Fa2014PP469_opthalmic-otic disorders- 3 slides pp - OPHTHALMIC AND OTIC DISORDERS K A R L E E N M E L O D Y P H A R M D B C A C P OBJECTIVES

11/24/14 1 KARLEEN MELODY, PHARMD, BCACP OPHTHALMIC AND OTIC DISORDERS OBJECTIVES • Differentiate ophthalmic and otic disorders based on signs and symptoms • Establish if a patient presenting with an ophthalmic or otic disorder is appropriate for self-care • Given a patient case recommend appropriate non- pharmacologic and pharmacologic treatment for ophthalmic and otic disorders • Provide counseling points on pharmacologic treatment options for ophthalmic and otic disorders including administration OPHTHALMIC DISORDERS

11/24/14 2 ANATOMY • External location • Susceptible to contamination • Natural Defenses • Eyelid • Removes debris • Produce and spread tears • Tears • Lubrication • Removes debris • Antimicrobial action ANATOMY ___________- responsible for most of drug absorption; damage can increase absorption rates (contact wear, trauma, topical anesthetics, UV light) ___________- maintains normal intraocular pressure (IOP) ___________- produces aqueous humor and focuses lens; part of tract which drains aqueous humor; ___________- colored portion of eye regulates amount of light entering eye; Pupil- opening in iris ___________- filled with vitreous humor; “Floaters” are deposits in vitreous humor (no self treatment) ___________- processing and transmitting light; detachment can cause vision loss

11/24/14 3 EXCLUSIONS FOR SELF-TREATMENT OF OPHTHALMIC • Eye pain • Blurred vision • Sensitivity to light • Contact lenses • Blunt trauma • Chemical exposure • Eye exposure to heat, excluding sun exposure • Symptoms lasting more than ______ hours with treatment DRY EYE • Pathophysiology • Aging • Anatomical defects • Disease • Medications • Environmental • Clinical Presentation • White or mildly red eye • Sandy gritty feeling • May present with excessive tearing TREATMENT OF DRY EYE Non-Pharmacological •Avoid dry environmental conditions •Avoid long periods viewing a computer screen •Eye protection •Humidifiers Pharmacological •Ocular lubricants •Increasing viscosity results in prolonged contact time •Artificial tears •Non-medicated ophthalmic ointments

11/24/14 4 ARTIFICIAL TEARS • Mechanism of action • Stabilize tear film, protect the corneal and conjunctival cells, prevent tear evaporation, enhance healing and lubrication • Formulations typically contain • Preservatives • Inorganic electrolytes • Water-soluble polymeric systems ARTIFICIAL TEARS • Vehicle/Lubricants • Cellulose ethers • Hydroxypropyl methylcellulose • Carboxymethylcellulose (CMC) • Povidone • Polyvinyl alcohol (PVA) ARTIFICIAL TEARS •1-2 drops BID typically •Can increase to QID dosing; hourly in severe cases Directions •Preservatives •Toxicity •Interactions with other drops Safety considerations

11/24/14 5 NON-MEDICATED OPHTHALMIC OINTMENTS • Mechanism of action • Enhanced retention time and stabilize tear film White petrolatum •Lubricant and ointment base Mineral oil •Helps ointment melt at room temp Lanolin •Facilitates the incorporation of