• author "Jorge"
    • tags "Optometry"
    • description "Optometry"
    • fileName "103"
    • freezingBlueDBID -1.0
    • Microbiology is?
    • Study of microbes such as bacteria, viruses, fungi, and protozoans
  1. Bacteria
    • Single cell microorganism
    • No cell nucleos
    • Can reproduce on its own
    • Lives in soil, water, organic matter ,animal or plant
    • all bacteria has potential to cause disease, the organism population size required to cause a disease varies among bacteria
  2. More common bacteria that infect the eye
    • Staphylococcus
    • Pseudonymous
  3. Staphylococcus
    • Found in skin
    • Lid infections, conjunctivitis, keratitis
  4. Pseudonymous
    • Risk for contact lens wearers
    • Highly destructive. Can perforate cornea within24hrs.
  5. Viruses
    • Small organisms smaller then one cell
    • only survie on living host
    • Cannot reproduce on its on
    • Most viral infrctions the immune system can fight off
  6. Most comman viruses that can infect the eye.
    • Adenovirus "cold"
    • Herpes simplex (cold sore)
    • Herpes zoster (chicken pox virus)
  7. Adenovirus
    Causes conjunctivitis
  8. Herpes simplex
    • Causes lid lessions, dendrictic corneal ulcerations (sores)
    • Can lead to permanent damage and vision loss
  9. Herpes zoster
    • Infects pts with compromised immune system
    • Can cause corneal and lid problem
    • Can lead to permanent damage and vision loss
  10. Fungus
    • Single or multi cell with cell wall of chitin
    • Can reproduce on its own
    • Ocular infections are rare
    • Uasually cased by contact with vegitative matter
    • Example aspregillus
  11. Protozoans
    • Ubiquitous organisms live in soil and water
    • Single cell
    • Can reproduceon its on
    • Found in hot tubs
    • No good drug therapy
    • Increaseed risk infection with contact lens
    • Can cause severe karatitis
    • Example acanthamoeba
  12. Diseases of the lids and lashes
    • Fairly common,usually not of serious consequences
    • Hordeolum
    • Chalazion
    • Blepharitis
    • Entropin
    • Ectropin
    • Ptosis
    • Tumors and Cysts
  13. Hordeolum
    • Acute infection of oil or sweat glznd zeiss, moll or meibomain
    • Present with red, swollen, tender lid
    • Can be internal or external
    • Most likely staph bacterial infection
    • Can result in Chalazion
  14. Chalazion
    • Is a granuloma or chronically inflammatory cyst typically associated with meibomian gland
    • Normaly presents as painless, non-red, firm nodule
    • Not an infectious process
    • Lessions tend to be higher on eyelid
  15. Blepharitis
    • Inflamation/infection of lids lashes
    • Appearance red lid margins scales clinging to lashes
    • Chronic condition that is usually associated with seborrhea of scalp
  16. Seborrhea is?
    Patholigic condition chronic skin disorder with swelling, redness, itching, and scaly skin patches
  17. Entropian
    • Inturning of eyelids usually lower lids
    • Lashes rub cornea
    • Lashes can be romoved or corrective surgery
    • Caused by injury, scarring, aging, or present at birth
  18. Ectropion
    • Outward turning of eyelid margin
    • Causes include congenital paralysis, aging, scarring, injury, allergy
    • May cause dry eye, conjunctival infection, keratatopathy
    • Tretment lubricants, anti-inflammatory meds, taping eye lids, and surgery
  19. Ptosis
    • Drooping or partial closed eyelid
    • Usually clear and quiet
    • Causes include congenital, acquired, pseudoptosis,III cranial nerve palse(nerve proble) horners syndrome
    • If severe enough surgical intervention is an option.
  20. Eyelid tumors and cysts
    • Basal Cell Carcinoma
    • squamous Cell Carcinoma
    • Cutaneous Horn
    • Molluscum Contagiosum
    • Benign Tumor
  21. Basal Cell Carcinoma
    • Most common form of cancer
    • 800,000 cases per year
    • Low rate mets
  22. Squamous Cell Carcinoma
    • 2nd most common
    • 250,000 new cases per year
    • Most are not serious
    • 96-97% are localized
    • In some cases it can spread to other areas Can be fatal if spreads
    • Early treatment is I portant
    • Harder to treat if overlooked
    • Can cause disfigurement
  23. Cutaneous. horn
    • Conical projection above skin surface, resembles miniature horn
    • Base may be flat, nodular, crateriform
    • Composesed of compacted keratin
    • Various histological lesions documented at base of keretin mound
    • Histological confirmation needed to rule out malignant changes
    • No clinical features reliably distinguish malignant or benign
    • Tenderness at base and lession of large size favor malignancy
    • Could be benign verruca, seborrhec keratosis, premalignant actinic keratosis
  24. Verruca
    Wart caused by virus infection can occur anywhere on the skin even eyelid
  25. Premalignamt actinic keratosis
    Flat scaly precancerous skin lession that appear on skin that is dry and wrinkled from years of sun exposure, usually in fair skinned peoplemay occur in eyelids
  26. Molluscum Contagiosum
    • Waxy raied nodule caused by virus in the pox group
    • Can lead to cronic conjunctivitis
  27. Benign tumor
    Does not threaten he health of life of the patient.
  28. Diseases of lacrimal system
    • Nasolacrimal duct occlusion
    • Dacrylocystits
  29. Nasolacrimal duct occlusion
    Can be congenital in which case may not become fully patent till about 12 months
  30. Dacryocystitis
    • Infection of Nasolacrimal ducr
    • Usually result of blockage of passage to nasal cavity or trauma
  31. Diseases of conjunctiva
    • Conjunctivitis
    • Chemical exposure
    • Pinguecula
    • Subconjunctival hemorrhage
  32. Conjunctivitis
    • Bacterial conjunctivitis
    • Viral conjunctivitis
    • Allergic conjunctivitis
  33. Bacterial conjunctivitis
    • Self limiting causes enlargiing of blood vessels in conjunctiva
    • Mucopurulent discharge is often present
    • Beefy red eye
    • Mild to moderate discomfort
    • Mucopurulent discharge
    • Lids may be red and swollen
    • Vission can be affected
  34. Viral conjunctivitis
    • Adenovirus most common cause
    • Cause red/pink eye
    • Possibly swollen lids and watery discharge
    • Self limiting, mainly supportive treatment available
  35. Allergic conjunctivitis
    • Red eyes swollen eye lids
    • Conjunctival chemosis(swelling of conjunctiva )
    • associated with mild to severe itchin(big indicater it is allergic )
  36. Chemical exposure
    • Conjunctiva can beome injected and swollen when exposed to many chemicals
    • Acis base and othe irritans
    • Bases usually cause most damage, allow alkaline to penetrate deeper tissues leaving more pronounced scarring
    • Either case flush with stirile saline or water for at least 30mins and test with ph paper ideal read should be normal neutral range 7.2-7.6
  37. Pinguecula
    • Benign yellow-white elevation or mass of degenerated tissue beneath bulbar conjunctiva
    • Usually found in the inner central area beneath caruncle and limbus
    • Usually bilateral
    • Frequently found in pts living in dry dusty areas and increased UV contact
  38. Subconjunctival hemorrhage
    • Harmless collection of blood between conjunctiva and sclera if first incident
    • Presents as painless, bright red, pooloing of blood behind conjunctiva
    • Harmless self limiting condition
    • Cause by blunt trauma, coughing, sneezing forcefully, straining while doing exercise, sudden change in pressure
    • Resolves within 2weeks
    • Avoid blood thinner
    • If question of penetration, refer
  39. Diseases of cornea
    • Such diseases cna lead to blindness
    • Cornea is impervious toall but pseudomonas and gonococcus
    • Diseases include
    • Keratitis
    • Corneal ulsers
    • Keratoconus
    • Pannus
    • Ptergium
  40. Keratitis
    • Inflamation of cornea characterized by loos of transparency
    • The conjunctival vessels near the limbus enlarge and thus appear red known as cir umcorneal flush
    • Mainly involves superficial layers od cornea
    • Exposure keratitis can result if lkids do not completely closeduring blinkin or sleepiing
    • Keratitis sicca occurs when there is inadequate lacrimation
    • Keratitis from chemical exposure varies depending on substance
    • Vision is usually affected
  41. Corneal ulcer
    • Pose one of the greatest threats to vision, involves deeper layeers (stoma), usually present as focal whir opacities called infiltrates with overlying epithelial defects
    • Conjunctivitis usually be "injected" or exhibit hyperemia which may be localized or diffuse
    • Purulent discharge may be present
    • Lid edema may be present
    • Pupillary reflex may be sluggish
    • Photophobia is almost always associated
    • Bacterial, herpatic, and fungal
  42. Dendrite ulcer
    • Caused by herpes virus
    • Lession appear like a fine line with a few branches
    • Recurrance is common, seldom cause blindness
  43. Keratoconus
    • Of unknown etiology causes progressive thining of the cornea
    • Causwinceresed myopia and significant irregular astigmatism
    • Can result in perforation of cornea
    • Resjlts in scaring and blindness
  44. Pannus
    • Infiltration of blood vessels into cornea
    • Usually result of corneal infection or contact use
  45. Pterygium
    • Abnormal wing like wedge shaped growth of conjunctiva that incroaches onto cornea
    • Causes irritation, chronic redness, foreign body sensation and photohpobia
    • Surgical intervention may be necessary
    • Both Pinguecula and pterygia most likely cause by uv light damage to conjunctival surface
  46. Diseases of orbit
    • Orbital cellulitis
    • Infection of loose tissue of the orbit
    • Usually result of severe ethmoiditis in young children
    • Tumor of orbit may cause exophthalmos or proptosis
  47. Diseases of anterior chamber
    • Hyphema
    • Hypopyon
    • Anterior Chamber Tunor
  48. Hyphema
    Hemorrhage within anterior chamber of eye may result of blunt trauma
  49. Hypopyon
    • Accumulation of puss in anterior chamber
    • Associated with infectious diseases of cornea, iris, or ciliary body
    • Associated with infectious and inflamatory diseases of anterior segment, posterior segment, and systemic diseases
  50. Anterior chamber tumor
    • Located in iris
    • Musr be observed for possible malignancy
  51. Afferent pupillary defects
    • Affects pupillary fibers carrying light stimulus from the eye to bfrain
    • Usually occurs in fibers betweeen optic nerve and optic chiasm
    • Optic neuritis and diabetes
    • Swinging light test
    • Sz and shape can be normal
    • Reaction can be diminished
    • Consensual response kntact in affected eye
    • When light shown in unaffected eye, both eyes will constrict (unaffected eye by direct response,. Affected eye by consensual response)
    • accommodation is intact
    • Caused by damage to oculomotor nerve, by tumor or aneurysm
    • Eye positioned down and out
    • Dilated pupil
    • Ptosis of lid
    • Sz and shape of pupils is fixed and dilated
    • No constriction in dilated eye
    • No consensual response in dilated eue
    • Accommodation normal in unaffected eye
  53. Audies pupil
    • Reffered to asthe tonic pupil with unknown etiology
    • Sz shape is unequal,. Afffected pupil is larger and most pronounced under phototopic conditions
    • Reaction is slugish
    • Consensual response is delayed and slow
    • Accommodation is intact/slow
    • Long acting near response in later stages
  54. Physiological anisocorias
    • Painless,usually unoticed condition
    • Unequal pulil sz
    • Normal responses
    • Relative difference or unequal sz betweeen pupils is similar under botj photopic and scotopic conditions
    • Reaction normal
    • Consensual response is normal
    • Accommodation is normal
  55. Horners syndrome
    • Occurs from damage to sympathetic pathway, can occur anywhere in brain or spinal cord
    • Triad includes ptosis, miosis, and facial anhydrosis (lack of normal sweating)
    • Sz shape of affected pupil smaller
    • Reaction normal
    • Consensual resposne is normal
    • Accommodation is normal
  56. Argyll Robertson Pupil
    • Occurs from damage to pupillary fibers in the midbrain
    • Neurosyphilis, diabetes, and peripheral neuropathies
    • Sz shape of pupils unequal affected pupil smaller and irregularly shaped
    • Consensual resposne is nonresponsive
    • Accommodation is nonreactive
  57. Acute Narrow Angle Glaucoma
    • Is an emergant situation
    • Symptoms-ocular pain and visual disturbances
    • CAUSED BY Blockage of aqueous draining from the anterior chamber
    • Sz and shape of pupils unequal
    • Reaction is fixed and no reaction
    • Consensual resposne is nonresponsive
    • Accommodation is nonreactive
  58. Diseases of the lens
    • Cataract
    • Dislocation (ectopia lentis)
  59. Cataract
    • Opification of lens leads to reduced visual acuity, glare, reduced color preception
    • Trauma, age, systemic manifestation, and medications
    • Surgical removal of lens may be required
  60. Dislocation. (ectopia lentis)
    • Caused by absent or broken Zonules
    • May cause reduction in visual acuity and changes in persons refractive status
  61. Diseases of uveal tract
    • Includes diseases of iris ciliary body and choroid
    • Iritis
    • Cyclitis
    • Chroiditis
    • Iridocyclitis
    • Uveitis
  62. Iritis
    Inflamation of iris
  63. Cyclitis
    Inflamation of ciliary body
  64. Chroiditis
    Inflamation of choroid
  65. Iridocyclitis
    Inflamation of iris and ciliary body
  66. Uveitis
    Inflamation affecting any part of the uvea
  67. Cause of Uveal Tract diseases
    • Unknown
    • Trauma
    • Penetrating injury
    • Corneal ulcer
    • Surgery
    • Systemic diseases
    • Autoimmune diseases
  68. Sypmtoms of Uveal Tract. Diseases
    • Pain
    • Headache
    • Photophobia
    • Lacrimation
    • Blurred vision
    • Ciliary flush
    • Sluggish pupil
  69. Presentation of uveal diseases
    • Aqueous Cell accumulation of white blood cells in aqueous. Fluid caused by infection of cornea, iris, or ciliary body
    • Aqueous Flare Inflamation of iris or ciliary body causing aqueous flare or small protien particles to float in aqueous fluid
    • Posterior Synechiae most common results of Iritis is a Posterior Synechiae or adhesion of iris to lens
    • Anterior Synechiae adhesion of iris to corneal endothelium
    • Sympathetic Opthalmia uveitis is serious one of mozt serious forms of sympathetic Opthalmia the uninjured eye developes (sympathizing eye) a serious uveitis and eventually leads to blindness in both eyes unless injured eye is surgically removed
  70. Vitreous is
    Transparent, colorless,gelatinous mass of collagen fibrils and hyalunaric acis that fills that fills rear 2/3 of eyeball beteween the lens and retina.being smi-liquid and having no blood vessels, the vitreous does not normally become the site of pathology. Other disease processes can caiuse unwanted results. Opacities of vitreous may be caused by result of uveitis, hemorrhage, systemic changes, or aging.
  71. Vitreous Hemorrhage. Or Vitreous Bleed
    • Hemorrhage from retina flows into vitreous ruducing visual acuity
    • Trauma
    • Neovascularization
    • Vitreous detachment
    • Retinal tears
  72. Vitreous Floaters
    • Moving cells or tissue floating in vitreous
    • Ifthrer is sudden increase of floaters statuspost trauma to head or eyes retinal detachment may be present
    • Seen as spots, cobwebs or spiders
    • Trauma
    • Aging
    • Intraocular Inflamation
    • Hemorrhage
    • High myopia
  73. Retinal detachment or separation
    • Results when the retina detaches from the pigment epithalamium,.dirupts visual cell structure, dramatically affects vision. Often requires urgent surgical intervention
    • Shrinkage of vitreous
    • Trauma
    • Stretching of scleral coats without retinal streching as in high myopia
    • Fluid formation beteween retina and pigment epithalamium
    • Loss of vision (sometimes seen as vector loss)
    • Sudden onset of floaters
    • Flashes of light (seen as streaks or lightening streaks)
    • Visual distortion disturbances
  74. Retinitis
    • Inflamation of retina symptoms are few, some change in vision and slight discomfort
    • As viewed with opthalmoscope
    • New lessons appear out of focus with fuzzy edges
    • Old healed retinitis apears clear with sharp edges and dark pigment throughout
    • Aquired color vision deficiencies early sign of rentinitis,only in affected eye
    • Usually a result of some other disease
  75. Circulatory disturbances of retina CRAO
    • Blockage of blood flow through the central retinal artery have a rapid complete loss of vision
    • Usually monocular
    • Arteries appear thin
    • Opaque retinal layers
    • Macula has cherry red spots
    • Produces a reduction of vision over a few hours
    • Correction of blockage must be intiated to prevent permanent vision loss
  76. Central Retinal Vein Obstruction. CRVO
    • Blockage of flow through central retinal vein, causes marked decrease in vision which may improve over many months
    • Dialated and engorged veins
    • Intraretinal and nerve fiber layer hemorrhage
    • Swollen optic disc margins
    • Retinal thickening
    • Secondary glaucoma results in most cases
    • Prognosis for vision is poorif vein is blocked
    • Central vision may be spared if only a branch of the vein is affected
  77. Systemic diseases
    • May have their first outward signs as retinal changes
    • Diabetes
    • Hypertension
  78. Solar Retinopathy
    • Macular damage from staring at the sun without protective glasses
    • CAUSES
    • Central scaring
    • Central scotoma
    • Permanent loss of central vision
  79. Tumors of retina
    • Rare with severe results
    • TYPES
    • Retinalblastoma
    • Malignant Melanoma
  80. Retinalblastoma
    • Almost always appesrs in children under age of 5
    • Appesrs as white feflection in the pupil known as a Luekocoria
    • Hereditary influence
    • Treatment. Is enucleation as soon as possible
  81. Malignant Melanoma
    • Usually occurs in adults
    • Causes a retinal detachment
    • Secondary glaucoma may result if untreated
    • Enucleation is indicated as soon as diagnosis is made
  82. Optic Nerve disease
    • Papilledma
    • Papillitis
    • Optic Atrophy
  83. Papilledma
    • Noninflammatory swelling of nerve head or optic disc resulting from increased intracranial pressure
    • Usually bilateral
    • Blurred optic disc margins
    • Flame hemorrhages
    • Enlarged blind spot
    • In early stages there is no reduction of visual acuity
  84. Papillitis
    • Inflamation that can be mistaken for Papilledma
    • Usually acute
    • Great disturbance in vision
    • Pain around the eye
    • Pain present when eye is moved
    • Usually unilateral
  85. Optic Atrophy
    • Gradual degeneration of nerve fibers with a corresponding reduction of vision
    • Primary Optic Atrophy. Occurs during middle life, slow in progression, veriable prognosis
    • Secondary Optic Atrophy. Occurs at any age, gfaster onset, better prognosis if causative agent is eliminated
  86. Glaucoma is
    • Group of eye diseases the lead to damage of optic nerve resulting in progressive optic neuropathy with characteristic cupping, loss of visual field and potentially blindness
    • Usually associated with high IOP Intraocular Pressure
    • Can occur in pts wkth normal pressure
  87. Aqueous Cycle
    • Flow from posterior chamber to anterior chamber, to the angle of anterior chamber, exits through trabecular meshwork
    • Mechanism of outflow is unknown
    • Fro meshwork,flows into Schlemms canal and into aqueous veins
    • Increased IOP results when aqueous. Is jnable to flow out of eye as fast as it is secreted
  88. Measuring cup to disc ratio
    Optic nerve is made up of about 1 million small individual thread like nerve fibers that come from the retina, this is the disc, there is a creater like indentation in the center of the disc called the cup. The enlargenent of the cup in comparisn to the disc is glaucoma.
  89. Diagnosnotic testing for glaucoma
    • Tonometry
    • Corneal pachymetry
    • Visual field testing
  90. Tonometry
    • Metjhod of measuring IOP done through putting pressure on cornea with an instrument. Or non-contact method. Important to get baseline on all pts
    • Treatment is always dependent on lowering IOP
  91. Corneal Pachymetry
    Measuring thickness of cornea since ocular pressure is measured by depressing the cornea, it is thought that the thickness of thr cornea may impact the ability to aquire accurate IOP. With refractive surgery thinning the cornea, the ocular pressure readings may not be accurate
  92. Visual field testing
    Used to detect visual field lkss and monitor the progression of the disease
  93. Types of glaucoma
    • Primary open angle glaucoma. POAG and or chronic open angle glaucoma. COAG
    • Primary angle closure or primary closed angle glaucoma
    • Secondary glaucoma
    • Congenital glaucoma
    • Low tension glaucoma LTG normal tension glaucoma NTG
    • Primary glaucoma exists without any preexisting ocular or systemic
  94. Primary Glaucoma
    • Comprises 60%-90% of all adult. Glaucoma
    • Trabecular meshwork dysfunction
    • IOP usually rises slowly over a long period of time
    • Relative lack of symptoms in early stages
    • Far advanced before noticed progresses slowly effecting peripheral fields
    • Mild aching or ocular discomfort
    • Can detect with routine eye exam. Opthalmoscopy, tonometry, pachymetry, visual fields
    • Familia and effects both sexes
    • High incidence with diabetes, blacks,high myopia
    • Also called chronic open angl glaucoma. COAG
    • Treatment first lin of TX is usually medication to lower IOP
    • If medication fail laser or incisional surgery zre available
  95. Primary Angle Clozed Glaucoma
    • Caused by structure abnormalities of the uveoscleral angle - narrow angles
    • As lens increases in sz it may block the aqueous outflow channels
    • IOP rises rapidly when angle is blocked
    • Usually occurs in pts over 60
    • Accounts for 10% of glaucoma
    • 3x more prevalent in females
    • Eskimos higher incidence than average population
    • More rare in blacks
    • Characterized by shallow anterior chamber angle
    • Typical attack unilateral, brought on by dark room conditions, emotional stress or pupillary dilating drugs
    • Disrinct symptoms such as severe pakn in the eye and face, nausea, vomiting,reduced vision, halos around light, cloudy corneas, mid-dilated pupil and red eye, all with rapid onset
    • Requires emergant TX
  96. Secondary Glaucoma
    • Exists due to a systemic or ocular condition that causes an increases IOP
    • Occurs secondary to another disease or disease process
    • Caused by reduced drainage of aqueous from inflamation, tumors, blood, vessel blockage,trauma, diabetes, and some medications used to trezt other diseases
    • Treat the primary disease and reduce IOP with medications
  97. Congenital Glaucoma
    • Developement third basic. Type
    • Rare disease in infants caused by malformation of anterior chamber angle
    • Affected pts often have other anatomical deformities
    • Surgical intervention is primary treatment
  98. Normal Tension Glaucoma
    • Low tension or normal tension is progressive optic neuropathy with characteristi cupping and visual field defect
    • iOP less then 21 mm Hg
    • Represents about 1/6 of all cases of primary open angle glaucoma
    • Age family history myopia are risk factors for LTG
    • Difficult to tx and prognosis is poor
    • Reducing IOP is still believed to be benificial so medication and surgical intervention are still used for treatment
  99. Ocular Hypertension
    • IOP which is greater than accepted standard pressure but not high enough to cause excavation of the optic disc or visual field loss
    • Some develope loss
  100. Treatment of glaucoma
    • Medication is intial treatment, surgical treatment is last resort.
    • Surgical reasons
    • Failure of drops or laser treatment to control IOP
    • Allergy to drops 1 to 6 pts develope allergy
    • Certain glaucomas can not be controlled with medication
    • COG
    • Congenital
    • Types of surgery
    • TREBECULECTOMY establishes drain from anterior chamber to subconjunctival space
    • Most popular, done in conjunction with peripheral iridectomy, 80% successful
    • IRIDECTOMY complete removal of a small section of peripheral iris, allows aqueous to flow directly from posterior chamber to anterior chamber, been replaced by laser surgery
    • CYCLOCRYOTHERAPY freezing procedure designed to decrease aqueous production by ablation of portion of ciliarry body and secretory epithalamium
    • TRABECULOTOMY procedure for opening up Schlemms canal, conjunctival and scleral flaps are raised and a cut into Schlemms canal a trabulatome is introduced into canal which lacerates meshwork
    • GONIOTOMY same as trabeculotomy but only done through cornea, but only if cornea is clear
  101. Major body systems
    • Cardiovascular
    • Respiratory
    • Endocrine
    • Nervous
  102. Inflammatory and autoimmune diseases with ocular manifestation
    • Myasthenia Gravis
    • Rheumatoid Arthritis
    • Sacoidosis
    • Sjogrens Syndrome
    • Systemic Lupos Erythematosus
    • Thyroid disorder
  103. Myasthenia Gravis
    Chronic autoimmune condition that can occur at an early age, causes ptosis, diplopia, limited eye movement
  104. Rheumatoid Arthritis
    • Chronic autoimmune diseases of unknown etiology
    • Symptoms include swelling, inflamation of lining on joints with dificulty, moving and pain
    • Scleritis
    • Episcleritis
    • Uveitis
    • Corneal Ulcers
  105. Sarcoidosis
    • Inflammatory disease of unknown etiology affecting blacks and hispanics
    • Can cause
    • Uveitis
    • Iris damage
    • Choroiditis
    • Optic neuropathy
  106. Sjogrens Syndrome
    • Autoimmune disease that often accompananies rheumatoid arthritis, lupus,scleroderma and polymyositis
    • Causes drh eyes, dry mouth results in keractoconjunctivitis sicca KCS
    • Symptoms
    • Burning grittiness and foreign body sensation
  107. Systemic Lupus Erythematosus
    • Chronic autoimmune disease of unknown etiology primarily affects woman
    • Causes
    • Dry eyes scleritis corneal ulcers retinal vasculitis and optic neuropathy
  108. Metabolic disorders
    • Thyroid disorders
    • Diabetic Mellitus
  109. Thyroid disorders
    • Thyroid is gland part of endocrine system regulates metabolism
    • Thyroid dysfunctions sometimes manifests in inflammatory disorders
    • Thyroid Opthalmopathy
    • Graves Disease
    • Swelling of eyelids orbital tissue, proptosis, opthalmoplagia, dry eyes, corneal damage,. Vision loss from optic nerve compression
    • Treatment
    • Restoration of normal thyroid function, artifical tears, and lid,orbital surgery if required
  110. Diabetes Mellitus
    • Metabolic disease that causes deficiency in production or effectiveness of insulin and affects many organs from the nerves to the kidneys
    • Vascular system effects include neovascularization and atherosclerosis
    • Systemic treatment includes proper diet, weight management, exercise, oral agents and insulin
    • Ocular manifestation
    • Transient variations in refractions
    • Diplopia
    • Opthalmoplagia
    • Non-proliferative diabetic retinopathy mild, moderate,severe NPDR
    • Proliferative diabetic retinopathy. Early, high risk PDR
  111. Diabetic Retinopathy Treatment
    • NPDR Management
    • Dilated fundus exam. Every 3-6 months
    • Fluorecein angiography
    • Clinically Significant Macula Edema CSME
    • Microaneurysms treated with argon laser more than 500 microns from fovea
    • Focal or grid treatment dependent on focal or difuse leakage detected by FA
  112. Vascular Disease
    • Cerebral Vascular Accident
    • migraine
    • Hypertension
    • Hypertensive Retinopathy
  113. CVA
    • Stroke and cerebral hemorrhage principal types of CVA
    • Emboli obstructs tiny vessels in eye
    • Porduce sudden vision loss
    • Leads to permanent visual loss if retinal damage occurs
    • Treatment includes releiving blockage and treating underlying causes
  114. Migraine
    • Produces intense headache, nausea, visual sensations of flashing or whirling lights (scintillation)
    • Treated by systemic drugs to relieve Symptoms and prevent recurrence
  115. Hypertension
    • Group classification. I - IV
    • Group I minimal narrowing of retinal arteries
    • Grlup II narrowing of retinal arteries in conjunction with regions of focal narrowing and arteriovenous nicking
    • Group III Abnormalities seen in groups I and II as well as retinal hemorrhages, hard exudation,and cotton wool spots
    • Group IV Abnormalities seen in grpups I through III as well as swelling of optic nerve head
  116. Infectious Diseases
    • AIDS
    • Histoplasmosis
    • Syphlis
    • Gonorrhea
    • Toxoplasmosis
  117. AIDS
    • Caused by human immunodeficiency virus
    • Sexually transmitted and aquired by bodily fluid contact
    • Cytomegalovirus retinits CMV
    • Kaposis sarcoma
    • Herpes zoster opthalmus
    • Antiretroviral drugs
    • For CMV INCLUDES Ganciclovir, foscarnet, cidofovir
  118. Histoplasmosis
    • Systemic fungal infection. Found in Mississippi River Valley and river Valleys of South America, Asia, Africa
    • Affects pulmonary system causing flu like Symptoms
    • Presumed Ocular Histoplasmosis Syndrome POHS,. Presumed because researches have not isolated Histoplasma Casulatum in ocular tissue
    • Ocular involvement includes
    • Midperipheral Choroiditis
    • Infilitrates and cause scarring
    • Yellow-white punched out lesions
    • Macular or Parafoveal subretinal neovascular membranes SRNVM
    • Grayish-green patch beneath the retina in the peripapillary and foveal areas
    • With or without subretinal blood, exudates, or disciform scarring
  119. Management of Histoplasmosis
    • Detection
    • Monitor
    • Steroid therapy to reduce inflammation
    • Flurescien angiography if sub-retinal neovascular membrane is suspected, treat with medication and or surgery
  120. Syphilis and gonorrhea
    • Highly contagious sexually transmitted diseases. Passed onto banies at birth
    • Syphilis. Causes uveitis, pupillary dysfunction, and optic neuropathy, and blindness if left untreated
    • Gonorrhea. Causes urinary tract infection, hyperacute conjunctivitis, and keratitis
    • Treatment
    • Uses antibiotic for both conditions
  121. Toxoplasmosis
    • Systemic infection caused by protozoan may be passed from mother to fetus
    • Contracted through animal feces especially from cats
    • Aquired form may cause mild fever, swollen glands, general illness
    • Ocular Toxoplasmosis. Causes retinal Choroiditis and choroiretinal scarring
    • Tincture of time and drug therapy. Antiparasitic, sulfanomides and prednisone
  122. Visual consequences of traumatic brain injury
    • Closed and or penetrating
    • Closed TBI MOST common
    • LOC, amnesia, neuroimaging findings
    • Blast, falls, MVA, gunshot wounds to head and neck
    • Closed may be missed on intial eval especially if concomitant with other injuries
    • Penetrating brain injuries are typically identified and treated immediately
  123. Causes of TBI include
    • IED
    • Mortar
    • Gunshot wound to head or neck
    • Rocket propelled grenade
    • Vehicle born IED
    • Motor vehicle accident
  124. Visual symptoms of TBI
    • Oculomotor based reading dificulty
    • Eyestrain
    • Diplopia
    • Headaches
    • Photophobia
  125. Signs of TBI
    • Receded near point of convergance
    • Abnormal Developmental Eye Movement DEM test results
    • Inability to focus
  126. True emergancy eye conditions
    • Should be seen by an eye care practitioner immediately
    • Visual Acuity should not be taken
    • Notify doc as soon as you have determined the status of pt
    • Should be seen within minutes
  127. Tru eye emergancies include
    • Chemical burns
    • Central retinal artery occlusion
    • Penetrating injuries to globe
    • Sudden loss of vision
  128. Chemical burns
    • Alkali
    • Acid
    • Irritant
  129. Alkali chem burn
    • Have ph>9. most devistating due to cell destruction properties, will continue to destroy and penetrate into eye
    • Chemical agents include cleaning agents,ammonia, lye, drain cleaners, solvents, dish washing detergents and fertilizer
  130. Acid chem burns
    • Binds to tissue and coagulates therfore the damage may not be as severe. Destroyed tissue will limit further distruction
    • Acetic and hydrochloric acids exm.
  131. Irritant chen burns
    • Cause surface irritations, many chemical weapons fall into this category
    • Symptoms may be pain, irritation, tearing and photophobia
    • Exposed ocular tissue may be first to be symptomatic
  132. Treatment of chem burns
    • All rquire same initial treatment
    • Topical anesthesia if possible
    • Do not perform any other type of testing prior to irrigation ( vision, pupils, etc.)
    • Copious irrigation for at least 20 30 minutes untill ph paper displays neutral reading 7.2-7.6
    • Use sterile LR SC or H2O
    • Reg tap water may be used if none of the above are available
    • Collect chemical info
    • Dont patch eye
    • Treat adjacent tissues
    • Immediate referral to opthalmologist or optomotrist
  133. If referral is not possible
    • Remove any retained particles
    • Use fluorocein to detect corneal defects
    • Some defects are hard to distinguish
    • Entire epithalamium missing
    • Even pattern with the fluroscein
    • If no corneal defects despense artificial tears
    • If corneal defects are present use braod spectrum antibkotic QID
    • Follow up daily
  134. Other emergency conditions
    • Sudden painless severe vision loss
    • Central Retinal Artery Occlusion. CRAO
    • Penetrating injuries to the eye
  135. Penetrating injuries to the eye
    • Do not remove
    • Check vision (reduced)
    • Pupil may be irregular with defect pointingtowards penetration
    • Fox shield and immediate evacuate
    • Never apply pressure. Stabilize any penetrating object and cover unaffected eye to prevent yoked movement
    • If questionable penetration treat as such
  136. Urgent conditions of the eye
    • Should be seen as soon as possible
    • Visual acuity shluld always be taken before seen by doc
    • Keep pt informed of time frame for being seen
    • Perform all immediate first aid care treatments ro reduce possibility of making condition worse
  137. Foreign body non penetrating
    • Irrigate and remove superficial foreign bodies
    • If irrigation is ineffective , use moist cotton swab
    • Consider using a ocular spud or needle approaching tangentlially to cornea
    • Questions, refer
    • Evert eyelid looking for foreign bodies
    • Treat secondary corneal abrasion
    • Refer for large surface defects
    • Always consider possible penetration into globe
    • Always ask yourself "could there be more?"
    • refer if doubt
    • Perform daily follow up
  138. Presentation of non penetrating foreign bodies
    • Pt may be almost asymptomatic, vision may be reduced with no pain,pupil may appear irregular and extend towards point of penetration
    • Dilated fundus exam may show foreign body imbedded into retina
    • Metallic foreign bodies may be ssen on reg films or CT NEVER USE MRI
  139. Patients with abrasions
    • Evert lids and examine
    • If abrasion is small treat with antibiotic ointment for prophylaxis coverage and lubrication.
    • May require patching
    • If abrasion is large,pressure patch with braod spectrum antibiotic unless pt is contact lens wearer or trauma is from organic source
  140. Laceration
    • Should repaired with emphasis on maintaining integrity with globe preservation
    • Check for seidel sign
    • Always hbe suspicious of underlying corneal laceration

    • Control bleeding with pressure if globe is intact
    • If questionable do not apply pressure
    • Apply fox shield evacuate
  141. Blunt trauma
    • Determine cause and if LOC
    • Rule out rupture of globe
    • Vision, Pupils, EOM, Retinal eval
    • Referral advised

    • Hyphema
    • Orbit floor fracture
    • Traumatic cataract
    • Disruption of retinal tissue
  142. Radiant injuries
    • UV exposure snow blindness, tanning booth, welders burns can cause delayed photokeratitis
    • Patch with antibiotic and cycloplegics
    • May require pain meds
    • Needs exam
  143. Laser and solar injuries
    • Can cause lens damage, corneal burn, retinal hole with heme
    • Referral needed
    • Document incident
  144. Electrocution
    F/U for cataract and macular edema
  145. Thermal or cold injuries
    • Needs refered if lids or globe are involved
    • Patch with moist dressing
    • Scarring, symblepharon, glaucoma possible
  146. Contact lens wearer
    • Can create corneal epithelial defect defect will begin to ulcerate
    • Pain
    • Photophobia
    • Reduced Vision
    • Epiphoria
    • Follow up daily
  147. Hypersensativity reaction to contact or solutions
    • Present with
    • Foreign body sensation
    • Irritation
    • Epiphoria
    • Photophobia
    • Decreased. Visual Acuity
  148. AR 40-63 Opthalmic Services. States what?
    Prohibits the wear of contacts lenses in the field or while deployed.
  149. Red eye
    • Conjunctivitis
    • Most difficult to rule out etiology
  150. Viral conjunctivitis
    • Watery discharge, irritation, pinkish red eye
    • Begins monocular but may spread
    • Very contagious
    • Discuss contamination precaution with pt
    • Provide supportive therapy, artificial tears, and vasodilators
    • If severe,. Or vision decreased,refer
  151. Bacterial conjunctivitis
    • Muculopurulent discharge with red, meaty lookong eye
    • Pt may be uncomfortable
    • Treat with antibiotics
    • If sevdre or no resolution within days,refer
  152. Severe Allergic conjunctivitis
    • Ithcy red wateryeye
    • May have ropey discharge
    • Lids may be edematous
    • History may reveal seasonal recurrence
    • Provide supportive therapy with artificial tears, cool compresses and vasoconstricts.
  153. Episcleritis scleritis
    • Rare can be caused by systemic or autoimmune conditions
    • Cna be differentiated from conjunctivitis because they affect deeper scleral vessels
    • Painful with sectoral or diffuse injection
    • Tearing and photophobia often accompany
    • Usually monocular and may involve scleral thinning if chronic
    • Referral warranted for diagnosis and determinatin of underlying etiology
  154. Uveitis
    • Characteristics are the following
    • Include pain, photophobia, ocular ache, limbal flush, and sluggish pupil
    • Cells flare in anterior chamber
    • May beof unknown etiology
  155. Angle closure glaucoma
    • Characteristics include
    • Intense pain
    • Injected conjunctivitis with hazy cornea due to breakdwon of endothelial pump
    • Pupil is mid dialated and fixed
    • Halo around lights with possible nausea and vomiting
  156. Retinal detachment
    • Characteristics include
    • Pt describes flashes of light, increase in floaters, and curtain crossing visual field
    • Opthalmoscopy shows elevated retina
    • Remember position pt so gravity is pulling detachment back to retina
  157. Semi-urgent ocular conditions
    • Are quite variable but require attention within a few days
    • Conditions vary from self-limiting to cancerous

    • Take visual acuity if pt is there
    • Make appt for these pts
    • Any questuons seek doc
  158. Routine ocular conditions
    • Sudden diplopia
    • Conjunctivitis
    • Hordeolum
    • Optic neuritis
    • Ocular tumor
    • Protrusion of eye
    • Previously undiagnosed glaucoma
    • Old retinal detachment
    • Lost or broken spectacles
    • Gradual loss of sight in quier eyes
  159. Triage facts
    • Triage means to sort
    • Used to assign priority for urgent or emergent ocular concern
    • Must make decisions based upon pts signs and symptoms
    • Do not trivialize pts concerns
    • Any questions as what to do with symptomatic pts ask docs
  160. Triaging wartime injuries
    • 1 chemical injuries are treated as emergencies
    • 2 nuclear injuries are triaged according to type of injury
    • 3 laser injuries are usually semi-urgent
    • 4 non-battle injuries are triaged according to type injury and potential for permanent injury
    • 5 the triage decisions you make could save a pts vision, perhaps even their life
  161. Tri-Service Conservation. And Readiness Program
    • Mission
    • Optimize vision readiness of DOD health care beneficiaries
    • Optimize vision readiness of DOD health care beneficiaries
    • Assure safe and healthy working environment Garrison/Base field, deployed
  162. Occupational Vision. Mission Element 1
    • Ensure soldiers sailors airman and dod civilians employee. Have sufficient, if not best, vision to work safely, efficiently and comfortably
    • Scope includes
    • Job vision standards
    • Vision screenings and exams
    • Night vision goggles
    • New tri-service Vision Readiness Program
  163. Environmental Vision Mission Element 2
    • Elevate and provide solutions for environmenal factors which impact negatively on visual efficiency and health
    • Vision Scope includes
    • Laser/microwave guidelines
    • Workplace illumination
    • VDT video display terminal ergomimics
  164. Eye Safety Mission Element. 3
    • To protect the eye and eliminate or minimize eye injury
    • Eye saftey scope
    • Perform worksite/threat evaluation of eye hazards
    • Advise on
    • Engineering controls such as barriers or UV screens
    • Administrative controls such as standard operating procedures or saftey signs
    • Personnel eye protection

    Train and educate personnel
  165. Vision Conservation Readiness Team
    • Perform surveys
    • Maintain inventory
    • Monjtor eye injuries
    • Recommend corrections
    • Coordinate vision screenings of employee
    • Referring personnel for comprehensive vision examinations
    • Ensure proper fitting industrial safety eyewear
    • Maintain current eyewear RX of employee
    • Maitaim vision screening, testing and RX, info in employee records
    • Providing technical input and assistance to employee health hazard education program
    • Reportinc VCRP Sstatus to command
  166. Visual conservation team
    • Collect eye injury data
    • Approve issue euye protection
    • Ensure wearing compliance
    • Industrial hygiene
    • Occupational hygiene
  167. Vision sight survey
    • Purpose of worksite survey
    • Pre-inspection planning
    • Worksite survey
    • Eye safety control efforts
  168. Personnel Protective Eyewear
    • Ansi Z87.1 primary standard
    • Goggles
    • Face Shield
  169. MCEP Military Eye Protection
    • Army MCEP GOALS
    • Enhance battlefield capabilities
    • Improve laser protection
    • Improve light transmission
    • Provide one system
  170. Air Force. Combat Eye Protection Protection Approved Eyewear Products
    • Combat approved eye protection products include
    • Spectacle
    • Authorized prorective eyewear
    • Goggles
  171. Army Rapid Fielding Initiative. Products
    • Soldiers requiring rx eyewear
    • Soldiers who do not wear rx eyewear
    • One spectacle. Oakley M frame
    • One goggle ESS LOW PROFILE
  172. BMT Army
    • Issue include Af issue only if due to deploy,
    • UVEX
    • ESS ICE
    • Revision Sawfly
  173. Sports eyewear. American. society for testing and, materials include sports eye protection
    • Racket sports
    • Paintball
    • Alpine skiing
    • Youth baseball programs
  174. Pharmacology
    Science of drugs including their composition, uses and effects
  175. Drug
    A substance used in the diagnosis treatment or prevention od disease or as a component of a medication
  176. Chenical name
    Systematically derived name that provides a complete and accurate chemical identification
  177. Generic name
    Nonpropriatory name
  178. Trade name
    Designation of a particular company brand name
  179. Solution
    Homogenous mixture of two or more substances
  180. Suspension
    Coarse dispersion containing finely devided insoluble material suspended in liquid medium
  181. Ointment
    Highly viscous or semi-solid preparation containing medicinal substances and intended for external application
  182. Continued release delivery
    A solidmdosage form that is placed beneath the neyelid to deliver medication over a period of time, usually days, ocular insert
  183. Absorbtion
    The taking in or incorporation of something, such as amgas or liquid
  184. Distribution
    Partitioning of a drug among the numerous locations where a drug may be contained in the body
  185. Metabolism
    Complex physical and chemical processes occurring within a living cell or organis that are necessary for the maintenance of life
  186. Tolerance
    Thencapacity to absorb a drug continuously or in large doses without adverse effect
  187. Stability
    Condition of being stable or resistant to change
  188. Buffer
    A substance that minimizes change in the acidity od a solution whenan acid or base is added to the solution
  189. Drug interaction
    The pharmacological result, either desirable or undesirable, of drugs ineracting with themselves or with other drugs
  190. Side effects
    A peripheral or secondary effect, especially an undesirable secondary effect of a drug or therapeutic regiman
  191. Toxic effects
    Effects due to excessive dosage
  192. Hypersensitivity
    Excessive response to the stimulus of a foreign agent, abnormally sensitive
  193. Drug dependency
    Chronic need for a drug, addiction
  194. Contraindication
    A factormthat renders the administration of a drug or the carrying out of a medical procedure inadvisable
  195. Dosage
    Amount to be administered
  196. Tonicity
    Osmotic pressure or tension of a solution usually relative to that of blood
  197. Sterility
    Being free from all live bacteria or other microorganism and their spores
  198. Viscosity
    The thickness or adhesiveneness of a fluid
  199. Routes of administration
    • Topical
    • Periocular
    • Systemic
  200. Topical
    • Applied to surface of area
    • Most commonly used route of eye meds
    • Medication should be delivered in lower culdesac and not directly over corneal surface
  201. Periocular treatment
    • Applied around eye
    • Subconjunctival injection under conjunctiva
    • Subtenon injection under Tenons space
    • Retrobulbar injection behind the globe
  202. Systemic treatment
    • Drugs that affect the whole body
    • Oral taken by mouth
    • Injection intravenous, subcutaneous intramuscular
  203. Topical anesthetics
    • Used for diagnostic procedure
    • Used for therapeutic procedure
    • Cautions
    • Pt warned not to touch eye till anesthesia is worn off
    • Stings burns
    • Loss of blink reflex
    • Preparation
    • Propocaine .5% Alcaine Opthetic
    • tetracaine. 5% (Pontocaine)
    • Benoxinate and Fluorescein (Fluress, Flu-Oxinate)
  204. Injectable local anesthetic
    • Anesthatise globe eyelid extraocular muscle or facial muscles
    • Cautions
    • CNS depression
    • Lower blood pressure
    • Allergic reaction
    • Preparation
    • Lidocaine w/wo epinephrine 0.5% to 4%
    • Bupivacaine .75%
  205. Antibiotics and Antivirals
    • Prevent bacteria formation or viral invasion
    • Cautions
    • Indiscriminate use of antibacterial agents may lead lead to the development of resistant strains of bacteria
    • With topical drops are preferred over ointments
    • Preparation
    • Bacitracin Tracin
    • Moxifloxacin. 3% Vigomax
    • Gatifloxacin. 3% Zymar
    • Chloramphenicol Chlormycetin
    • Polymixin B Sulfate neomycin Sulgate Bacitracin Zinc. Neosporin
    • Sulfacetmide. Isopto-Cetamide
    • Erythromycin. Iiotycin
    • Trimethoprim. Polytrim
    • Tobramycin. Tonrex
    • Acyclovir, Zovirax. Oral antiviral
    • Vidarabrine. Vira-A antiviral
    • Trifluridine. Viroptic. Antiviral
  206. Anti-inflammatory
    • Used to reduce inflamation
    • Cojunctivitis, uveitis, episcleritis, keratits. Usually topical steroid used for disorders involving the anterior chamber segmenrs to the eye to prevent scarring
    • Cautions
    • High doses,repeated or chronic use of corticosteroids presents 4 potential problems
    • Elevated IOP
    • Induced glaucoma
    • Cataract formation
    • Fungal infection
    • Preparation
    • Dexymethasome Sodium Phosphate Decadron
    • Flurometholone FML Liquifilm
    • Medrysonen HMS Liquifilm
    • Hydrocortisone Neomycin and Polymixin B cortisporin
    • Prednisolone and Sulfacetamide. Blephamide
    • Moxifloxacin. 3%. Vigamox
    • Gatifloxacin. 3% Zymar
    • Livostin. Levocabastine
    • Alomide. Lodoxamide
  207. Mydriatics and Cyclopegics
    • Used as dilating drlps for fundus examination, paralyzing the muscle of accommodation, paralyzing muscle of accommodation in uveitis
    • Cautions
    • Contraindication pts with primary glaucoma or tendency toward glaucoma
    • Use lowest possible dose
    • Especially toxic to children
    • Preparation
    • Phenylepherine. 25%. Neo synepherine
    • Atropine sulfate. .5%-2%. Isopto Atropine
    • Cyclopentolate. 5% - 2%. Cyclogyl
    • Hematropine 2%. & 5%. Isopto Homatropine
    • Tropicamide. 5% & 1%. Mydriacyl
  208. Miotics
    • Used for constriction of pupil to help outflow of aqt by stimulating sphincter muscle. Treatment of POAG. ACG accommodation insufficiency
    • Cautions
    • Fixed or chronic accommodation
    • Loss of night vision
    • Ocular discomfort and pain
    • Preparation
    • Pilocorpine. 25%- 10%. Pilocoar, isopto carpine
    • Carbochol. .75%. Caboptic, Isopto Carbachol
  209. Agents used to treat glaucoma
    • Control IOP decreasing formation of aqueous
    • Cautions
    • Infrequent side effects
    • Drowsiness, tingling somtimes confusion
    • Preparation
    • Dipiverfrin. 1%. Propine
    • Levobunotol. 25% &.5%. Betagan Liquifilm
    • Betaxolol. 25%. 5%. Betopic
    • Metiprannolol. 3%. OptiPranolol
    • Timolol. 25% &. 5%. Timoptic
    • Brimonidine Tartrate. 1%. Alphagan P
    • Dorzolamide 1% Azopt
    • Lantanprost. 005%. Xalatan
    • Acetazolamide PO 125mg, 250mg, 500mg. Diamox
    • Mannitol inj. Osmitrol
    • Glycerine inj Osmoglyn
    • Urea inj Ureaphil
    • Bimatoprost. .03%. Lumigan
    • Travoprost. 004%. Travatan
  210. Artificial Tears
    • Used to provide lubrication
    • Cautions
    • Preservatives can cause ocular allergic reaction
    • Preparation
    • Artificial tears
    • Murine
    • Natures tears
    • Tears Naturale
    • Celluvisc
  211. Anti-Allergy agents
    • Used to alleviate ocular symptoms related to allergies
    • Preparation
    • Ketorolac Tromethamine. 4%. Acular
    • Loteprednol Etabonate. 2%. Arlex
    • Ketotifen Fumarate. 025%. Alaway, zaditor
    • Olopatdine Hydrochloride. 1%. Patanol
  212. Ocular Decongestant
    • Used for immediate relief of redness. And or itching
    • Cautions
    • Overuse may mask underlying disease
    • Preparation
    • Phenylepherine.. .12%. Prefrin Liquifilm
    • Naphazoline. 012%. Naphcon
    • Tetrahydrozoline. 025% Visine
  213. Irritating solution
    • Used to flush eyes
    • Cautions
    • Check package integrity
    • Preparation
    • Balanced Salt Solution.BSS
    • Dacriose extraocular
    • .9% Sodium Chloride
  214. Diagnostic. Preparation. Include
    • Fluorescein Inj AK-Flour
    • Fluorescein Solution. Ak-Fluor
    • Fluorescein Strips Rosets
    • Tear Test Strips. Sno-Strips
  215. Misc agents
    • Cautions
    • Check container
    • Preparation
    • Sodium Hyaluronate Healon. Agent used for cataract surgery
    • Hydroxypropyl Methylcellulose. Goniosol agent used as surgical aid
    • Botulinum Toxin Type A Botox
    • Hyaluronidase Wydase agent used to increase absortion and dispersio of other drugs
  216. Techniques for storage and handling

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