Common conditions of eyes & ears

43 important questions on Common conditions of eyes & ears

Eye drops can be used in the ear, but ear drops can never be used where?

In the eyes

Because ointments can make vision blurry, they should not be used with what?

Contact lenses

Before putting a gel into the eye, what should be done?

To get the med into the tip, invert & shake once (with the cap on)
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Eye disease that results in damage to the optic nerve & loss of visual field

Glaucoma

What is the intraocular pressure (IOP) like in most glaucoma cases?

Above normal range of 12-22 mmHg

What is the most common type of glaucoma that is often without symptoms and is treated with eye drops or surgery?

Open-angle glaucoma

Which type of glaucoma is a medical emergency that usually presents with eye pain, headaches, & decreased vision from a blockage that causes a sudden increase in IOP, and is treated surgically?

Closed-angle glaucoma

What is the treatment goal of glaucoma?

Decrease intraocular pressure (IOP)

In what ways can the intraocular pressure be decreased?

Make less fluid in the eye (aqueous humor)
Move more fluid out of the eye
OR do both

What drugs reduce aqueous humor production (make less fluid)?

Beta Blockers
Carbonic anhydrase inhibitors

What drugs increase aqueous humor outflow (move fluid out)?

Prostaglandin analogs

Which drugs are usually 1st line because they are most effective & once daily (QHS)?

Prostaglandin (PG) analogs

Why are beta blockers preferred if the pressure is high in 1 eye only?

The effects of PG analogs (iris darkening, eyelash thickening) is not desirable in only 1 eye

Main side effects of PG analogs

Blurred vision, stinging, darker iris, eyelash growth/thickening

Can products that contain the preservative benzalkonium chloride (BAK) be used with contact lenses?

NO, remove before use.
Wait 15 min before putting lenses back in.

How should Latanoprost (Xalantan, Xelpros) be stored?

Before opening: refrigerator
After opening: room temp

Which PG analog is indicated to increase eyelash growth and should NOT be used with other PG analogs for glaucoma?

Bimatoprost (Latisse) [to upper eyelid]

Main side effects of beta blockers

Burning, stinging, bradycardia, fatigue, bronchospasm

Which beta blocker is less likely to cause pulmonary adverse effects in patients with chronic lung disease (asthma, COPD) because it is the only selective beta blocker?

Betaxolol

How should the BB gels be applied?

Shake once before use
If use another eye drop, wait 10 min before using the gel

Carbonic anhydrase inhibitors should be avoided in what allergy?

Sulfonamide allergy

What is the combo drug that only works to decrease aqueous humor production?

Timolol [BB] + Dorzolamide [Carb Anhydrase Inhib]   (Cosopt, Cosopt PF)

Which drugs work by increasing aqueous humor outflow AND decreasing aqueous humor production?

Adrenergic alpha-2 agonists

What are ways to prevent spreading pink eye?

Avoid touching eyes
Proper hand hygiene (thoroughly, frequently)
Change towels/washcloths daily
Discard eye cosmetics

What treatment is for adenovirus (the most common viral type)?

There is no topical treatment

What are the causes of bacterial pink eye?

Staphylcoccus aureus
More severe- neisseria gonorrhoeae or chlamydia 

How should Azithromycin (AzaSite) for pink eye be stored?

Store in refrigerator, but stable for 14 days at room temp

What is eyelid inflammation that most commonly involves the eyelid margins (where eyelashes come out of the skin)?

Blepharitis

What is the preferred treatment for blepharitis?

A warm, moist washcloth

What can be used for mild eye inflammation?

NSAID eye drops: Ketorolac (Acular)

What can be used for severe eye inflammation?

Steroid eye drops: Prednisolone (Pred Forte, Pred Mild)

Why should steroid eye drops only be used for a short time period?

They can increase intraocular pressure (IOP)

What can be used for eye dryness?

OTC "Artificial tears"
Refresh, Systane 

What can be used for chronic dry eye disease?

Cyclosporine Emulsion Eye Drops (Restasis)

What can be used for eye redness & allergic conjunctivitis?

Tetrahydrolozine (Visine)
Nephazoline (Clear Eyes Redness Relief)
Nephazoline/Pheniramine (Naphcon A, Visine A)

What drugs can cause retinal changes/retinopathy?

Chloroquine & Hydroxychloroquine

What drugs can cause optic neuropathy?

Amiodarone (plus corneal deposits)
Ethambutol
Linezolid   

What drugs can cause intraoperative floppy iris syndrome (IFIS) [causes difficulty in cataract surgery]?

Alpha blockers (tamsulosin)

What drugs can cause color discrimination?

Digoxin (with toxicity)- yellow/green
PDE-5 inhibitors (sildenafil)- green
Voriconazole- color vision changes

Which drugs can cause vision loss/abnormal vision?

Digoxin (with toxicity)- blurry, halos
PDE-5 inhibitors- loss in one or both eyes; possibly permanent
Isotretinoin- decrease night vision, dryness, irritation
Topiramate- visual field defects
Vigabatrin- permanent vision loss
Voriconazole- abnormal vision, photophobia

What can be used to treat an ear blockage when wax (cerumen) accumulates?

Carbamide peroxide (Debrox)

Mild cases of otitis externa ("swimmer's ear") can be treated with what?

Ear drops containing acetic acid and a glucocorticoid (VoSol HC)

What antibiotics are used to treat moderate to severe otitis externa?

Ciprofloxacin + dexamethasone (Ciprodex) 

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