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Copy of opthalmic disorders

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esraa hassan

on 5 April 2014

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Transcript of Copy of opthalmic disorders

ophthalmic disorders
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 are the precautions to follow if a piece of glass or wood got into your eye?
What are the eye drops that should be keep in the fridge?
How to apply eye drops without contaminating it and for how long could it be used after opening?
The proper method of applying more than one eye drops?
What are the other types of eye trauma? What are its symptoms? And what would be the possible management?
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?
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?
I feel something in my eye and there is a pus discharge:
• Explain various infective ophthalmic disorders?
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?
A 63 years old suffers from a high intraocular pressure in his eyes, is that a condition of glaucoma or cataract? What is the difference, possible symptoms and treatment?
Enumerate the ophthalmic symptoms calling for medical referral, Explain possible eye disorder underlying these symptoms
Thank you
Types of Eye trauma:
Blunt Eye Trauma: (black eye)

Bruising (black eyes), Swelling
Blurred or cloudy vision.
Eye redness
Bleeding between the cornea and iris, known as (hyphema)
Foreign Body:

metal slivers, wood chips, dust, sand and glass.
depend on location, material and type of injury range from irritation to intense pain. Burning , redness, difficulty in opening eye, blurred vision.

Thermal exposure:



tearing, photophobia, foreign body sensation.

chemical exposure:

Immediate irrigation

Blepharitis is
into two types:
Anterior blepharitis
occurs at the outside front edge of the eyelid where the eyelashes are attached.
Posterior blepharitis
affects the inner edge of the eyelid that comes in contact with the eyeball.


sore ,swollen eyelid red ,dry eye and the formation of dandruff-like scales on eyelashes ,burning or itching feeling in eye
Bacterial eye infection (staph.).
Exposure to chemical fumes, smog or other irritants.
topical Corticosteroid: eg; flourometholone (flucon®) eye drops
oral antibiotic (tetracycline , doxycycline).
eye lubricants (artificial tears and lubricating ointments)

Other causes for eye dryness:
Antihistamines, Decongestants.
Medical conditions (Rheumatoid arthritis, Diabetes, Thyroid problems, Blepharitis).
Environmental conditions.
Long term use of contact lenses.
Age and gender.
A patient comes to your pharmacy with a complaint of red tearing eyes accompanied with itching, what is your diagnosis?
Allergic conjunctivitis!!!
Types of conjunctiva:

Symptoms of allergic conjunctivitis:
Red eyes , watery discharge , itching , excessive tearing

What is the treatment of allergy?
1.Anti allergic drugs:
Sodium cromoglycate: cromolyn-opticure ointment
Lodoxamide:alomide eye drops

(mast cell stabilizers)
Levocabastin: livostin eye drops
Emedastine difumarate:emadine eye drops

Drainage may be poor because the angle between the iris and the cornea is too narrow.

Naphazoline HCL+chloropheniramine: prisoline eye drops

Tetrahydrozoline HCL:visine eye drops
Naphazoline HCL+pheniramine: naphcon A eye drops

(caution for patients with asthma and rhinitis)
Ketorlac tromethamine:samulgin-acular
Diclofenac sodium: voltaren
Are there any prophylactic measures to minimize the recurrence of this case?
Avoiding contact with infected people
disinfection of household surfaces
good hygienic practices can help prevent the spread of infectious pink eye.
avoid the irritants like dust and contact eye lenses.

Symptoms :
1.Painful inflammation
2.reduced visual clarity & sensitivity to light
3.clouding of the cornea with small white spot on the cornea.
4.corneal scarring.
6.pus or thick discharge
7.feeling that something is in the eye

Refer to physician
Antibiotic-corticisteroids combinations(POM):
Prednisolone+neomycin+polymycin:predmycin-p eye drops
Tobramycin+dexamethasone:tobradex eye drops

Oxytetracycline+hydrocortisone:terracortil eye drops & ointment

The inflammation of uvea
(Uvea the middle layer of the eye)
It is
anatomically into :
anterior posterior
panuveitic forms.
Red eye
Pain and decreased vision
Dilated ciliary vessels
Keratic oreciptates on the posterior surface of the cornea

Treatment by POM only:
As keratitis
Prednisolone+neomycin+polymycin:predmycin-p eye drops
Tobramycin+dexamethasone:tobradex eye drops
Oxytetracycline+hydrocortisone:terracortil eye drops &ointment

chemical exposure
How would you differentiate between them (look into other accompanying symptoms)?
• Viral conjuctivitis
• Thermal damage
• Photo keratitis
• keratitis

All these drugs are contraindicated in case of fungal or viral eye infection , herpes simplex keratitis
Uveitis may be a normal immune response to fight an infection inside the eye possible
infections include :
brucellosis, herpes simplex,herpes zoster, lyme disease,toxoplasmosis.
What are the eye drops that should be keep in the fridge?
There is an
in my eyes but I do not know the reason, Can I use an ophthalmic
a doctor's prescription

What are the important
for their use?

  If it is a bacterial infection, is there any combination of
a corticosteroid
and antibacterial?
1 – allergic conjunctivitis
2- giant papillary conjunctivitis.
It's an allergic condition
Topical mast cell stabilizer .

3- idiopathic superior limbic keratoconjunctivitis .
Hydrogel lens
Women ,, abnormal thyroid function
Ophthalmic Corticosteroid drugs (POM)

Antibiotic-Corticosteroids combination (POM)

Ophthalmic Corticosteroid drugs (POM)
Not > 7 days .. If more : ( Monitoring )

Prolonged use corneal thinning , increase IOP leading to glaucoma and cataracts .

Not with ophthalmic viral or fungal infection

Age ( children )

Contact lenses ( after 15 min. )

Storage (RT)

Reduction of dose ( gradual )

Driving or other unsafe tasks

Missed dose
Ophthalmic Corticosteroid drugs (POM)
Antibiotic-Corticosteroids combination (POM)
Ophthalmic Corticosteroid drugs (POM)
Antibiotic-Corticosteroids combination (POM)

Hydrocortisone + Oxytetracycline
Ophthalmic Corticosteroid drugs (POM)

Antibiotic-Corticosteroids combination (POM)
Patient who came to buy
inhalers for his asthma as well as
tablets (amlodipine) for his blood pressure .
He also came for his prescription of
eye drops for glaucoma.

Detect two possible interactions.
What is your intervention?
Antibiotic-Corticosteroids combination (POM)
Side effects ..
Antibiotic-Corticosteroids combination (POM)

Treatment & Relief of ..
Ophthalmic Corticosteroid drugs (POM)
Contraindications ..
Ophthalmic Corticosteroid drugs (POM)
Treatment & Relief of ..
Swelling of eye (inflammation) caused by (chemicals, heat, radiation, infection, allergy, or foreign bodies in the eye , etc )

Undiagnosed red eye .. ( aggravate herpes virus and other infections )
Eye infections (Mycobacterial, fungal, viral infections)
Cataracts , glucoma .. ( make them worse )
Diabetes mellitus ( develop cataracts or glaucoma )
Asthma patients .. ( Sulfites allergy )
Pregnancy .. (C)

Steroid-responsive inflammatory ocular conditions with superficial bacterial infection or risk of infection (Greater patient compliance)

Not > 7 days .. If more : ( Monitoring )

Not with ophthalmic viral or fungal infection

Shake well before use
not > 20 mL suspension
Contact lenses

Elevated IOP
Bacterial resistance may develop.
Photosensitivity (TC.)

Although systemic effects are extremely uncommon, there have been rare occurrences of systemic hypercorticoidism after use of topical steroids.
Prednisolone + Neomycin + Polymyxin B
Dexamethasone + Tobramycin
A patient came to ask for advise because he has
a stye
in his eye lid .
What is a stye? What is
the management

A stye (i.e., hordeolum) is a localized infection or inflammation of the eyelid .

It may start off as a small red lump but, as it develops into a collection of pus (a little abscess), it looks like a yellow pus-filled spot.

Internal Stye ( more painful )
  The swelling develops inside the eyelid (Meibomian glands)
{ suppurate on the conjunctival surface of eyelid }
External Stye ( most common )
 Emerges along the edge of the eyelid due to infection in the follicle of an eyelash (The glands of Zeis )
{ Purulent material exudes from the eyelash line }
Symptoms ..
A stye is a red, hot, very tender swollen bump near the edge of the eyelid usually is painful, erythematous, and localized

A small pimple develops in the affected area.

Usually this is accompanied by Swollen eyes (surrounding area or the entire eyelid)

Causes ..
A sty results from an infection of the oil glands of the eyelid that help to lubricate the eyeball.

A sty also may arise from an infected hair follicle at the base of an eyelash

The bacterium Staphylococcus aureus is responsible for 90%-95% of cases

A sty also can develop as a complication of BLEPHARITIS

Complications ..
Chalazion ( most common )
Preseptal cellulitis ( RARE )
Stye Vs Chalazion

Chalazion ..

Chronic , non-infectious painless granuloma of the meibomian glands.
Mimics a stye for the first few days , then turns into a painless hard, round bump later on.
Management ..
Spontaneous healing is common (7 - 10 days )

Hot compresses (5-10 minutes, 3-4 times a day)

Cleaning of eyelashes (improve drainage and reduce recurrence)

Antibiotics ( Topical , Oral )


Incision and drainage ( professional .. Why ?)

Topiacal antibacterial drugs (OTC)
Glaucoma !!!
increase IOP .
acute ( closed – angle glaucoma or acute closure glaucoma )
chronic ( open - angle glaucoma ).
severe eye pain .
blurred vision and holes around the light .
may lead to optic nerve damage .
Nausea and vomiting .
red eye .fixed mid dilated eye pupil

Causes :
Anatomy of the eye .
drugs .
glaucoma may be :
1 – Primary congential ( infantile glaucoma)
2 – secondary glaucoma .
3 – associated with hereditary or familial diseases
Treatment (POM) :
1 – Xalatan ( eye drops ) .
2- timolol eye drops
3 – Isoptocarpine eye drops .
4 – Alphagan eye drops .
5 – Azpot eye drops .
cataract !!!
Traumatic cataract .
Congenital cataract .
Radiation cataract .
types of cataract
Treatment :
Catalin may prevent progress of cataract till surgery and mydriatic drugs

Describe eye problems caused by wearing contact lenses
1 – mechanical injury .
Damaged lenses ,
2- tight lens syndrome.

Corneal odema
Rewetting drops.

3- microbial keratitis.
Pseudomonas and klebsiella
AB as vancomycin and fluoroquinolon
4- superficial punctate keratitis .
Most common .
Dry eye ( smoke , dust , medication )
It's clouding of the lens in the eye.
1 – swelling , traumatic eyelid cut .
2- bleeding on ocular surface or infront of the eye
( these 2 symptoms mainly due to eye trauma )
3- scaly or greasy eyelid accompanied with buring or itching sensation , swollen eye lid ( blepharitis ) .
4 - blurred vision and holes around the light with a severe pain . ( glaucoma and corneal damage )
5 – pus or thick discharge with corneal scarring ( keratitis )
6 – keratic perciptate in the posterior of the cornea . ( uveitis )

7 – foreing sub. Contact
8- thermal damage
9 – chemical exposure

Conjunctival problems :
Corneal problems :
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