Ear and Ear Responding to symptoms.pptx

Pharmacy Ethics and law

1. RS: Management of Eye/Ear Disorders 3 rd Year: Pharmacy Practice Ms. Thelma K Mhango

2. Objectives • To summarise use of topical agents in eye conditions • To review presentation of common eye disorders • To address management of glaucoma • To appreciate principles of contact lens use and care .

3. Eye Disorders Ocular symptoms most likely to be encountered in the pharmacy are red eyes, styes , swollen, painful eyelids and sore, gritty eyes. Responding to these symptoms requires special care to differentiate between minor disorders and potentially serious conditions that could have significant consequences

4. Eye Disorders Stye ( hordeolum ) 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 Presents with painful swelling and inflammation of the edge of the eyelid Management : hot compresses and application of local antibacterial eye preparations.

5. 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.

6. 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 .

7. Contact Dermatitis • Presentation: swelling, scaling or redness of the eyelid , itching • Could be due to make-up, soap • Management: cold compresses, oral antihistamines .

8. 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 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.

9. Management • Allergic: ocular decongestants, topical or systemic antihistamines • Viral: artificial tears, ocular decongestants • Bacterial: topical antibacterial preparations.

10. Dry Eye • 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.

11. Subconjunctival Haemorrhage • May develop at any age following minor trauma, sneezing , coughing • Alarming, but extravasation absorbed gradually within 2 weeks.

12. Subconjunctival Haemorrhage Accompanying symptoms indicative of referral • Eyelid irritation: with history of trauma or with swelling and failed nodule treatment • Red eye: with pain, blurred vision, photophobia , history of trauma, contact lens wear, foreign body sensation and possible contamination or vomiting.

13. Eye Disorder Symptoms Ocular symptoms most likely to be encountered in the pharmacy are red eyes, styes , swollen , painful eyelids and sore, gritty eyes. Responding to these symptoms requires special care to differentiate between minor disorders and potentially serious conditions that could have significant consequences.

14. Eye Preparations 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.

15. 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 .

16. How to apply \ ointiments When the application of eye ointments is relevant , it may be recommended to use the eye ointment at night and then complement therapy with the eye drops . Application of eye ointments is associated with blurring of vision and this may impact negatively on patient compliance if three to four times daily administration is requested

17. 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.

18. Other Anti-inflammatory Agents • Used for allergic conjunctivitis • Antihistamines: e.g. antazoline , azelastine , emedastine , levocabastine • Sodium cromoglicate and nedocromil sodium.

19. 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.

20. Others Aciclovir 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

21. 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). 1.Acute glaucoma (closed angle): sudden onset of pain blurred vision dilated pupil if untreated can lead to blindness

22. •1.Acute glaucoma (closed angle): Symptoms sudden onset of pain blurred vision dilated pupil if untreated can lead to blindness pain in and around eye • nausea and vomiting

23. 2.Chronic glaucoma (open angle): more common v\ symptoms insidious onset with loss of peripheral vision blurring halos around lights headaches feeling of fullness around eyes.

24. 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.

25. 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 .

26. Beta-Blockers Examples : timolol , betaxolol Reduce aqueous humour production Betaxolol has cardioselective properties whereas timolol is non- cardioselective 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.

27. 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

28. Carbonic anhydrase inhibitors 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.

29. 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 .

30. Monitoring of Glaucoma Glaucoma requires constant monitoring of the outcomes of therapy by evaluating intraocular pressure. When monotherapy is not effective , rather than increasing dosing frequency , combination therapy should be adopted .

31. Practical Summery 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.

32. Assignment : Contact Lenses What are they used for Types Advantages and disadvantages Cleaning and care of contact Lenses Complications of Contact Lenses

33. Questions 1 Differentiate between chalazion and blepharitis. 2 What are the unwanted effects that could result from topical ocular administration of corticosteroids ? 3 Giving examples, describe what is a miotic agent and comment on its use in glaucoma.