The following are the major areas of the eye and its function
Cornea: covers the iris and pupil
Sclera is the white part of the eye and the conjunctiva is the clear membrane that covers it
Iris and the pupil form the aperture that light passes through to the lens
Lens focuses light by refraction to the back of the globe to the retina
The retina is a collection of neurons that triggers the optic nerve and carries the “image” to the occipital lobe of the brain
The eye contains two chambers as well. The aqueous humor which is filled with water and the vitreous humor in the back of the eye
The lens is controlled by the muscles of the ciliary body which adjusts the lens to control refraction of light
The basic function of the eye is to focus and concentrate light waves to a focal point on the retina which converts it to electrical impulses (EI). EI are carried to the brain via the optic nerve
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Style: a bacterial infection of the sebaceous glands of the eye lid. Antibiotics like ophthalmic erythromycin can be used but infection is self limited and will resolve in usually seven days
Blepharitis: inflammation of the eyelids cause by usually bacteria. Tx: Blephamide® (prednisolone/sulfacetamide) is a combination Abx/steroid used to treat this disorder
Conjunctivitis is an inflammation of the conjunctival membrane of the eye.
Allergic conjunctivitis (red eye)
Bacterial conjunctivitis
Viral conjunctivitis (Pink eye)
Inflammatory condition of the conjunctiva caused by seasonal allergies and airborne allergens
Called “red eye”
Intensive itching
Eye watering
Tx: Ophthalmic antihistamines products: (Visine A® naphazoline 0.025% and pheniramine 0.03%) or
Patanol®, olapadine which is Rx only antihistamine
Caused by mixture of different bacterial
Symptoms same as for allergic conjunctivitis
In addition pus and mucus causes the lids to “stick together”. This is the hallmark of this infection
Usually resolves on its own but antibiotics can be used
Ciprofloxacin 0.3% (ciloxan®), Erythromycin
Ophthalmic Ointment USP, 0.5% and others
Women infected with chlamydia or gonorrhea can pass bacteria to their infants as they pass through birth canal
Erythromycin ophthalmic ointment 0.5% USP has been used to treat the infants
Can cause blindness if not treated
Commonly called pink eye
Commonly caused by the same viruses causing the common cold (adenovirus)
Other virus can include varicella and herpes simplex virus
No therapy except supportive. Oral acyclovir is used for cases caused by varicella zoster virus or herpes simplex virus.
Glaucoma is a disease of the eye where the pressure inside the eye ball is elevated above normal
Open angle glaucoma is the most common type (90%) with closed angle glaucoma (10%) following
Treated with drugs that reduce the pressure in the eyeball by relaxing the trabecular network and increase aqueous humor outflow. Beta Blockers and carbonic anhydrase inhibitors are examples of drugs in this category. (Cosopt ® is a combination of timolol and dorzolamide)
Xalatan ® (Latanoprost) and Travatan® (travaprost) are prostaglandin analogues that increase outflow of humor as well. They are both ophthalmic drops give once a day
Can lead to a loss of vision if not treated
The outer ear consists of the pinna and auricle
Auditory canal leads from the outer ear to the tymphanic membrane (ear drum)
Middle ear: the three ossicles vibrate in response to sound waves and transmit the energy of the sound waves into the inner ear
Inner ear: The cochlea is a conical shape organ filled with fluid and lined with hair cells. The energy of sound waves is transmitted here and the movement of hair cells to electrical action potentials in cochlear nerve (CN VIII)
Infections of the ear are the most commonly treated malady of the ear
Medications include otic antibiotics that contain a combination of antibiotics and a steroid.
Example is Cortisporin Otic Solution (neomycin and polymyxin B sulfates and hydrocortisone otic solution,
USP) is a sterile antibacterial and anti-inflammatory solution for otic use. Each mL contains: neomycin sulfate equivalent to 3.5 mg neomycin base, polymyxin B sulfate equivalent to 10,000 polymyxin B units, and hydrocortisone 10 mg (1%)
Bacteria that infect the eustachian tube include:
Staphylococcus pyogenes, Streptococcus pneumoniae, moraxella species, and haemophilus influenza
Very common in children because of the horizontal nature of the tube position
Caused intense pressure in the middle ear that can rupture the eardrum and ozze pus from the ear
Myringitis is the associated inflammation of the eardrum
Called Bacterial Acute Otitis Media
In children, Amoxicillin is normally prescribed usually as suspension and given three times a day
In refractory cases, Augmentin ® (amoxicillin/clavulunate sodium) is used
Parasympathomimetics (Cholinergic drugs)
MOA: agonists at the cholinergic receptor in the eye
Indications: pupillary constriction and glaucoma tx
Drugs
Pilocarpine (Pilocar)
Carbachol (Miostat)
Sympathomimetics (mydriasis agents)
MOA: binds to beta and alpha receptors or blocks cholinergic receptors
Indications: dilate the pupil for ophthalmic exams
Phenylephrine
Cyclopentolate (Cyclogyl)
Atropine