Eye and Ear Medication

The Eye

 Eyelids, eyelashes, and eyebrows protect the eye from irritants and infections
 The hard sclera protects the outer eye and contains a layer called the choroid. The
choroid consists of the blood vessels that nourish most of the eye with nutrients and
oxygen
 The cornea is provided with oxygen and nutrients through aqueous humor and not
blood vessels
 The anterior chamber contains a watery aqueous humor
 Aqueous humor is produced by the ciliary bodies, drains from the posterior chamber,
to the anterior chamber, and out through the trabecular network and canal of
Schlemm where it is absorbed by the episcleral vein
 The iris regulates the amount of light that enters the eye by dilating or constricting
pupils
 Cranial nerve 3 controls pupil size
 The dark cavern of the posterior chamber contains a viscous (thick) vitreous humor
 The retina is the light sensitive tissue located at the back of the eyeball. The inverted
images are then sent to the brain via the optic nerve for interpretation
 The rods of the retina process black and white
 The cones of the retina process color
**Atropine is the drug used to dilate the pupil and facilitate eye exams

**Patients should be encouraged to see an ophthalmologist or optometrist annually. The specialist uses
a tonometer to measure pressure in the eye

Glaucoma

 Glaucoma-In this disease, an increase in pressure in the eye damages the optic nerve. Thus,
 impairing it’s ability to transmit visual information from the eye to the brain
 Glaucoma is the leading cause of blindness

Types of Glaucoma

o Open-Angle Glaucoma is the most common form of glaucoma. It occurs when the eye’s
Schlemm canal(drainage tube for aqueous humor) becomes obstructed leading to increased
pressure. Usually has no symptoms, but if not diagnosis, it can result in vision loss
- Angle of the eye is not the problem, the clogging of the trabecular network is. Open angle
glaucoma is the “silent thief” of eyesight because it has NO symptoms
- S/S: No pain and tunnel vision
- Treatment: Surgery; results are temporary and it does not correct any lost vision
A. Selective Laser Surgery
-laser beams directed to the trabecular network to create an opening
 B. Traditional Trabeculectomy
- removal of some of the trabecular network; pt. will have a bleb located under the
eyelid
o Angle-Closure Glaucoma aka narrow-angle glaucoma. This type is rare and differs from open-
ended glaucoma in that the eye pressure is applies rapidly. Angle-closure glaucoma occurs
when drainage is obstructed but at a different place in the eye. The iris is too small and usually
covers up the drainage canal. Symptoms include multicolored halos around lights at night,
blurred vision, and nausea
- Closed angle is a medical emergency
- Can be caused by medications that causes pupil dilation such as, anticholinergic,
antihistamines, glucocorticoids, drugs that treat COPD
- S/S: multicolored halos around lights at night, headache, and eye pain
- Treatment: Treatment: Surgery; results are temporary and it does not correct any lost vision
A. Laser Iridotomy
B. Iridectomy
o Other Types of Glaucoma
- congenital glaucoma, secondary glaucoma, pigmentary glaucoma
o Secondary glaucoma is secondary to a disease that causes or contributes to increased eye
pressure, injury, or medications.
- Medications that treat secondary glaucoma include the following: anticholinergic drugs,
antidepressants, antihistamines, and glucocorticoids
o Pigmentary glaucoma results when the pigment granules break off and lodge in the drainage
system

** Medications such as glucocorticoids, antihypertensive, antihistamines, and antidepressants can

predispose a patient to increased intraocular pressure because of a decrease in aqueous humor flow
in the eye**

** Goal of treatment of glaucoma is to decrease intraocular pressure promoting drainage or

decreasing production**

Drugs that treat Glaucoma

o Glaucoma drug treatment includes:

Miotic
Prostaglandin
beta blockers
alpha blockers
carbonic anhydrase inhibitors
osmotic diuretics

Miotic “end in pine”

 Treat glaucoma by increasing the flow of the aqueous humor

 Miotic Drug Ex:
-Pilocarpine HCL(Isopto Carpine
-Pilocarpine HCl Ophthalmic Soluction USP)
 -Pilocarpine HCl gel 4%
-Carbachol (Isopto Carbachol)
 These drugs constrict pupils
 Activate cholinergic receptors that reduce IOP
 Dilate the meshwork of the Schlemm canals that allow increased output of the aqueous humor,
as more aqueous humor is absorb, IOP decreases
 Side Effects: Corneal edema, clouding, stinging/burning, and tearing

Beta Blockers “end in olol”

Beta Blockers decrease intraocular fluid. In low doses it doesn’t have a systemic effect, but if absorb,
they can.

 Medications:
-Betopic S (betaxolol)
-Istalol (timolol maleate)
-Timolol Maleate ophthalmic gel (Timoptic-XE)
 Side Effects: low HR, bronchospasms, & hypotension
 Contraindicated: Bronchial Asthma, COPD, sinus bradycardia
 Systemic effects can be minimized by closing the eye following application to prevent drops
from entering the tears ducts

Alpha Blockers “end in dine”

 Alpha blockers dilate the blood vessels in the eye and have a mild effect on the cardiovascular
and respiratory systems.
 They treat glaucoma by decreasing the production of intraocular fluid and increasing the
drainage of the aqueous humor
 Medications:
-Brimonide(Alphagen P)
-Apraclonidine(Iopidine)
-Dipivefrin(Propine)

Prostaglandins “end in prost”

 Treat glaucoma by increasing the flow of the aqueous humor

 Do not affect pupil diameter but does dilate the meshwork of the Schlemm canal
 These drugs can change the pigmentation of the iris, thus changes eye color
 Prostaglandin Drug Ex:
-Bimatoprost(Lumigan)
-Lantanoprost(Xalatan)
-Travoprost(Travatan Z)
 Side Effects: turns the iris of the eye brown, and makes eyelashes thicker and longer

Carbonic Anhydrase Inhibitors “end in mide”

 Decrease IOP by reducing the production of intraocular fluid

  Can be administered topically or systemically, however systemic use is reserved for patients
who don’t respond well to topical use
 Carbonic Anhydrase Inhibitors Drug Ex:
-Acetazolamide (Diamox & Sequels)
- Brinzolamide(Azopt)
-Dorzolamide(Trusopt)
 Side Effects: bitter taste

Osmotic Diuretics

 This class of medication is used to decrease the amount of aqueous humor rapidly
 Glycerin(Osmoglygn, Ophthalgan Solution) is an Osmotic Diuretic
 Side Effects: disorientation, fluid & electrolyte imbalances, dry mouth

Eye Irritations and Infections

 Minor eye injury and irritations can be treated with the following:
- Local anesthesia
- Antimicrobials
- NSAIDs
- Glucocorticoids

Local Anesthetics “end in caine”

 Anesthetic prior to surgery that causes impaired blink reflexes. Patients need to wear dark
glasses when going outside until medication wears off
 Medication Ex:
- Tetracaine(Altacaine,Opticaine)
- Proparacaine(Ophthetic 0.5% solution, Alcaine)
 Side Effects: Stinging and burning

NSAIDs

 Used to treat inflammation and pain

 Medication Ex:
- Ketorolac Tromethamine 0.5% solution(Acular)
- Nepafenac 0.1% suspension(Nevanac)
- Diclofenac 0.1% solution(Cambia,Voltaren)
- Lifitegrast Ophthalmic(Xidra)
 Side Effects: burning/stinging, irritation, and corneal edema
 Contraindicated: pregnancy and breastfeeding

Glucocorticoids “end in sone”

 Used for inflammation and pain due from injury or surgery

 Long term use can suppress the immune system
 Medication Ex:
- Hyrdocortisone acetate(Hydrocortone)
- Dexamethasone(Decadron solution/ointment, AK-Dex, Ocu-Dex, Maxidex suspension)
 - Prednisolone Opthalmic(Encopred,Omnipred,Pred Forte)
 Side Effects: immunosuppression with long term use

Eye Infections- Antimicrobials ”end in cin or mycin”

 The most common eye infection is conjunctivitis (pink eye) and is treated with an antibiotic such
as gentamycin ophthalmic ointment.
 Eye infection can spread to other parts of the body, therefore good handwashing and not
rubbing the eyes is imperative to be taught
 A stye is another common eye infection. It is a bacterial infection of the oil gland in the eyelid
that causes a painful red bump
 Persistent or multiple styes are treated with topical ophthalmic antibiotics such as the following:
-Gentamicin Ophthalmic(Garamycin)
-Tobramycin(Tobrex, Tobralcom)
-Erthromycin(Eyemycin)

Eye Examination Medications

 Some drugs are used to make it easier for a health-care professional to examine the eyes.
 Cyclopegic(mydriatic) relaxes capillary muscles and dilate pupils so the HCP can peer into the
eye
 Side Effects:
- Transient burning/stinging

Local Anesthetics “end in caine”

 Anesthetic prior to surgery that causes impaired blink reflexes. Patients need to wear dark
glasses when going outside until medication wears off
 Used to remove foreign objects from the eye
 Medication Ex:
- Tetracaine(Altacaine,Opticaine)
- Proparacaine(Ophthetic 0.5% solution, Alcaine)
 Side Effects: Stinging and burning

Staining Agents

 Nontoxic water soluble dyes used to find foreign objects such a contacts, stain colors the object
green

Dry Eye Medications

 Immunomodulators are used to treat a certain type of dry eye by increasing tear production.
It takes time for the drug to work and up to 6 months for maximum benefits. Restasis is a type
of immunomodulator, the liquid portion of the drug is castor oil which provides immediate
moisturizing benefits
 Xiidra is a newer immunomodulator, and causes changes in vision, blurred vision, and redness
of the sclera
  Ranibizumab(Lucentis) and Aflibercept(Eylea) are used to slow the process of macular
degeneration. These drugs are injected into the infected eye once a month. These drugs are
used to treat macular degeneration

** Although the cause is unclear, glaucoma is prevalent amongst patients with hypertension,
diabetes, migraines, nearsightedness, farsightedness, and advance age**

**Wait 3-5 minutes between eye drops if applying more than one type, and always apply drops
BEFORE ointment**

**Inform pt. not to blink but to close eye and apply pressure to the puncta for 2-3 minutes

**Aqueous humor is different from tears, it is similar to plasma and is produced by ciliary bodies.
Tears are similar to saliva and are produced by the lacrimal glands

EYE MEDICATION ADMINISTATION RULES HERE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

The Ear

 Cerumenolytics softens earwax examples include:

- Carbamide peroxide solution(Auro,Debrox)
- Mineral Oil
 Antibiotics
- Acetic acid and aluminum acetate(Domeboro Otic)
- Ofloxacin(Floxin)
 Combination Drugs treat both inflammation and infection, these include the following:
- Ciprofloxacin and dexamethasone(Ciprodex)
- Hydrocortisone, Neomycin, and Polymyxin
 Oral Antibiotics are usually used for middle and inner ear infections.
 Dramamine is used to treat motion sickness, it is a anticholinergic/antihistamine.
-Side effects of this drug include: extrapyramidal effects, dry mouth, blurred vision, hypotension,
and sedation
 When administering ear medications be sure to pull adult ears