Self-Care Pharmacotherapy: Ophthalmic, Otic, and Oral Disorders PDF

Self-care & non prescription medicine(PHDR412) 1st. Semester, 2023-2024 Self-Care Pharmacotherapy: Ophthalmic, Otic, and Oral Disorders College of Pharmacy, University of Hafr Al Batin The eye is made up of three coats, which enclo...

Self-care & non prescription medicine(PHDR412) 1st. Semester, 2023-2024 Self-Care Pharmacotherapy: Ophthalmic, Otic, and Oral Disorders College of Pharmacy, University of Hafr Al Batin The eye is made up of three coats, which enclose the optically clear aqueous humour, lens, and vitreous body. The outermost coat consists of the cornea and the sclera; the middle coat contains the main blood supply to the eye and consists, from the back forward, of the choroid, the ciliary body, and the iris.  The eyes Preparations for the eye should be sterile. Eye drops in multiple-application containers used in domiciliary care should not be used for more than 4 weeks after first opening. Eye drops: drugs penetrate the globe, probably through the cornea; systemic effects may arise from absorption of drugs into the general circulation Eye ointment: applied to lid margins Eye lotions: solutions for irrigation. Stye (hordeolum) Eyelid disorders Local pyogenic infection involving the follicle or sebaceous gland of an eyelash Occurs on the outer surface of the eyelid as a palpable, tender nodule  Chalazion Inflammatory granulomatous swelling on the eyelid or its margin Occurs due to blockage of one of the meibomian glands which lubricate the eyelid More common in adults than in children Management: surgical removal may be required, local antibacterial preparations may be considered if infection is suspected. A chalazion is a less painful chronic infection on the inside edge of the eyelid (conjunctival side) affecting the Zeis or meibomian (oil-secreting) glands. Styes, or hordeola, are painful infected lesions on the edge of the eyelid (eyelash follicles) that come on quickly and eventually break open and drain.  Blepharitis Inflammation of the margins of the eyelids Presentation: inflammation, scaling, pruritus, oedema, yellow crusts form on the eyelashes Causes: unknown, due to allergy, occurs with seborrheic dermatitis Management: cleanse the eye with saline solution and apply of local antibacterial preparations.  Entropion and ectropion Entropion and ectropion are conditions that affect your eyelid. A. Entropion — Where your eyelid turns in and causes your eyelashes to rub against the cornea (the clear, dome-shaped outer layer at the front of your eye). B. Ectropion — Where your eyelid turns out and does not touch your eye. Entropion and ectropion are conditions that occur in old age and lead to eye discomfort and dryness.  Ocular surface disorders 1.Foreign substance contact Remove foreign particles with care. Refer in cases where metallic foreign bodies, chemical exposure or thermal damage has occurred.  Conjunctivitis This is inflammation of the membrane that lines the eyelids (conjunctiva). It presents with erythema and swelling of the lids and can be acute or chronic. It may be due to: allergy: occurring in both eyes; watery discharge, itchiness and rhinitis may be concomitant symptoms. viral infection: occurring in both eyes; watery discharge, gritty feeling and usually patient Pink eye is the inflammation or infection of the transparent membrane that lines your eyelid and eyeball. Typical symptoms include redness and a gritty sensation (the feeling of having sand in the eye) in your eye, along with itching. Often a discharge forms a crust on your eyelashes during the night also presents with respiratory viral infection (cold)  bacterial infection: initially presents in one eye but may spread to both eyes; purulent discharge, gritty feeling and not usually associated with other symptoms. Management Allergic: ocular decongestants, topical or systemic antihistamines Viral: artificial tears, ocular decongestants Bacterial: topical antibacterial preparations. Dry eye (Keratoconus) Presentation of mildly red eye, gritty feeling or sensation of foreign body, excess tears Management: artificial tears which can be applied as often as required. Subconjunctival haemorrhage May develop at any age following minor trauma, sneezing, coughing Alarming, but extravasation absorbed gradually within 2 weeks. Ophthalmic preparations Topical antibacterial preparations Broad spectrum: chloramphenicol, ciprofloxacin, ofloxacin, gentamicin, framycetin Anti-staphylococcal activity: fusidic acid Available as monotherapy or in combination with corticosteroids  Dosing schedule normally requires administration three to four times a day It is recommended to advise patient to continue treatment 48 hours after healing, about careful hand washing and to be careful when administering the drops or ointment in the lower conjunctival sac to avoid contamination of dropper. Anti-inflammatory preparations Corticosteroids: e.g. betamethasone, dexamethasone Use: allergy, herpes simplex keratitis (aciclovir), post surgery Cautions: undiagnosed red eye since the use of the steroid may clear the symptoms while the underlying condition is not treated; precipitation of steroid glaucoma, steroid cataract and increased susceptibility to microbial infections. Other anti-inflammatory agents Used for allergic conjunctivitis Antihistamines: e.g. antazoline, azelastine, emedastine, levocabastine Sodium cromoglicate and nedocromil sodium. Decongestants Examples: phenylephrine, naphazoline Cause vasoconstriction and are useful in inflammation Chronic use may lead to rebound conjunctival congestion (conjunctivitis medicamentosa) Care: may mask diagnostic signs since redness and inflammation may be removed while underlying condition is not treated. Others Acyclovir eye ointment used in herpes infections Tear deficiency products (e.g. hypromellose used in dry eyes) Diclofenac sodium available as eye drops used postoperatively Astringents: distilled witch hazel used in eye lotions for irrigation. Glaucoma Glaucoma describes a range of ocular conditions where the intraocular pressure is too high for the eye to withstand without damage to the structure or impairment of function. The upper limit of normal pressure is 21 mmHg. The condition is classified into acute glaucoma (closed angle) and chronic glaucoma (open angle). Acute glaucoma (closed angle): sudden onset of pain blurred vision dilated pupil if untreated can lead to blindness pain in and around eye nausea and vomiting. Glaucoma and cataracts affect two different areas of the eyes. Glaucoma involves eye pressure and affects the optic nerve, and cataracts involve the breakdown of proteins and affect the lens. Chronic glaucoma (open angle): more common insidious onset with loss of peripheral vision blurring halos around lights headaches feeling of fullness around eyes. Drugs used in the treatment of glaucoma Miotics Examples: pilocarpine, carbachol Parasympathomimetic agents Act on ciliary muscle leading to opening up of drainage channels in trabecular meshwork, resulting in increased aqueous flow Effective Disadvantages: small pupil, near vision.  Sympathomimetics Examples: adrenaline (epinephrine), dipivefrine Increase in outflow and reduction of aqueous humour production Cause mydriasis Side-effects: red eye, conjunctival pigmentation Contraindicated in closed-angle glaucoma due to onset of mydriasis. Beta-blockers Examples: timolol, betaxolol Reduce aqueous humour production Betaxolol has cardio-selective properties whereas Timolol is non-cardio-selective Note: use in patients with asthma and obstructive airway disease should be avoided due to risk of bronchospasm if there is some degree of systemic absorption Contraindications: bradycardia, heart block, uncontrolled heart failure. Carbonic anhydrase inhibitors These decrease aqueous humour production. Acetazolamide: available for oral administration side-effects: malaise, fatigue, muscle weakness long-term side-effects: electrolyte imbalances. Brinzolamide and dorzolamide: available as eye drops used as monotherapy or in combination with beta-blockers  side-effects: bitter taste, burning and stinging of eyes common; other side-effects associated with systemic activity may occur including paraesthesia, flushing, headache, dizziness, fatigue, irritability, thirst, polyuria contraindications: renal impairment, hyperchloraemic acidosis, breast-feeding. Prostaglandin analogues Examples: bimatoprost, latanoprost, travoprost Increase uveoscleral outflow and result in a decreased intraocular pressure in open-angle glaucoma May cause increase in brown pigmentation of iris Application once daily, preferably in the evening Available in combination products with timolol.  Contact lenses Contact lenses were first designed more than 100 years ago: 1940: hard lenses made of Perspex 1960: soft hydrogel lenses 1990s: disposable lenses. Most extended wear contact lenses are made out of silicone hydrogel - a material that combines the water-absorbing plastic of soft lenses with silicone. Adding silicone to the hydrogel plastic creates a lens that stays moist and allows more oxygen to transmit through the contact lens into the eye. Advantages Preferred to spectacles for cosmetic reasons Better peripheral vision Help to correct myopia, astigmatism. Disadvantages Not suitable for people with allergies Manual dexterity (skill in performing tasks, especially with the hands ) required Tolerance may be reduced during pregnancy Diabetic patients and immunocompromised patients are at greater risk of developing eye infections. Cleaning solutions Used for daily cleaning to remove fresh deposits of lipids, proteins and other contaminants Applied to both surfaces of the lens and digital pressure is used in a rotating manner in the palm of the hand. Rinsing and disinfection solutions Rinsing: sterile saline solution Disinfectants: contain hydrogen peroxide. Lenses should be rinsed before insertion into the eye. Comfort solutions These are intended for instillation directly into the eye with the lenses on. They provide fluid to main- tain adequate lens hydration and improve comfort. Protein removal These are used periodically after cleaning and before disinfection. They consist of proteolytic enzymes (e.g. papain) as tablets that are dissolved in saline. The lenses are soaked in this solution before being cleaned and rinsed. Protein removal tablets are suit- able for soft and hard lenses. The use of extended-wear disposable products eliminates the need for this step since at this stage the lenses are discarded. Complications related to contact lens wear Most complications are self-limiting if the lens is removed at the first sign of trouble. Complications could be as a result of: poor lens care inadequate hygiene overwear poor fitting. Problems occur more in hot, dry environments. Chronic conjunctivitis Red eye, itchy, mucus discharge Stop contact lens wear  Disinfect and clean or change lenses for disposable lenses. Ulcerative keratitis Rare but serious complication Precipitating factors include overnight wear and long intervals between cleaning. Effects of systemic medications on contact lens use Reduced tolerance due to oral contraceptives: oestrogen component causes eyelid oedema, allergic conjunctivitis Anxiolytics, hypnotics, antihistamines: reduce blink rate Atropine, antimuscarinics, beta-blockers, TCAs: decrease tear volume Aspirin: appears in tears and may be absorbed by soft lenses resulting in ocular irritation and redness. Effects of topical medications on contact lens use May damage contact lens and increase contact time of the drug Eye drops should be administered 30 minutes before inserting lens. Practice summary Preparations administered in the eye should be sterile. Eye drops in multi-dose containers for domiciliary use should be discarded within 4 weeks of opening and those used in institutions should be discarded within 1 week of opening. Patients should be advised on the correct administration of eye drops and eye ointments. When using anti-infective preparations, care should be taken not to contaminate dropper. Administration of corticosteroids should be undertaken with care due to risk of misdiagnosis and risk of side-effects.  In glaucoma more than one type of drug may be used to control intraocular pressure. Use of contact lenses requires strict adherence to recommendations for storage and lens use to avoid conditions related to contact lens wear.