Treatment of certain Eye ConditionsTreatment of certain Eye Conditions

byby

Dr GL MuntinghDr GL MuntinghDept of PharmacologyDept of Pharmacology

The most common eye infections are:The most common eye infections are:

   Viral

        Conjunctivits: Conjunctivits: Allergic

Bacterial

        StiesSties

        BlepharitisBlepharitis

The three most common types of conjunctivitis The three most common types of conjunctivitis areare:

 

        Watery discharge

        Burning

        Irritation

        Glossy looking redness

        Infection usually begins with one eye, can spread.

• Often follows URT infection adenovirus

1. Viral

Two specific signs on exam are enlarged follicular bumps on the inside of the eyelids (these look like tiny blisters) and swelling of the preauricular node located in front of the ear

‘Pink Eye’

Treatment:Treatment: Most common & usually >50% cases in adults

There is no cure for viral conjunctivitis

Symptoms can be relieved with cool compresses and artificial eye lubrication Herpes simplex kerititis – Acyclovir oitment

Topical steroid drops to reduce discomfort from inflammation or diclofenac eye drops

Viral conjunctivitis usually resolves within 3 weeks.

2. Allergic

 

 

        Usually affects both eyes

        Itching

        Tearing

        Swollen eyelids

• Watery or stringy discharge

Treatment for allergies:Treatment for allergies: • Remove the allergen if possible. Cool

compresses and artificial tears sometimes relieve discomfort in mild cases.

• In more severe cases, non-steroidal anti-inflammatory e.g. diclofenac eye drops

• Some patients with persistent allergic

conjunctivitis may also require:- Topical antihistamines e.g. antazolin, phenylephrine,

levocabastine

- Topical steroid drops e.g. betamethasone, dexamethasone - Mast Cell Stabilizers: Sodium Chromoglycate

3. Bacterial3. Bacterial

        Purulent (pussy) discharge. Lids often stick together overnight.

        Swelling of the conjunctiva meaty Redness

        Tearing

        Irritation, pain and/or a gritty feeling

• Usually affects only one eye, often spreads 2nd eye.

Bacterial eye infections

It is caused by bacterial growth and characterized by a thick yellow discharge from the eye, often enough to stick the eye shut overnight.

It is contagious not just to the neighbor eye but also other persons especially children and therefore should be treated ASAP

Children especially those in crèches and primary school should be kept @ home

"Ha! no School for me Today! "

Most common causes are Staph and Strep, although with children you should also consider Hemophilus influenza.

In addition, sexually active adults may harbor chlamydial and gonococcal infections (especially with severe or sudden discharge).  Gonococcal conjunctivitis requires intravenous or intramuscular antibiotics in addition to topical therapy

Sties

A sty (hordeolum) is a red, painful lump on the edge or inside of your eyelid that may look like a boil or a pimple. Usually a sty is filled with pus. As it swells in size, the sty may make it difficult for you to see clearly because you can't fully open your eye

Sties..Most sties eventually fill with pus and then rupture.

The release of pus relieves one major symptom of sties - pain. Usually the sty then disappears.

• Symptoms of sties include:• Pain • A red lump similar to a boil or a pimple • Swelling on your eyelid • Light sensitivity • A scratchy sensation in your eye • Tearing

Sties

Causes

• a bacterial infection, usually staphylococcus.

• Usually the bacterial infection develops at the (follicle) of an eyelash. You may have more than one sty at a time or several in succession

Sties….• Wash eyelids and eyelashes several times a day using

mild soap. Be sure eyes are closed tightly when washing eyes with soap. Eyelid hygiene is key to treat a sty and to keep from getting them.

• Abstain from wearing contact lenses / cosmetics while there is a sty and keep the eyelid area clean.

• Apply warm compresses to the area of the sty for 15 minutes, 2 to 3 times a day.

• Topical Ophthalmic antibiotic as needed

   Blepharitis means inflammation (itis) of the eyelids (bleph), specifically the eyelid margin.  

   

Blepharitis

Anterior blepharitis:

With these patients you’ll find a buildup of debris, or “scurf”, that form as collarets at the base of the eyelashes.

Bacteria and irritants live in this debris and constantly shed irritants into the tear film. If severe, you can see small ulcerations and eyelash loss in affected areas

Blepharitis…

Posterior blepharitis:This is when the meibomian gland orificesclog up. When examining the eyelids, always push on the lid edges with a Q-Tip. If pus-like material oozes out of the pores, then you know the gland isn’t draining properly.

Blepharitis…

Burning, itching, or a feeling of having something in the eye.

        Crust on the eyelids that makes them stick together in the morning. Red and sore eyelid edges.

        Eyelash loss.

        Sometimes, lice that can be seen on the lashes.  

Treatment: topical antibiotic

Antibiotics commonly used topically in the treatment of bacterial eye infections:

 

Chloramphenicol Gentamycin

Ofloxacin    Neomycin

Polymixin      Tobramycin

Sulphacetamide Tetracyclines

Hang-Over-Headache?

Glaucoma• Think of your eye as a sink, in which the faucet is

always running and the drain is always open. • The aqueous humor is constantly circulating through

the anterior chamber. It is produced by a tiny gland, called the ciliary body, situated behind the iris.

• It flows between the iris and the lens and, after nourishing the cornea and lens, (≈ 80%) flows out through a very tiny spongy tissue, called the trabecular meshwork, which serves as the drain of the eye; 20% drains the via uveoscleral route

• The trabecular meshwork is situated in the angle where the iris and cornea meet.

Open-angle Glaucoma

Closed-angle Glaucoma

Glaucoma treatmentBeta blockers:

Timolol

reduce the production of aqueous humor

bronchospasm,

fatigue, erectile

dysfunction, bradycardia

Alpha-adrenergic agents.apraclonidine, brimonidine

Decrease aqueous

production; may

increase uveoscleral

aqueous outflow

itchy or swollen eyes; dry mouth; and allergic reactions.   Headaches burning of the eyes

Carbonic anhydrase inhibitors: dorzolamide

Reduce the amount of aqueous humor

S/e include frequent urination and a tingling sensation in the fingers and the toes

Prostaglandin analogues: latanoprost

Increase uveoscleral

outflow rather than altering

conventional aqueous

outflow

stinging of the eyes, darkening of the iris, changes in the pigment of the eyelid skin, swelling of the central retina

Glaucoma treatment….

Prostamides: bimatoprost

increase the outflow of aqueous humor

Possible side effects include mild to moderate reddening of the eyes and itchy eyes.

Miotics: pilocarpine, carbachol

increase the outflow of aqueous humor

include pain around or inside the eyes, brow ache, blurred or dim vision, nearsightedness, allergic reactions, a stuffy nose, sweating, increased salivation