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OTC of ophthalmicdisorders

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shehab essam

on 6 April 2014

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Transcript of OTC of ophthalmicdisorders

OTC of ophthalmic disorders
7- A 63 years old man suffers froma high intraocular pressure in his eyes, is that a condition of glaucoma or cataract? what is the difference ,possible symptoms and treatment ? (Give examples from the Egyptian market.)
*Symptoms :
1.Severe pain
2.Blurred vision
3.Optic nerve damage
*Treatment :
-It’s a case of medical referral
- “ Myotic & Beta Blockers (POM) “ :
1.Latanoprost ( Prostaglandin analogue : Xalatan®)
2. Brinzolamide ( Carbonic anhydrase inhibitor : Azopt®)
3.Pilocarpine (Miotic parasympathomimetic : IsoptoCarpine®)
4.Timolol & Betaxolol ( Beta Blockers : Timolol®& Betoptic®)
5.Brimonidine ( α2 adrenergic receptor agonist : Alphagan®)

It is a condition of "Glaucoma'' ..
8-Enumerate the ophthalmic symptoms calling for medical referral, Explain possible eye disorder underlying these symptoms
9-There is an inflammation in my eyes but I do not know the reason, Can I use an ophthalmic corticosteroid without a doctor's prescription? What are the important precautions for their use?  If it is a bacterial infection, is there any combination of a corticosteroid and antibacterial?

-Corticosteroids are POM
-Precautions ???
a)NMT 5-7 days
b)Not used in case of viral or fungal infections
BUT
: in case of bacterial infections we can use “ Antibiotic – Corticosteroid “ combinations as :
-( Prednisolone + Neomycin + Polymycin ) : Predmycin-P®eye drops
-( Tobramycin + Dexamethazone ) : Tobradex®eye drops
-( Oxytetracycline + Hydrocortisone ) : Terracortil®eye drops & ointment.

1-I was in the chemistry lab, my friend was boiling a test tube that effervesced on my face and a drop got into my eyes, what do I have to do? (What about thermal exposure?) What are the precautions to follow if a piece of glass or wood got into your eye?
And What are the other types of eye trauma? What are its symptoms? And what would be the possible management?

Different types of eye trauma :

2)thermal exposure:
*symptoms: tearing ,photophobia
*causes :sun’s uv radiation
*management : use of eye lubricant

3)foreign body contact:
If a particle of wood, glass , metal becomes trapped in your eye
What should you do ?

4)corneal abrasions (scratched eye)
:
*causes
*cause eye redness & sensitivity to light
*management: see your eye doctor
*scratches may cause infection

5)eye swelling
:
*causes
*you may have bruising around your eye
*management : use ice pack & see your eye doctor to be sure there is no internal damage.

1)chemical burn
*causes
*symptoms :pain , redness
*what should I do ?

2-I feel a burning sensation in my eye and my eyelids are swollen with some fine scales on it, my friend is a doctor she told me it might be an inflammation in the eyelids, is that true and what are the causes?

It’s case of blepharitis
*Causes
:
(bacterial infection , seborrhoeic dermatitis , exposure to chemical fumes &smoke)
*treatment
:
1)antibacterial drugs(terramycin ointment & chloramphenicol eye drops)
2)corticosteroid anti inflammatory drugs (POM):
Fluorometholone & dexamethasone eye drops
(*shouldn’t be used if there is superfacial viral or fungal infection)

3-I recently got on an antihypertensive therapy but it leaves my eyes dry, is there any possible treatment? Are there other causes for eye dryness? (Mention the available eye drops in Egyptian market.)


Dry eye :

Definition :
Condition in which there are insufficient tears to lubricate the eye

Causes
:
1)Decrease tear production due to
*age
*certain medical conditions (diabetes , blepharitis, rheumatoid arthritis,thyroid disorders)
*tear gland damage
2)medication that cause dry eye
3)environmental factors (wind, dry climate)
4)long term use of contact lense

Treatment

Artificial tears : (OTC)
..tears gaurd, natural tears, refresh tears.
...genteal eye gel - eye gel occasionally cause transient burning sensation and blurred vision

14-Describe eye problems caused by wearing eye lenses..
Eye dryness
:
1-methyl hydroxyl propyl cellulose (
Tears Natural
)
2-Chlorbutanol (
Liquifilm Tears
)
3-Carbomere+Hyperomelose (
Genteal Eye Gel
)
4-soft parrafin (
Lacrilube S.O.P.
)
Corneal oedema
:
1-Flourometholone (
FML eye drops
)
2-Prednisolone(
Acetate Pred-Forte eye drops
)
3-Dexamethasone (
Dexonium eye drops
)
Keratitis :
*Predmycin-P-eye drops
*Torbadex eye drops
*Terracortil eye drops
4) A patient comes to your pharmacy with a complaint of red tearing eyes accompanied with itching what is your diagnosis? Are their specific questions relevant to the patient history that would confirm your diagnosis? Are there Prophylactic measures to prevent recurrence of this case? What is the treatment?

Diagnosis
:
allergic conjunctivitis


Questions relevant to patient history to confirm the diagnosis
:
• whether he suffers from asthma or allergic skin conditions, or allergic rhinitis
•if he was exposed to allergy triggering substance such as : dust , pollen , mold

The best prophylactic measure is
:

1) Anti allergic drugs:
a) Anti histaminics ((Emadine® eye drops , livostin® eye drops)
b) Mast cell stabilizer ( Alomide® eye drops , opticure® eye drops)
2) avoid allergens: Mold , pollen , dust
Treatment
:
OTC medications:
a)Artificial tears ex: refresh tears® , tears guard®
b)Ophthalmic decongestants: Prisoline®
c)Antihistamines: azelastine® eye drops
d)NSAIDs: Aspirin®, Ibuprofen® , ketoprufen®.

5) I feel something in my eye and there is pus discharge: Explain various infective disorders How would you differentiate between them (look into other accompanying symptoms) In which case would you interfere with OTC medication & what would you recommend, explain proper method of use & patient monitoring time frame.

infective ophthalmic disorders
:
Feeling that something in eyes
: viral conjunctivitis

Accompanying symptoms
:
Itchy eyes
Tearing Pink eye
Watery Discharge
Blurred vision
Pus discharge : bacterial conjunctivitis
Accompanying symptoms
:
Itching ..no pain ..no effect on vision.
Both symptoms together
:
keratitis
Bacterial keratitis :
fungal keratitis
viral Keratitis (due to herpes simplex Keratitis)
Amoebic keratitis

General symptoms of keratitis
:
• Painful inflammation
• Reduced visual clarity & sensitivity to light
• Clouding of the cornea with small white spot on the cornea
• Tearing
• Pus or thick discharge (bacterial: yellow , fungal: white , viral: transparent)
• Feeling that something in the eye
In which case would you interfere with OTC medication?
Viral conjunctivitis OTC medications:
1) Artificial tear preparations (Refresh tears® , tears guard® )
2) Ocular Decongestants ( prisoline® )
NB: if the patient suffers blurred vision the patient must refer to physician
Bacterial conjunctivitis OTC medications
:
Antibacterial drugs:
• Miphenicol® eye drops (chloramphenicol)
• Terramycin® ointment ( polymyxin+oxytetracyclin)

6)A patient steps to your pharmacy asking for prisoline® eye drops and Marcofen® , a combination he has lately tried to relief similar symptoms , you notice some fat like white spots on his iris what does this imply ? What are the possible predisposing symptoms? How would you respond?(answer explaining what is the eye “uvea” differentiating anterior and posterior uveal structure)?

fat like white spot : uveitis
The uvea is made up of
three parts
.
Uveitis
may be caused by:
• autoimmunity
• Infections or tumors.
• Bruises to the eye.
• Toxins that may penetrate the eye.
Symptoms
:
1) Pain & decreased vision
2) Red eye
3) photophobia
4) Dilated ciliary vessels
5) Keratic precipitates(KP) on the posterior surface of the cornea



Inflammation of the iris is called iritis (anterior uveitis) :
.• It is the most common form of uveitis
• Predominantly occurring in young and middle-aged people.
• May only affect one eye

Inflammation of the ciliary body is called cyclitis (intermediate uveitis) :
• Intermediate uveitis is common in young adults.
• inflammation appears in the vitreous cavity
• It has been linked to several disorders including: sarcoidosis and multiple sclerosis.

Inflammation of the choroid is called choroiditis or Chorioretinitis (posterior uveitis) :
• It is the least common form of uveitis.
• often involving both the retina and the choroid.


Inflammation of all three is called panuveitis.
• Behcet's disease is one of the most well-known forms of pan-uveitis and it greatly damages the retina.
*Intermediate, posterior and pan-uveitis are the most severe and highly recurrent forms of uveitis.
*They often cause blindness if left untreated

 Inflammation of a lash follicle or its sebaceous gland in the eyelid.

10-
What’s a Stye ?

Inflammation of the Meibomian glands, more posterior in the eyelid.

Not to be confused with.. a Chalazion

Etiology
:
*Normal skin flora Staphylococcus aureus through rubbing of the eyes and poor hygiene.
*Other triggering factors include malnutrition and sleep deprivation.
Prevention
:
*Eyelid hygiene
*avoid haring of washclothes or face towels.
*Remove yelid and face make up completely before sleep






A patient came to buy Ventolin® and Seretide® inhalers for his asthma as well as Norvasc® tablets (amlodipine) for his blood pressure . He also came for his prescription of timolol eye drops for glaucoma.
Detect two possible interactions. What is your intervention?


Question 11

Medication Review

Salmeterol
Salbutamol
Timolol
Amlodipine
Salmeterol
Salbutamol
Intervention
:
*Consult a physician for possible repalcement of Timolol by Pilocarpine.
*Dispense Seretide or Ventolin

12- What are the eye drops that should be keep in the fridge?

Xalatan (Latanoprost)
:
refrigerate Xalatan until you open it. Once opened , it may be stored at room temperature for 6 weeks.

Viroptic (Trifluridine)
:
store between 2 and 8 Celsius

AzaSite (Azithromycin)
:
store between 2 and 8 Celsius

Question 13
B - The proper method of applying more than one eye drops
:
*Wash
*Avoid touching
*Pull down the lower lid
*The other hand...without touching it
*The pocket
*Close your eyes for 2 or 3 minutes..Try not to blink or squeeze
*Wait 5 minutes
*Wash your hands.
How to apply eye drops without contaminating it and for how long could it be used after opening ?
*1 month
*A 7 day ..stored in the refrigerator after opening
Eye swelling
: if caused by injury then it’s “ eye trauma “ , it might be accompanied by : bleeding or cloudy lens
Meanwhile , if patient feels sore swollen eyelids accompanied by burning or itching sensation then it might be “ blepharitis “

Blurred vision
: if accompanied by burning sensation & feeling you have a foreign body in your eyes & that your eyes are dry then , it’s a “ dry eye “ condition which can be treated simply by lubricants
Meanwhile , if there is severe pain then it might be either a condition of “ corneal oedama “ or “ glaucoma “

Redness
: it may be due to simple “ dry eye “ condition or due to “ conjunctivitis “ which might be accompanied by :
1.Watery discharge & itching “ allergic conjunctivitis “
2.Watery discharge & blurred vision “ viral conjunctivitis “ ( Here , eye appears pinkish )
3.Creamy white discharge “ bacterial conjunctivitis “
Also, redness might be caused by “ uveitis “ which is accompanied by pain & keratic ppts on the posterior surface of the cornea
Or , “ foreign substance contact “ or “ chemical exposure “ ..

Any type of discharge is a case of medical referral
:
“ Pus or thick discharge “ : then it’s a case of “ keratitis “
“ watery or creamy white discharge “ : then it’s probably a case of “ conjunctivitis “ as mentioned before

In addition to other logic cases that require immediate medical referral as
:
“ chemical exposure “ or “ thermal exposure “ or “ foreign substance contact “


Management
:
*Patient conseling and referral to physician.
*Apply warm compresses.
Topical antibiotics.
*Minor surgery mat be needed

Chloramphenicol eye drops 0.5% W/V
:
Store between 2 and 8 Celsius

References
:
*American Academey of Ophthalmology
*Drugs.com
*Medscap

Proper method of use & patient monitoring time frame
:
a)Chloramphenicol (Miphenicol® eye drops)
*Eye drops should be stored at 2 to 8 C
*Apply 1 drop at least every 2 hours then reduce frequency as infection is controlled and continue to 48 hours
b)Polymyxin + oxytetracyclin (Terramycin® ointment)
*long term use may support fungal infection
*If superinfection occurs, the antibiotic should be discontinued
*Approximately ½ inch of the ointment is squeezed from the tube onto the lower lid of the affected eye two to four times daily.
*Avoid contamination of the tip of the tube when applying the ointment.
Bacterial conjunctivitis can be also treated with POM as:
Antimicrobial-Corticosteroid combinations ( predmycin-p eye drops , Tobradex® eye drops , Terracortil® eye drops and ointment )



Treatment
:
1)
Corticosteroid anti-inflammatory drugs (POM) :
a) Flourometholone (FML® eye drops or Flumetholone® eye drops or Flucon ®eye drops)
• It has the least corticosteroids side effects
• Dose: adult & child over 2 years , apply every hour for 24 – 48 hours , then reduce frequency to 2-4 times daily

b) Prednisolone acetate ( predforte ® eye drops)
• one to two drops into the two to four times daily.
• Shake well before use

c) Dexamethazone (Isopto Maxidex® eye drops or Dexonium® eye drops)
• It interacts with aspirin , diuretics and ketoconazole
• Side effects: corneal edema , raised IOP , retinal detachment

2)
Antibiotic – Corticosteroid combinations (POM) :
a) Prednisolone + Neomycin + polymicin (predmycin-p® eye drops )
b) Tobramycin+ Dexamethasone (Tobradex® eye drops)
c) Oxytetracyclin + Hydrocortisone(terracortil®eye drops & ointment )
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