Eyelid Disorders & Lacrimal Disorders PDF

EYEBALLS (AND FRIENDS) CLINICAL MED: OCULAR 1&2 Joseph D Klauer OD January 27, 2025 Objectives Lid Disorders Blepharitis Refractive/Binocular Hordeolum Status Chalazion Nystagmus Ectropion En...

EYEBALLS (AND FRIENDS) CLINICAL MED: OCULAR 1&2 Joseph D Klauer OD January 27, 2025 Objectives Lid Disorders Blepharitis Refractive/Binocular Hordeolum Status Chalazion Nystagmus Ectropion Entropion Strabismus Lumps/Bumps Amblyopia Lacrimal disorders Myopia Dacryocystitis Dacryoadenitis Hyperopia Conjunctival disorders Astigmatism Conjunctivitis Presbyopia Pterygium Pinguecula Episcleritis/Scleritis OCULAR MEDICATIONS Corneal disorders Ulceration Keratitis Dry Eye Eyelid Disorders/ Lacrimal Disorders Lid Disorders Blepharitis Hordeolum Chalazion Ectropion Entropion Lumps and Bumps Lacrimal disorders Dacryocystitis Dacryoadenitis Objectives Describe the etiology, signs/symptoms, and treatment for eyelid disorders. Meibomian Gland Primary purpose of meibomian glands is to secrete the lipid layer of the tear film Meibomian gland lipid content (sebum) spills out of the acini at the mucocutaneous lid junction to coat the ocular surface. The lipid then becomes the smooth film meibum on the Meibomian Glands Modified sebaceous glands located within the tarsal plates of the eyelids Responsible for secretion of the oily layer of the tear film. Oily layer prevents tear evaporation, reduces the surface tension of the tear layer, and facilitates the spread of tears. It is critical for normal eye lubrication. Blepharitis Two main types of Blepharitis Staphylococcal blepharitis and seborrheic blepharitis BOTH can result in anterior and/or posterior involvement Pt often asymptomatic; reports vision that clears after blinking, burning, itching, tearing, crusting (especially in morning). Chronic bilateral inflammatory condition of the lid margins Common cause of recurrent conjunctivitis Benign Essential Blepharospasm (BEB) Most common in ages 50-70 (mean onset 56 years) Women affected 2x more than men Involuntary, sustained, repetitive bilateral twitching of eyelids Spasms of orbicularis oculi, procerus, and corrugator muscles Most commonly idiopathic, but found 50% pts have OSD. Posterior Blepharitis Most common Inflammation of meibomian glands Appearance: Lid margins hyperemic with telangiectasis Meibomian glands and their orifices are inflamed Mild entropion- eyelid turns in on itself Tear film frothy or abnormally greasy Tx: regular meibomian gland expression, warm compresses Inflammation of the conjunctiva and cornea long-term low-dose oral antibiotic therapy and possibly short-term topical corticosteroids Antibiotic: Tetracycline, Doxycline, or Minocycline Azithromycin, Erythromycin Prednisolone acetate (if all else fails) Anterior Blepharitis Lid skin, eyelashes, associated glands Seborrheic/Ulcerative Ulcerative: infection from staphlyoccci Seborrheic: seborrhea of the scalp, brows and ears Eyes are “red-rimmed” and scales or granulations can be seen clinging to the lashes Tx: eyelid hygiene, eyebrows, and scalp. Warm compresses Gentle eyelid massage and lid scrubs (OcuSoft) Acute exacerbations: anti-staphylococcal antibiotic eye ointment, (bacitracin or erythromycin) Demodex: face mites Lives in human hair follicles (normal) Multiply too quickly, proliferate in immunocompromised patients or patients with other underlying skin conditions. itching/irritation presenting as anterior blepharitis  Hordeolum Acute infection, Staphylococcus aureus, of eyelid glands. Localized red, swollen, acutely tender area on eyelid Internal hordeolum vs. external hordeolum (stye) Internal: meibomian gland abscess May lead to eyelid cellulitis External: Gland of Zeis or Moll Known as a stye, may express outward Treatment: Warm compresses Incision and drainage An antibiotic ointment (bacitracin or erythromycin) Internal vs. External  Chalazion Common granulomatous inflammation of a meibomian gland May follow internal hordeolum Hard, nontender swelling on the upper or lower lid with redness and swelling of the adjacent conjunctiva Tx: initially with warm compresses Incision and curettage, corticosteroid injection Ectropion Outward turning of the lower lid due to loss of muscle tone to the orbicularis oculi. Common with advanced age (involutional) Mechanical (tumor related) Cicatricial (scar tissue/trauma, chemical burn) Paralytic (facial nerve palsy) Surgery if there is excessive tearing, exposure keratitis, or a cosmetic problem. Entropion Inversion of eyelid against the globe Involutional (age related) Cicatricial (trachoma, SJ syndrome). Common in: Trichiasis: eyelashes grow posterior from site of origin Distichiasis: second row of lashes from MG opening May follow extensive scarring of the conjunctiva and tarsus Blindness from trachoma due to corneal ulceration secondary to entropion and trichiasis. Tx: Surgery (lashes rub on the cornea leading to ulceration) Botox for temporary correction Lid Lumps and Bumps (and lesions) Eyelid Cyst: develop from epithelium of epidermis and dermal tissues associated with glands of the lid Inclusion cyst: often appears white due to keratinous debris- tx: lance Milia: occlusion of sweat pores- self resolve with exfoliating face wash Dermoid Cyst: congenital lesion firm and immobile, superior temporal or superior nasal eyelid Sebaceous Cyst: retention of fluid in the glands of Zeis or MG. Usually solitary, smooth, yellow or opaque.- tx: lance Malignant Tumors of the Eyelid Basal Cell Carcinoma (BCC) Most common skin cancer in US Males > Females (2:1) Most common eyelid cancer (90%) ‘Lesion bleeds and will not heal” Minimally invasive (metastasis incidence less than 0.1%) Shiny, firm, pearly nodule with superficial telangiectasia Lower eyelid (50-66%) medial canthus (25-30%) most common Malignant Tumors of the Eyelid Squamous Cell Carcinoma (SCC) More common in males (2:1) 2nd most common eyelid cancer, 40-50x less common than BCC Malignancy of stratus spinosum layer of epidermis Appearance similar to BCC WITHOUT surface vascularization Actinic keratosis association Most common precancerous skin lesion (precursor to SCC) Pink-red, scaly, elevated lesion on sun-exposed skin (25% progress) More aggressive than BCC; metastasis to nearby lymph nodes (20-30%) Mohs procedure/surgery Malignant Tumors of the Eyelid Sebaceous Gland Carcinoma Rare, more common in elderly females History of chronic unilateral blepharitis/recurrent chalazia Poor prognosis if greater than 2cm, mortality rate 60% Tumor often firm/hard, yellow and associated with madarosis and thickened lid margins Prior radiation therapy Malignant Melanoma Rare (less than 1% of eyelid cancers) but most lethal Malignancy of melanocytes (cells that produce pigment) Asymmetry, Border irregularity, Color difference, Diameter, Enlarged bcc sgc scc mm Identify the epidemiology, signs and symptoms, diagnosis and treatment of Lacrimal disorders Dacryocystitis Infection of the lacrimal sac due to obstruction Due to congenital or acquired obstruction of the nasolacrimal system (ask about concomitant ENT infections) Occurs most often in infants (NLDO) and in persons over 40 years Unilateral; staph aureus, staph coccus, pseudomonas, H influenza in kids Secondary dacryocystitis common in cases of congenital NLDO due to stagnant tears Pain, crusting, tearing. Prominent edema and tenderness Congenital nasolacrimal duct obstruction, swelling below medial canthal tendon (ABOVE should raise suspicion for lacrimal sac tumor) Spontaneous resolution, treated by probing the nasolacrimal system, supplemented by nasolacrimal intubation or balloon catheter dilation Jones I & Jones II Testing To test the ability of the tears to pass through the lacrimal drainage system. JONES I: Test patency. NaFl instilled, should drain off the ocular surface within five minutes. (+) JONES I = Patent System (NaFl has drained) JONES II: Irrigation with saline after NEGATIVE Jones I test.- there is still fluoresceine present in the eye (not draining) Reflex of fluid through same punctum: obstruction within upper –or-- lower canaliculus Retrograde flow through opposite canaliculus indicates nasolacrimal blockage Patient tastes saline, gag reflex, cleared obstruction. Still obstructed  Dacryocystorhinostomy Dacryoadenitis Children and younger adults Ask for recent hx of fever Inflammation of the lacrimal gland (acute or chronic) Acute: bacterial infection (staph a, Neisseria gon, streptococci) Acute: viral (mumps, mono, influenza, herpes zoster) Chronic: more common than acute; result from inflammatory disorders (sarcoidosis, TB, Graves) Acute classically presents with S-Shaped ptosis, temporal upper eyelid pain, redness, swelling. Chronic has less associated redness and swelling, with longstanding proptosis.  Identify the epidemiology, signs and symptoms, diagnosis and treatment of Conjunctival Disorders.  Conjunctiva Provides protection and lubrication of the eye by the production of mucus and tears Prevents microbial entrance into the eye and plays a role in immune surveillance Lines the inside of the eyelids and provides a covering to the sclera Highly vascularized and home to extensive lymphatic vessels The conjunctiva can be divided into three regions: Palpebral or tarsal conjunctiva (inside of eyelid) Bulbar or ocular conjunctiva (on white part of eye/sclera) Conjunctival fornices Conjunctiva Tenon's capsule binds to the underlying sclera. The potential space between Tenon’s capsule and the sclera is frequently used for local anesthesia. Conjunctival fornices form the junction between the palpebral and bulbar conjunctivas. This protective covering is loose and flexible, unlike its bulbar counterpart, allowing for movement of the globe and eyelids. Conjunctivitis Inflammation of the mucous membrane that lines the surface of the eyeball and inner eyelids Inflammation of the conjunctiva (tarsal, bulbar) Viral, bacterial, allergic Transmission: direct contact (fingers), contaminated eye drops, contact lenses, respiratory secretions Differentials: acute uveitis, acute glaucoma, corneal disorders– these hurt and the vision is much worse than conjunctivitis Extreme light sensitivity: acute uveitis and corneal disorders Glaucoma- so much pain, they’re vomiting  Viral Conjunctivitis “Pink eye”. Most commonly adenovirus. Signs/symptoms: bilateral, watery discharge, possible foreign body sensation, injected/red, morning crusting easily spread Epidemic keratoconjunctivitis (EKC). Cornea + conjunctiva adenovirus types 8, 19, and 37 Acute corneal keratitis Extremely contagious 5% betadine sterile ophthalmic prep solution. HSV Unilateral, lid vesicles Topical: ganciclovir 0.15% gel (not used much anymore, go straight to orals) Systemic: 800mg acyclovir 5x per day, valacyclovir Treatment (Not EKC, HSV) Artificial tears and cold compresses Frequent hand and linen hygiene is encouraged to minimize spread. Clean your slit lamps!  Bacterial Conjunctivitis Staphylococci, including methicillin-resistant S aureus (MRSA); streptococci, particularly S pneumoniae; Haemophilus species; Pseudomonas; and Moraxella Copious purulent discharge, no blurring of vision and only mild discomfort Hyperpurulent- stained conjunctival scrapings and cultures is recommended identify gonococcal infection that requires emergent treatment Usually self-limited (10–14 days if untreated) A topical antibiotic will usually clear the infection in 2–3 days. Treat contact lens wearers Bacterial Conjunctivitis Gonococcal Conjunctivitis Chlamydial Keratoconjunctivitis Trachoma Inclusion conjunctivitis  Gonococcal Conjunctivitis Usually acquired through contact with infected genital secretions Copious purulent discharge Ophthalmic emergency [emergency room] corneal involvement may rapidly lead to perforation diagnosis confirmed: stained smear and culture of the discharge Systemic Treatment: 1-g dose of intramuscular ceftriaxone. Topical antibiotics such as erythromycin and bacitracin may be added. Treat for chlamydia, consider other STIs Chlamydial Keratoconjunctivitis Inclusion Conjunctivitis & Trachoma Trachoma most common infectious cause of blindness worldwide remote, resource-limited areas chronic keratoconjunctivitis caused by recurrent infection with Chlamydia trachomatis Conjunctivitis  pain and blurred vision Recurrent episodes of infection in childhood manifest as bilateral follicular conjunctivitis, epithelial keratitis, and corneal vascularization (pannus) Scarring of the tarsal conjunctiva leads to entropion and trichiasis in adulthood with secondary central corneal ulceration and scarring. Diagnosis: Can test conjunctival samples, but treat based on clinical findings. Tx: Azithromycin Inclusion conjunctivitis The eye becomes infected after contact with infected genital secretions Starts with acute redness, discharge, and irritation. Eye exam: follicular conjunctivitis with mild keratitis Nontender preauricular lymph node Weeks to months duration that has not responded to topical antibiotic therapy Dx: immunologic tests or polymerase chain reaction on conjunctival samples Assess for genital tract infection and other STIs Tx: Azithromycin Two Phases of Trachoma Cicatricial disease: Trichiasis and its Active trachoma: Inflammation sequelae (usually children) (usually adults)  Follicular Conjunctivitis Conjunctival follicles are round collections of lymphocytes, often most prominent in the inferior fornix. Blood vessels may overly the follicles, but Patient has folliculosis due to viral conjunctivitis are not a prominent component within them. This helps differentiate follicles from conjunctival papillae. Patient has a follicular reaction resulting from allergy to brimonidine drops. Allergic Conjunctivitis Late childhood and early adulthood History of atopy, seasonal allergy, or specific allergy (pets) Itching, tearing, redness, stringy discharge, and occasionally, photophobia and visual loss. Seasonal or perennial Contact lens wear Clinical signs: conjunctival hyperemia, edema (chemosis), fine papillae  large papillae (contact lens wearers) Tx (topical): antihistamines, mast cell stabilizers, NSAIDS Throw VISINE and CLEAR EYES (vasoconstrictors) in the garbage can nearest you. Pat yourself on the back. Lumify is great for “get the red out” relief. Chemosis  Allergic Eye Disease- Vernal keratoconjunctivitis Late childhood and early adulthood Usually seasonal, with a predilection for the spring Large “cobblestone” papillae are noted on the upper tarsal conjunctiva. Lymphoid follicles at the limbus May be corneal involvement during exacerbations Stepladder for treatment, cool compresses and saline rinses, artificial tears Antihistamines and mast cell stabilizers  topical corticosteroids immunomodulating agents  Allergic Eye Disease- Atopic keratoconjunctivitis Chronic disorder of adulthood Associated with atopic disease Bilateral conjunctivitis Papillary conjunctivitis with fibrosis on upper and lower tarsal conjunctivas The primary symptom is ocular itching. Mucoid discharge and tearing. Periocular eczema is almost always present. Lid manifestations include hypertrophy, crusting, ectropion, and madarosis. May be corneal involvement during exacerbations Tx: Stepladder for treatment, cool compresses and saline rinses, artificial tears Topical and then oral: Antihistamines and mast cell stabilizers  corticosteroids immunomodulating agents periocular eczema and corneal haze Pterygium Fleshy, triangular encroachment of the conjunctiva Nasal side of the cornea Associated with prolonged exposure to wind, sun, sand, and dust. Become inflamed and may grow. Indications for excision: growth that threatens vision by encroaching on the visual axis, marked induced astigmatism, or severe ocular irritation Pinguecula Yellow, elevated conjunctival nodule Nasal side, in the area of the palpebral fissure Rarely grow but may become inflamed (pingueculitis) Tx: No treatment required artificial tears are often beneficial Episcleritis vs. Scleritis Young adults Female predilection (4 th-6th Frequent reoccurrence decade) Less common Benign, self-limiting Granulomatous inflammation of the inflammation of sclera often episcleral associated with systemic Often idiopathic disease (rheumatoid Acute, unilateral, mild arthritis) Severe, boring, ocular pain; pain Sectoral injection radiates to forhead Edematous, thin sclera with Nodule moves with bluish hue cotton-tip applicator Cotton swab does not move Episcleritis vs. Scleritis (tx) Self-limiting Systemic meds Oral NSAIDS without Cool compresses & steroid use cooled artificial tear Failure of NSAIDS after 2-3 Topical NSAIDS week trial steroidal use ineffective Prednisone, slow taper Oral NSAIDS for IV methylprednisolone in severe cases recurrences, nodular Periocular injections of components steroid (controversial) Treat underlying Immunosuppressive agents conditions (rosacea, (methotrexate gout, herpes) intramuscular)  Identify the epidemiology, signs and symptoms, diagnosis and treatment of Corneal disorders. Infectious Keratitis Bacterial Viral Corneal Ulceration Dry Eye Consists of five layers, from anterior to posterior: corneal epithelium, Bowman’s layer, corneal stroma, Descemet’s membrane, and corneal endothelium. Infectious Keratitis vs. Ulceration Bacterial keratitis most common etiology for infectious keratitis (don’t forget about contact lens wearers) Most common microbes are psuenomonas aeruginosa [gram -], staph epi, staph a. PSUEDOMONAS severe, thick, mucopurulent, hypopyon, dense stromal infiltrate, rapid progression (perforate cornea in 48hrs) Severe pain, red eye, photophobia, decreased vision. An infiltrate is a sign of the body’s immune system attacking an antigen via antibodies. An infiltrate WITHOUT an overlying epithelium defect is an immune mediated response and NOT a sign of infection.  Corneal Ulcer By definition, corneal ulcer is an infiltrate WITH and overlying epithelium defect. A) Infectious (bacteria, viral, fungal, or parasitic) B) Noninfectious (sterile) neurotrophic keratitis (loss of corneal sensation) exposure keratitis (inadequate lid closure) severe dry eye severe allergic eye disease Presents with: pain, photophobia, tearing, reduced vision Exam: red, predominantly circumlimbal injection, discharge Prompt referral, start on antibiotic gtt treatment. circumlimbal injection An infectious corneal ulcer will have NaFl staining area ratio of 1:1. Presentation of moderate to severe pain, mild anterior chamber reaction. A sterile corneal ulcer will have NaFl staining in less than 1:1 ratio, with less pain and less injection. A sterile infiltrate will NOT stain with NaFl (remember, this is NO overlying epithelial defect.  Fungal Keratitis & Acanthamoeba K. Most common type of corneal ulcer after traumatic injury from vegetative matter.- (biking or hiking and get a tree branch to the face) Candida infections, opportunistic esp. in immunocompromised patients. Aspergillus and Fusarium. Cornea is hazy, ulceration has feathery borders with adjacent stromal involvement Corneal ulcer is scraped for culture on Sabouraud’s agar prior to starting treatment with antifungal. Acanthamoeba rare parasitic infection associated with inadequate contact lens hygiene (tap water, open water, hot tubs and swimming pools). Protozoa found in soil and water, oral cavity of humans. Compromised epithelium allows infection. Progresses slowly and is often misdiagnosed. Cultured on non-nutrient agar with heat-killed E.Coli. Early: punctate epithelial defects confused with herpes simplex Late: radial keratoneuritis (inflammation of corneal nerves) and patchy infiltrates progress to ring ulcer  Fungal Keratitis Parasitic Keratitis Occur after corneal Acanthamoeba. injury involving Contact lens wearer vegetative material in Severe pain with eyes with chronic ocular perineural and ring surface disease, and increasingly in contact infiltrates in the corneal lens wearers. stroma Corneal scrapings Long-term intensive should be cultured topical treatment Topical antifungals. Corneal transplant  Viral Keratitis Herpes Simplex Keratitis May be precipitated by fever, excessive exposure to sunlight, or immunodeficiency Exam: dendritic (branching) corneal ulcer with NaFl Refer to optometry/ophthalmology Herpes Zoster Ophthalmicus Trigeminal nerve. Tip of the nose or the lid margin Malaise, fever, headache, and periorbital burning and itching. 24-48hrs later: vesicular, quickly becoming pustular and then crusting Refer Treatment: oral antiviral (acyclovir, valacyclovir, etc) Viral Keratitis Dendritic lesion of cornea; margins stain with fluorescein, center stains with rose bengal/lissamine green DDx: herpes simplex keratitis can have NaFl pooling but no frank staining; generally doesn’t stain with RB except maybe end bulbs Highly suspect corneal involvement if tip of nose is involved (Hutchinson’s Sign) Can cause many ocular complications including cornea scarring, uveitis, retinal necrosis, muscle paresis, and irreversible vision loss Caution with steroids!!– can’t worsen the infection initially. Only apply after the dendritic appearance has subsided Tx: Needs referral for full eye exam; start oral acyclovir/ ganciclovir/ valacyclovir  Dry Eye Disease Common chronic disorder, a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort. Most common in aging, especially among post-menopausal women Medications (anticholinergic effects, “anti” drugs) Systemic Disease (Thyroid, RA, Sjogren’s, Lupus) Environmental (ceiling fan, humidity levels, dust) Dry Eye Disease Symptoms: Dryness, redness, foreign body sensation, and variable vision. In severe cases: persistent marked discomfort, photophobia, difficulty in moving the lids, and excessive mucus secretion. Slit-lamp examination: abnormalities in tear film stability and reduced tear volume (TBUT, tear meniscus). The Schirmer Test: performed without anesthetic, measures the rate of production of the aqueous component of tears. Dry Eye Disease 1. Aqueous Deficient Dry Eye Sjogrens (Dry mouth, reduced salivary secretion, 95% female) Non-Sjogren’s Primary lacrimal gland deficiency (age-related dry eye syndrome) Secondary lacrimal gland def (sarcoidosis, lymphoma, CN VII damage, diabetes, infection, corneal surgery 2. Evaporative Dry Eye Excessive water loss in the presence of normal lacrimal secretory functions. Can be either intrinsic or extrinsic. Intrinsic: Meibomian Gland Dysfunction **MOST COMMON** Extrinsic: No lid pathology (Vitamin A def, chronic CL wear) Dry Eye Disease Treatment Tx: artificial tears (PF) Warm compress (bruder mask) Immunomodulating drops (Cyclosporine) if proven to be inflammatory dry eye. Lacrimal punctal occlusion by canalicular plugs is useful in severe cases.  RED Cycloplegic/Dilating Atropine, Homatropine, Cyclopentolate, Tropicamide PINK OR WHITE Anti-inflammatory (steroids) Omnipred, Pred Forte, Lotemax, Durezol, **Natamycin** (antifungal) TAN Antiobiotics Vigamox, Moxeza, Ocuflox GREY NSAIDS Xibrom, Nevanac, Voltaren, Acular YELLOW ß-Blockers Timolol LIGHT BLUE Selective ß-Blockers Betopic GREEN Miotic Pilocarpine PURPLE Alpha-Agonist Alphagan ORANGE CAIs (carbonic anhydrase Azopt, Trusopt inhibitors) TEAL Prostaglandins Xalatan, Lumigan, Travatan DARK BLUE Alpha-agonist/ ß-Blocker Combigan SQUARE BOTTLE CAI/ ß-Blocker Cosopt LIGHT GREEN CAI/Alpha-agonist Simbrinza Topical ophthalmic agents Antibiotics (Ofloxacin) Carbonic anhydrase inhibitors Antifungal agents Prostaglandin analogs Combo preparations (Natamycin) Antiviral agents (Ganciclovir) Mucolytics Acetylcysteine Anti-Inflammatory agents Mydriatics and Cycloplegics Antihistamines Mast cell stabilizers Vascular Endothelial Growth Combo antihistamines/mast cell Factor Inhibitors (VEG-F) NSAIDS Corticosteroids (Prednisolone A) Immunomodulators Glaucoma/Ocular HTN Sympathomimetics Beta blocking agents Miotics Ocular Medications- Antibiotics Indications Common Medications Azithromycin Bacterial conjunctivitis Bacitracin ointment Blepharitis Ciprofloxacin Hordeolum (coverage) solution/ointment Erythromycin ointment Corneal abrasions (also Gentamicin following FB removal) solution/ointment Bacterial keratitis Ofloxacin Solution (Ocuflox) Polymyxin B/ Trimethoprim (Polytrim)- sulfate (kids) Tobramycin solution/ ointment (Tobrex) Ocular Medications- Antifungal agents Indications Common Medications Fungal blepharitis Natamycin Fungal conjunctivitis Fungal keratitis Ocular Medications- Antiviral agents Indications Common Medications Herpes simplex keratitis Ganciclovir gel Herpetic keratitis Topicals are not used anymore as oral is a better route Trifluridine solution Ocular Medications- Anti-inflammatory Indications Common Medications Anti-histamines (emadastine Allergic eye disease difumarate- Emadine) Postoperative Mast-cell stabilizers (cromolyn inflammation (following sodium) cataract extraction and Combo (ketotifen fumarate aka laser corneal surgery) Zatidor, Olopatadine aka Patanol) Inflammatory conditions NSAIDS Flurbiprofen Diclofenac Ketorolac Corticosteroids Dexamethasone (strong) Prednisolone Acetate Ocular Medications- Dry Eye Indications Common Medications Dry eyes Cyclosporine (Restasis) Severe allergic eye Xiidra disease Miebo OTC Drops Systane Get the red out: Refresh LUMIFY Blink Say NO to Visine and Clear Eyes Retaine MGD Ocular Medications- Glaucoma agents Indications Common Reducing intraocular medications: pressure Carbonic anhydrase Acute or chronic angle- inhibitors closure glaucoma (dorzolamide) Pupillary restriction Miotic (Pilocarpine) May have systemic Prostaglandin analogs effects (latanoprost) Change in eye color Sympathomimetics Decreased BP (brimonidine) Beta-blockers (timolol) Low or irregular pulse Ocular Medications-VEGF inhibitors Indications Medications Wet age-related macular Aflibercept (Eylea) degeneration Pegaptanib (Macugen) Retinal vein occlusion Ranibizumab (Lucentis) Diabetic macular edema Ocular Medications- Mydriatics and Cycloplegics Indications Medications Cease ciliary spasm Mydriatics (tropicamide) Iritis (anterior uveitis) Cycloplegics Corneal abrasions (cyclopentolate) Ocular Medications- Anesthetics, Dilation, Corticosteroid Local anesthetics: Not for home/patient use Toxic to the corneal epithelium Patient may further damage the eye tetracaine, proparacaine Pupillary dilation: (check anterior chamber angles and IOP before use) Can precipitate acute glaucoma in those with narrow anterior chamber angle Use short-acting mydriatic tropicamide, phenylephrine Corticosteroid: Repeated use hazardous – herpes simplex keratitis, fungal keratitis, open-angle glaucoma Increases risk of corneal perforation in herpes simplex keratitis May cause cataract formation Prednisolone acetate, dexamethasone Medications used in ocular disorders Aware of contamination Use single use fluorescein strips or drops Aware of sensitivities Preservatives (CL soln.) Antibiotics Periocular contact dermatitis due to eye drop Systemic effects preservative. Beta-blockers Drug – drug interactions Sources Cheatham, Kyle; Applied Science Review Guide. KMK Educational Services. 2022 American Optometric Association online www.aoa.org Wills Institute Eye Manual (2023). American Journal of Ophthalmology [online] www.ajo.com American Academy of Ophthalmology [online] www.aao.org Indiana University School of Optometry Course and Study Materials [2014-2018].