OCULAR PHARMACOLOGY EYE EDUCATION FOR EMERGENCY CLINICIANS These - - PowerPoint PPT Presentation

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OCULAR PHARMACOLOGY EYE EDUCATION FOR EMERGENCY CLINICIANS These - - PowerPoint PPT Presentation

Oct 02, 2023 381 likes •616 views

Education Session Eight OCULAR PHARMACOLOGY EYE EDUCATION FOR EMERGENCY CLINICIANS These presentations have been prepared by: Jillian Grasso, Clinical Nurse Consultant, Ophthalmology Janet Long, Clinical Nurse Consultant Community

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OCULAR PHARMACOLOGY

EYE EDUCATION FOR EMERGENCY CLINICIANS

Education Session Eight

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These presentations have been prepared by:

  • Jillian Grasso, Clinical Nurse Consultant,

Ophthalmology

  • Janet Long, Clinical Nurse Consultant Community

Liaison, Ophthalmology

  • Joanna McCulloch, Transitional Nurse Practitioner,

Ophthalmology

  • Cheryl Moore, Nurse Educator, Ophthalmology

Further information contact us at Sydney Hospital & Sydney Eye Hospital: 02 9382 7111

Modules originally designed for emergency nurses as a component of the Eye Emergency Manual Project.

December 2008

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Aim and Objectives

On completion of this session you will be able to:

  • Explain principles of instilling eye drops
  • Describe appropriate storage of drops
  • Identify the common eye drops used with
  • phthalmic patient
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Instilling Drops

  • Review Eye Skills session Six.

– Wash hands – Place single drop in outer side of lower fornix – Where possible wait at least 5 minutes between eye drops – This allows better absorption of the drug

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Instilling Drops (cont)

  • Compliance is the most important issue so

always keep eye drop instructions simple

  • If your patient has poor vision, instructions for

the eye drops should be in large print

  • Eye drop dispensers are useful for people with

limited dexterity (available at some pharmacies)

  • If eye discharge is present always clean gently

before instilling drops

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  • Some eye medications take longer to absorb

than others

  • Solutions are absorbed quickly and look clear;

e.g. chloramphenicol, glaucoma preparations

  • Suspensions are cloudy or milky. Shake well

before instilling; e.g. Pred Forte, Maxidex

Instilling Drops (cont)

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Instilling Drops (cont)

  • Gels and ointments remain in

the eye longest; e.g. Zovirax, Chloramphenicol

  • If using more than one type of medication:

instil solutions first, suspensions next, and any ointments / gels last

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Punctal Occlusion

  • Systemic absorption of topical ophthalmic

drops occurs through the nasopharyngeal mucosa

  • Place pressure on

the punctum for two minutes to prevent this

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Storage of Eye Drops

  • Correct storage is important to reduce the rate of

breakdown of the ingredients in the eye drops

  • Always follow manufactures’ guidelines

regarding expiry date and storage

  • nce opened e.g. protect from light
  • Unopened drops should be stored

in their box, in a cupboard or refrigerator (as directed)

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Storage (cont)

  • Multi-use bottles contain preservatives
  • Once opened, multi-use bottles should be

discarded after 28 days. Mark with date

  • pened
  • Do not confuse with expiry

date for unopened bottles

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Storage (cont)

  • Minims are preservative

free and sterile

  • Minims should be stored in

the fridge

  • A single Minim may be

used for the same patient for up to 24 hours after

  • pening
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Artificial Tears and Ocular Lubricants

  • To help alleviate ocular discomfort and maintain

the integrity of the corneal epithelium in dry eyes

  • Large number of preparations available over the

counter

  • Available as solutions, gels and ointments
  • Available with / without preservatives
  • Ophthalmic consult recommended if symptoms

persist Examples: Systane, Polytears, Liquifilm, Refresh

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Ocular Corticosteroids

  • Used post operatively or for ocular

inflammation

  • ALWAYS used under the guidance
  • f an ophthalmologist
  • Usually the dose is tapered down

before stopping

  • Suspensions: must shake bottle

before using

  • Side effects include; raised

intraocular pressure, systemic effects

  • May cause a premature cataract
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Antimicrobial Agents

  • Used to prevent growth of bacteria

introduced into the wound by surgery or

  • injury. Examples: Chlorsig, Tobrex, Ciloxan ™
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Mydriatics

  • Mydriatics are drugs that cause pupil dilation
  • Usually used to examine the fundus
  • May be used for pain relief eg Iritis
  • The most common one used is Mydriacyl

(Tropicamide)

  • 15 minute onset, can last for 3 to 6 hours.
  • Will blur vision
  • Instruct patients to take care with

stairs, curbs, pouring hot liquids

  • Do not drive until blurring resolves
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Mydriatics (cont)

  • Other dilating drops for example:

– Atropine – Homatropine

  • Long acting: may last 7-10 days.
  • Different mode of action – effects close vision.

Recommendation: Sun glasses and a hat useful when outdoors due to glare

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Miotics

  • Miotics are drugs that constrict

the pupil: miosis e.g. Pilocarpine

  • Used to treat glaucoma
  • Can cause:
  • night blindness,
  • stinging on instillation
  • brow ache or spasm
  • Patients who have been on long-term

Pilocarpine may be very difficult to dilate

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Glaucoma Medications

  • Summary of glaucoma medications can be

found in the Eye Emergency Manual

  • Patients may be on multiple glaucoma

medications and can become confused in their management, especially in the elderly

  • There are potential side effects /

contraindications

Timolol and Betoptic are beta blockers. Acetazolamide (Diamox) is a sulfonamide.

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Ocular Topical Anaesthetics

  • Ocular topical anaesthetics temporarily block

nerve conduction in the cornea and conjunctiva. Examples: Amethocaine 0.5%, 1%; Oxybupricaine 0.4%

  • Quick onset:10 - 20 seconds.
  • Duration: 10 - 20 minutes.
  • Drops sting on instillation.
  • Do not use in the case of penetrating eye injury
  • Used to assist with eye examination and visual

acuity testing: chemical burn, welding flash, foreign bodies.

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Ocular Topical Anaesthetics

  • Advise patient not to rub the eye for at least 20-

30 minutes

  • Do not apply an eye pad during this time
  • May wear sunglasses or prescription glasses if

eye still affected on discharge

  • Must not be used for long term pain relief

Patients must not be sent home with local anaesthetic drops as it retards healing.

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Ocular Diagnostic Drops

  • Diagnostic drops selectively stain certain cells to

provide useful information on examination Examples: Fluorescein, Lissamine Green

  • Use care when instilling as they may stain skin

and clothing

  • Does not interfere with vision
  • Caution: Do not use with soft contact lenses will

take up dye – not reversible

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KEY POINTS TO REMEMBER

  • Most ocular drugs have the potential for marked

systemic effects

  • Always consider the correct storage
  • Eye medications are absorbed at different rates,

so use correct order for instilling drops

  • Do not forget to ask patient if they are presently

using eye medication, this will indicate current

  • cular diseases and disorders

Eye drops or ointments are never instilled in a penetrating eye injury.