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56 Cards in this Set
- Front
- Back
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Name the FOUR minor cornea conditions in which pharmacists may offer help |
Allergic conjunctivitis, infective conjunctivitis, subconjunctival haemorrhage and dacrocystitis |
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what is the likely diagnosis if both eyes are affected? |
If both can be viral or allergic conjunctivitis. If both but one before the other, bacterial conjunctivitis |
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What is the likely diagnosis if the discharge is watery vs purulent |
Water is viral or allergic conjunctivitis. Purulent is bacterial conjunctivitis |
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What is the likely diagnosis is the patient experiences itching, pain, and no pain? |
No pain is experienced in all conjunctivitis and subconjunctival hemorrhage |
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what is the likely diagnosis is the patient experiences itching/gritty |
bacterial or allergic conjunctivitis |
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What is the likely diagnosis if the patient experiences redness around the center of the eye vs generalised, diffuse |
Generalised diffuse is all conjunctivitis - around the center of the eye is a more serious condition |
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What is the diagnosis depending on duration? |
2-3 days - infective conjunctivitis, if it is variable or depends on exposure to allergens then it is allergic conjunctivitis. If it is up to 10 days then it is subconjunctival haemorrhage |
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What is the likely diagnosis is there are some associated factors? |
No associated factors is bacterial conjunctivitis, cough and cold symptoms is viral conjunctivitis, allergic rhinitis is allergic conjunctivitis |
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What is open-angled glaucoma and what are the signs and symptoms? |
Open-angle (chronic) glaucoma results from an increase in ocular pressure due to an imbalance between production and drainage of aqueous humour. It develops slowly and initially is symptomless, but eventually it produces headache and loss of visual fi eld. It affects both eyes and can cause blindness if not treated. |
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What is closed-angle glaucoma and what are the sign and symptoms |
Closed-angle (acute) glaucoma is due to obstruction to drainage of aqueous humour. It presents as severe pain in one eye, accompanied by headache, nausea and vomiting. Visual fi eld is reduced and haloes may be seen around lights. |
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Whats is episcleritis and what are the signs and symptoms |
In episcleritis there is infl ammation of the sclera, the tissue immediately beneath the conjunctiva, producing a localised patch of redness. It is usually painless or there may be a dull ache. It is most common in young women. It is self-limiting, but could take several weeks to resolve |
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What is scleritis and what are the sign and symptoms |
Scleritis is of similar appearance to episcleritis but much more painful. It is oftenassociated with autoimmune conditions such as rheumatoid arthritis |
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What is uveitis and what are the symptoms |
Uveitis is infl ammation of the uveal tract (the structures around the iris). There is localised central redness, with pain and photophobia, and vision may be impaired. It may be associated with rheumatoid arthritis or ulcerative colitis |
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What is keratitis and what are the symptoms |
Infl ammation of the cornea is keratitis. There is severe pain with a watery discharge and photophobia. Redness is concentrated in the centre of the eye. It may result from trauma, long-term use of steroid eye drops or use of soft contact lenses |
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what is dry eye and what are the symptoms? |
Dry eye is a chronic condition, often associated with a systemic disorder such asrheumatoid arthritis. It may cause irritation and photophobia. Can be water or oil deficiency, |
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What are EIGHT criteria for referral for eye symptoms PRDSUNRD - PRRe SUND |
Pain distinct, Redness localised, Recurrent subconjunctival haemorrhage, Shape of pupils uneven, Uneven reaction to light, nausea and vomiting and headache, dry eyes and disturbed vision |
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Name two over the counter drugs for infective conjunctivitis |
Chloramphenicol and propamidine |
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What is the dosage of chloramphenicol eye drops? |
Dosage is one drop into the infected eye every 2 hours for the fi rst 48 hours and then every 4 hours, during waking hours only. Treatment should be continued for 5 days, if symptoms improve. |
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In which patients should chloramphenicol be avoided? |
Chloramphenicol eye drops should not be used in patients hypersensitive tochloramphenicol, who have experienced myelosuppression during previousexposure to chloramphenicol or with a family history of blood dyscrasias, andit is not recommended for pregnant or breastfeeding women. |
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why should frequent use of chloramphenicol be avoided? |
Prolonged or frequent intermittent use should be avoided, as it may increase the likelihood of sensitisation and emergence of resistant organisms. |
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When should patients on chloramphenicol be referred? |
The drops should not be used for more than 5 days, and patients should bereferred if symptoms do not improve within 48 hours of starting treatment. |
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Can you wear contact lenses with chloramphenicol treatment? |
As with all ocular antibiotic and most other eye preparations, contact lensesshould not be worn during treatment and soft contact lenses should not bereplaced for 24 hours after completing treatment |
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What are some counselling points for propamidine 0.1 and 0.15% |
discard after ONE month, ointment BD, drops QD. stop after 24hrs if improved, discard after 48hrs is no significant improvement. Store are room temp. |
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What is the only eyelid condition pharmacists may treat? |
There is one minor condition – stye (hordeolum) – for which pharmacists canoffer advice and treatment. It is caused by staphylococcal infection of a hairfollicle at the base of an eyelash. |
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What are the symptoms of stye hordeolum? |
Principal symptoms are pain, redness, swelling and irritation. Initially, the whole of the lid may be affected, then swelling becomes localised, and a yellow pustule may develop near the lid margin |
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What is the treatment for stye hordeolum? |
Naturally resolves once spontaneous rapture, use a flanel to perform compression for 5 to 10 minutes. If really painful, can be clinically punctured with sterile needle. Avoid contacts |
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What is blephartis? |
Blepharitis is chronic infl ammation of the lid margins, affecting both eyes. There are three main types: staphylococcal, seborrhoeic (frequently associated with seborrhoea of the scalp, eyebrows and ears) and contact dermatitis (due to cosmetics). |
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What are sign and symptoms of blephartis? |
The lid margins appear raw and red, with irritation, burning and itching. If contact dermatitis is the cause then there is generally a history of atopy, and other areas of skin may be affected. Scales are frequently seen on the lashes of both upper and lower lids, which tend to be dry in staphylococcal infections and greasy in seborrhoeic blepharitis. The lids become deformed in staphylococcal blepharitis due to ulceration. Lashes are frequently lost or may be distorted, turn inwards and rub on the cornea; this in turn can cause conjunctivitis. |
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What is the treatment for blepharitis? |
Mild seborrhoeic blepharitis can often be managed with eyelid hygiene without prescribed medication. However, medical diagnosis is always necessary fi rst and the condition may not respond to over-the-counter treatment. |
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What is a chalazion? |
A chalazion is a cyst of a meibomian gland: the meibomian gland secretes fl uid to stop the eyelashes sticking together. It may become infected or develop into a sterile chronic granuloma, a fi rm, painless lump in the lid which gradually enlarges. |
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What are the symptoms of chalazion? |
Initially, the chalazion may resemble a stye but is not infl amed. Chalazia usually grow inwards towards the conjunctival surface, which may be slightly reddened or elevated. Infected cysts are treated as styes. |
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How are chalazion treated? |
A third of cases willresolve spontaneously and virtually all will resorb within 2 years, but they areoften surgically removed before then |
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What is ectropion? |
This is mainly a condition of old age, as is entropion (see below). Sagging andturning outward of the lower eyelid occur from a natural loss of muscle tone andorbital fat. |
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what are the sign and symptoms of ectropion? |
Tears overfl ow and there is insuffi cient lubrication and protection for the eye. The lower lid may become chronically infected and scarred. This then requires surgical correction |
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how is Ectropion treated? |
It requires surgical correction |
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What is entropion and how is it treated? |
The lower lids turn inwards and lid margins and eyelashes abrade the surface ofthe eye. Lashes may fall out and susceptibility to infection is increased. Entropionrequires surgical correction |
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Whats is basal cell carcinoma and how is it identified? |
Basal cell carcinoma presents as a reddish nodule on the eyelid. There is no painor discomfort. There may be a history of prolonged exposure to sun or ultravioletlight. |
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What are some causes of sore and tired eyes? |
Redness and mild irritation in the eyes can be caused by activities such asdriving and close work, and environmental pollutants, including tobaccosmoke. |
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How can soreness and redness from fatigue be treated over the counter?
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astringents and vasoconstrictors. distilled witch hazel (hamamelis water), with astringent and anti-inflammatory properties Naphazoline, a sympathomimetic vasoconstrictor, is included in someophthalmic preparations to shrink the dilated blood vessels that cause redness |
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What is dry eyes? |
Dry eye (keratoconjunctivitis sicca) is a chronic condition characterised by dryness of the surface of the eye. |
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what causes dry eyes? |
It is caused by either a deficiency of conjunctival mucus, due to the absence or significant impairment of the mucinproducing goblet cells of the conjunctiva, or tear deficiency, the latter often associated with rheumatoid arthritis. |
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Should dry eyes be treated over the counter? |
The cause of dry eye requires medical diagnosis first |
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What are some treatments for dry eyes? |
Treatment is usually with tear substitutes (‘artificial tears’), containing compounds that enhance wetting, viscosity and stability of tears. These are: hypromellose, polyvinyl alcohol (PVA), carbomer 940, and hydrophobic ocular lubricants containing liquid and soft paraffi ns, such as Simple Eye Ointment. All preparations are available as P medicines |
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How do you apply the chloramphenicol oitnment |
The ointment, if used inconjunction with the drops, should be only applied at night– approximately 1 cm of ointment should be applied tothe inside of the eyelid, after which blinking several timeswill spread the ointment. If used alone, then the ointmentshould be used three or four times a day. |
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What is sodium cromoglicate used for |
allergic conjunctivitis, - Mast cell stabilisers (sodium cromoglicate) Intraocular sodium cromoglicate (e.g. Opticrom Allergy, Optrex Allergy) is a prophylactic agent and therefore has to be given continuously whilst exposed to the allergen. |
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how should sodium chromoglicate be used and which groups should it be avoided in? |
One or two drops should be administered in each eye four times a day. Although no minimum age is stated for their use, data on file from Sanofi Aventis (Opticrom Allergy) show it can be used from children over the age of six. Clinical experience has shown it to be safe in pregnancy |
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Which sympathomimetics can be used for red-eye conjunctivitis? |
These agents can be used to reduce redness of the eye.Products either contain a combination of sympathomimeticand antihistamine (antazoline/xylometazoline,Otrivine Antistin) or sympathomimetic alone (e.g. Naphazoline0.01%). |
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which groups should avoid sympathomimetics? |
They should be limited to short-term use to avoid rebound effects. Like all sympathomimetics they can interact with monoamine oxidase inhibitors and should not be used by patients receiving such treatment or within 14 days of ceasing therapy |
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Why should people not wear contact lenses when being treated with antibiotic eye drops? |
Patients who wear soft contact lenses should be advised to stop wearing them while treatment continues and for 48 hours afterwards. This is because preservatives in the eye drops can damage the lenses |
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Give a stepwise instruction set for administering eye drops? |
1. Wash your hands 2. Tilt your head backwards, until you can see the ceiling 3. Pull down the lower eyelid by pinching outwards to form a small pocket, and look upwards 4. Holding the dropper in the other hand, hold it as near as possible to the eyelid without touching it 5. Place one drop inside the lower eyelid then close your eye 6. Wipe away any excess drops from the eyelid and lashes with the clean tissue 7. Repeat steps 2 to 6 if more than one drop needs to be administered |
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Give a stepwise instruction set for administering eye ointment? |
1. Repeat eye drop steps 1 and 22. Pull down the lower eyelid3. Place a thin line of ointment along the inside of the lower eyelid4. Close your eye, and move the eyeball from side to side5. Wipe away any excess ointment from the eyelids and lashes using the clean tissue6. After using ointment, your vision may be blurred, but will soon be cleared by blinking |
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Counselling for lacri-lube a simple ointment |
These products contain a mixture of white soft paraffin, liquid paraffin and wool fat. They are useful at bedtime when prolonged lubrication is needed but because they blur vision are unsuitable during the day. They are pharmacologically inert and can be used in pregnancy and breastfeeding. |
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counselling for carbomer (clinitas, gel tears, liposic, liquivis, viscotears) |
Manufacturers recommend that adults and the elderly use one drop three or four times a day or as required, depending upon patient need. Due to the products viscosity, carbomer should be used last if other eye drops need to be instilled. Manufacturers advise avoidance in pregnancy and lactation due to insufficient data. Clinical experience, however, has shown carbomer can be used safely in these patient groups. |
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counselling points for polyvinyl alcohol |
Two proprietary products are available; Liquifilm Tears and Sno Tears. The standard dose is four times day. Liquifilm is also available as a preservative-free formulation. It can be given to all patient groups
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What medicaiton can cause dry eyes? |
Diurectics, antichilinergics (TCAs, antihistamines), HRT, SSRIs, beta blockers, |
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Which drugs are used for dry eyes? |
Dry eyes are managed by the instillation of artificial tears and lubricating ointments. Products in the UK consist of hypromellose (0.3 to 1.0%), polyvinyl alcohol, carmellose, carbomer 980, sodium hyaluronate and wool fats. |
