Week 4 Lecture 2 Eye Ear Oral.pdf - Nonprescription Drug Therapy Ophthalmic Otic and Oral Disorders Karen Steinmetz Pater PharmD BCPS CDE PHARM 5210

9/16/2016 1 Nonprescription Drug Therapy: Ophthalmic, Otic and Oral Disorders Karen Steinmetz Pater, PharmD, BCPS, CDE PHARM 5210 Objectives ° Review basic anatomy of the eye ° Understand the common causes and signs/symptoms of common eye disorders ° Discuss treatment options for common eye disorders ° Recommend appropriate treatment strategies for common eye disorders Anatomy of the Eye ° Eyelids ° Sclera and cornea ° Anterior chamber ° Iris ° Ciliary body ° Vitreous humor ° Retina Eyelids ° Multi-layer tissue – skin externally – palpebral conjunctiva internally ° Role: – Protect the anterior surface of the eye and spread tears produced by glandular tissue – Force the flow of tears toward the nose >> drainage canals >>> lacrimal sac Tear Layer ° Role – Maintains ocular surface lubrication ° Multi-lipid layers: – Outer lipid layer ° maintains optical properties and prevents evaporation – Middle aqueous layer ° wetting properties – Inner layer: ° maintains constant adhesion across cornea and conjunctiva ° Contains enzymes and IgA for antimicrobial properties Sclera and Cornea ° Visible external portion of the eye ° Sclera ° rigid and encases internal eye structures ° source of visible eye redness during irritation and inflammation ° Cornea ° Aspherical and avascular ° Refractive element of the eye ° Controls drug absorption into the eye

9/16/2016 2 Anterior Chamber ° Anterior chamber – filled with aqueous humor ° Role of Aqueous humor – Maintains normal internal eye pressure – Provides nutritional support for the cornea and crystalline lens Intraocular pressure (IOP) ° Increased IOP – significant risk factor for primary open angle glaucoma (POAG) ° Angle-closure glaucoma – precipitated by mydriatic and anticholinergic medications ° Symptoms – browache – Headache – N/V Common Anticholinergic Side Effecs ° Dry mouth and mucous membranes ° Urinary retention ° Constipation ° Blurry vision – MYDRIASIS ° Sedation ° Cognitive dysfunction Extreme Anticholinergic Side Effects ° Red as a beet – Flushing ° Dry as a bone – Dry membranes and constipation ° Blind as a bat – Blurry vision (fixed dilated pupils) ° Mad as a hatter – Mental status changes ° Hot as a hare – Fever Common Anticholinergic Medications ° OTC Antihistamines – Oral – 1 st generation – Ocular ° Tricyclic Antidepressants – Amitriptyline - Nortriptyline - Imipramine Other Anatomy of the Eye ° Iris – Regulates the amount of light striking retina ° Ciliary body – Focusing lens for near viewing ° Vitreous humor – Damage usually determined by complaint of floating spots ° Retina – Process and transmits light signals

9/16/2016 3 Ophthalmic Disorders ° Dry Eye ° Allergic Conjunctivitis ° Viral Conjunctivitis ° Corneal Edema ° Loose Foreign Substances in the Eye Various Types ° Minor Eye Irritation ° Chemical Burn ° Contact Dermatitis ° Macular Degeneration ° Blepharitis ° Hordeolum/Chalazion Dry Eye ° Causes – Aging – Lid defects – Environment – Medications: Anticholinergics Beta blockers Diuretics ° Signs/Symptoms – White, mildly red eye, excess tearing –