Deng – Eye Disorder

Deng – Eye Disorder 3/5/25 5:35 PM Dry Eye • S/sx • • • • • • • Stinging/burning Redness Feeling of having something in your eye Sensitivity to light Blurry vision Watery eyes RULE OUT for any red flags → refer to medical provider for further evaluation ○ Discharge ○ Blurry vision ○ Difficulty w/ vision • Moderate to severe dry eye disease or those whose symptoms do not improve with over-the-counter treatments within 72 hours → referred for an ophthalmology evaluation • Non-Pharmacological • Warm-compress: stimulate tear production and improve blood flow to eyes • Pharmacological • Discontinuation of the causative agent, if possible, or switching to preservative-free ophthalmic drops and products can help alleviate symptoms • 1st-line: Artificial Tear ○ If contacts or using more than 3-4x/day → use w/o preservatives • If necessary to use w/ preservatives → remove contact lenses before applying + wait 15-min (15-minute rule) ○ Dose: 1-2 drops as needed (w/ preservatives: limit to 4x/day) • Preservative help increase shelf-life • Discard any open artificial tear product when 3-4 months old or use single vials ○ Forms: drops, gels, ointments (gels + ointments: apply before bedtime due to blurry vision) • Moderate-Severe Symptoms ○ Cyclosporine (Restasis, Cequa) ○ Lifitegrast (Xiidra) ○ Both medications: • Dose: 1 drop in each eye twice daily approx. 12 hours apart ○ If used w/ other eye drops: ▪ Ensure 15-minute interval between each eye drop for Restasis ▪ Remove contact lenses before dose and reinsert 15 minutes after dose Blepharitis • Clinical presentation • Inflammation of eyelid • Irritation • Redness, swelling of eyelid • Sensitivity to light • Swollen, itchy eye lid • Eyelid sticking • More frequent blinking • Itchy, and appear greasy and crusted with scales that cling to the lashes • Dry eye or excess tearing • Non-pharmacological • Warm (NOT HOT) compress to loosen up crust • Eyelid cleansing w/ sterile water, boiled (cooled) water, or baby shampoo • Pharmacological: Artificial tear Conjunctivitis (Pink Eye) • Inflammation of conjunctiva within the eye • Treatment Strategy • Viral: self-limiting, supportive care, medications ineffective on viral activity. ○ In severe cases caused by Herpes, varicella zoster, referral needed for oral anti-viral medications (e.g. acyclovir) • Bacterial ○ ABx eye drops/ointments shorten length of infection ○ Referral to MD • Allergic ○ Allergy medications ○ Eyedrops • Non-pharmacological • Eyelid cleansing if crusting • Cold/warm compress • Do not wear contact lenses for 48 hours after symptoms have subsided • Pharmacological • Artificial Tear (some products come in combination with decongestants) • Topical Decongestants/antihistamine: 1-2 drops QID PRN ○ Antihistamines: ketoprofen/ketotifen (Zaditor ®), olapatidine (Pataday ®), alcafatdine (Lastacaft ®), azelastine, pheniramine (no mast cell stabilizing effect) ○ Decongestants (alpha adrenergic agonists): tetrahydrolazine 0.05% or Naphazoline 0.012-0.03% (often in combination with antihistamines), brimonidine 0.025% (Lumify ®) • Topical corticosteroids ○ Effective for ocular allergies but prone to overuse ○ Not available OTC • Topical Rx ophthalmic antibiotics (only for bacterial conjunctivitis) ○ Chloramphenicol, Azithromycin, Gentamycin, Levofloxacin, Moxifloxacin ○ Duration: 1 week Glaucoma • Pharmacological Treatment (all work by decreasing IOP [intraocular pressure]) • 1st-line: Prostaglandin Analogs ○ Improved nocturnal IOP compared to timolol ○ Greater reduction in IOP compared to BID timolol • Can be used in combination w/ other agents for additional IOP control ○ Generally well tolerated w/ fewer ADR compared to timolol ○ Bimatoprost may be slightly more effective in lowering IOP, getting a larger percentage of patients to lower IOPs, and for patients unresponsive to latanoprost • Tafluprost is preservative free solution • Bimatoprost available as an implant ○ If the patient does not respond to one prostaglandin agonist → switch ○ Counseling Points • Once daily eye drops → administered at night • Altered iris pigmentation (15-30%) ○ Cosmetic but irreversible upon discontinuation • Eyelash hypertrichosis (hair growth) is common • Another 1st-line: Beta-blockers ○ One of the most commonly used antiglaucoma medications ○ Dose: BID (except Timoptic XE gel) ○ These are commonly one of the agents of first choice—along with prostaglandin analogs—in treating POAG if no contraindications exist ○ Have minimum effect on nocturnal IOP ○ Risk of systemic absorption • Timolol gel, fewer drops per day, therefore lower chance nd • 2 -line: Alpha-2 agonists ○ Dose: TID ○ Combination product: Timolol + brimonidine= Combigan ®→ dosed BID ○ Considered second line (after PG analog or beta blocker use) or as adjunct • 3rd-line: Carbonic Anhydrous Inhibitors (CAI) ○ Dose: BID or TID ○ Dorzolamide and brinzolamide are well tolerated and are considered second line (after PG and b-blockers) for monotherapy or adjunctive therapy of POAG and ocular hypertension ○ Generally are well tolerated • Local adverse effects include transient bitter taste in mouth, burning and stinging, ocular discomfort and transient blurred vision, tearing ○ Caution: pts with sulfa allergies (cross reactivity risk is low) ○ Systemic CAIs are also available (vs ocular) indicated for patients failing to respond to or tolerate maximum topical therapy • Very effective but due to intolerable ADR, considered 3rd line • Do not use in combination with ophthalmic CAI (no data on effectiveness) • Hypokalemia may occur when used in combination with diuretics • Rho Kinase Inhibitors • Parasympathomimetic agents Age-Related Eye Disease (AREDS) • • Treatment Options • Anti-VEGF agents retinal injections (typically Q4-6 weeks injections) • Can limit the progression of AMD and stabilize or reverse vision loss • Bevacizumab (off-label), ranibizumab, Ranibizumab-nuna (biosimilar) and brolucizumab-dbll, Aflibercept, pegaptanib