guidelines for the use of eye medications

8/8/2019 Guidelines for the Use of Eye Medications

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Do not double the dose of your medication.If you miss a dose of your medication at the scheduled time, dont panic. Take it as

soon as you remember. However, if it is almost time for you next dose, skip the missed

dose and return to your regular medication schedule.Do not keep medication that is outdated or no longer needed.Store medications in a dry area away from moisture (unless your doctor or pharmacist

tells you the medicine needs to be refrigerated).Always keep medications out of the reach of children.Contact your doctor immediately if you experience any unusual side effects after

taking your medication.Do not share your medications with others.If you store your medications in a container, label it with the medication name, dose,

frequency, and expiration date.Anticipate when your medications will be running out and have your prescriptions

renewed as necessary.Use one pharmacy, if possible.Keep your medications in your carry-on luggage when you travel. Do not pack them in

a suitcase that is checked, in case your baggage is lost.Take extra medication with you when you travel in case your flight is delayed and you

need to stay away longer than planned.Always follow your doctors instructions exactly and take medications according to the

label.If you have any questions about your medication, ask your doctor.


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Instillation of Eye DropsWash hands before and after instilling eye drops.Shake eye drops before using.Open eye and tilt head backward and look toward ceiling. This may be easier to do lyingdown.Gently pull down the lower lid to form a pouch.

Approach the eye from the side and hold the bottle near the lid but do not touch the eyelid or lashes.Instill one drop into the pouch.Close the eyes gently for one minute (do not rub the eyes.)Blot excess solution below the eye with a tissue if necessary.Do NOT use solution if it is discolored or has changed in any way since being purchased.

If possible, have another person administer the eye drops for you.If this medication causes blurred vision, do not drive a car or operate machinery.Contact your physician if the medication irritates your eye(s) for more than just a few minutesafter use. Many eye medications sting for a short time immediately after instillation.If you are having difficulty in determining if the drops actually go into the eye, the medicationcan be refrigerated. If the drops are kept cool, it is easier to determine when the solution is

instilled.


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Instillation of Eye OinmentWash your hands.Sit in front of a mirror so you can see what you are doing.Take the lid off the ointment.Tip your head back.Gently pull down your lower eyelid and look up.Hold the tube above the eye and gently squeeze a 1cm line of ointment along the inside of the lower eyelid, taking care not to touch the eye or eyelashes with the tip of the tube.Blink your eyes to spread the ointment over the surface of the eyeball.Your vision may be blurred when you open your eyes - DON'T rub your eyes. The blurring will clear after a few moments if you keep blinking.Wipe away any excess ointment with a clean tissue.Repeat this procedure for the other eye if you have been advised to do so by your doctor or

pharmacist.Replace the lid of the tube.Take care not to touch the tip of the tube with your fingers.If you are using more than one type of ointment, wait for about half-an-hour before using the nextointment, to allow the first to be absorbed into the eye.If you are also using eye drops use them first, then wait for five minutes before applying the eyeointment.


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A natomy & Physiology of Nose


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The nose is made up two different sections, the part that elongates from the nasal cavityand projects from the face and the cavity which in at its base and allows for the passageof air. The external portion of the nose is created by skin, cartilage, and two supporting

nasal bones. The nasal bones create the basic structure and form the bridge of the nose.The pliable cartilage forms the protrusion, and of course the entire visible package isthen covered in skin, nerve ending, and a thin layer of muscle.

Fu nctions:smellpu rification of airhu midification of airwarming of air

The anterior section of the nasal septum is created by septal cartilage. Lateral cartilage

on either side and alar cartilages form the basic framework around the nasal cavity,creating the nostrils. The framework for the nasal septum is formed by the vomer and

perpendicular plate of the ethmoid bone. Septal cartilage then contributes to theframework of the nasal septum, which segregates the nasal cavity in half laterally. Eachof these halves is referred to as a nasal fossa.


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The nasal fossa expands anteriorly to create the nasal vestibule. The individual nasalfossas each also widens anteriorly through the nostril. The fossas each communicatewith the posterior nasopharnyx via the choana, or the internal nares.

The frontal bone and the two nasal bones create the anterior roof of the nasal cavity.The cribriform plate belonging to the ethmoid bone forms the medial portion, and thesphenoid bone forms the posterior section of the nasal roof. The floor of the nasal cavityis created by the palatine and maxillary bones.

Three boney structures jut out along the internal lateral walls of the nasal cavity. Theseare referred to as the superior, middle, and inferior nasal conchae or turbinates. In

between each conchae are the nasal meatuses, or air passages. The conchae are linedwith cilia, technically referred to as the pseudostratified ciliated columnar epithelium.The anterior openings of the nasal cavity are lined with the stratified squamous

epithelium. Both regions are amply supplied with mucous secreting goblet cells.

The nasal cavity performs three basic functions. The conchae are covered with nasalepithelium which is designed to warm the air, cleanse the air, and moisten the air as it ininhaled. The significantly vascular nasal epithelium covers a vast area throughout thenasal cavity. While being highly vascular means that it is effective at warming theincoming air, it also creates the hazards of nose bleeds when it dries out and cracks.


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The nasal cavity performs three basic functions. The conchae are covered with nasalepithelium which is designed to warm the air, cleanse the air, and moisten the air as it in

inhaled. The significantly vascular nasal epithelium covers a vast area throughout thenasal cavity. While being highly vascular means that it is effective at warming theincoming air, it also creates the hazards of nose bleeds when it dries out and cracks.

The vibrissae are the nasal hairs which line the outer edge of nostril and are responsiblefor the filtering of macro-particles that may enter the airway and cause difficultiesconcerning the passage of air. The combination of the cilia and the moist mucousmembrane trap potentially dangerous particles such as smoke, pollen, dust, and other common allergens before it enters the lungs.

The sense of smell, as it relates to the respiratory system, is contributed to by the

olfactory epithelium which is located in the upper medial portion of the nasal cavity.

The nasal cavity also contributes to vocalization, as part of the process of voice comesfrom the resonation of sound against the cavity.


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Diagnostic Test

P hysical examination-Blood pressure. High blood pressure may be a cause of

bleeding nose-After nasal trauma, must always inspect inside the nose

for a blood clot in the septum because it may be later complicated by abscess formation and collapse of the

nasal septum causing a permanent deformity-Full examination of the ears, nose and throat-Feel the lymph nodes in the neck for enlargement.


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B lood tests-Full blood count and ESR -Electrolytes

-Growth hormone level (high level in Acromegaly which causes anenlarged nose)-RAST allergy testing for specific allergens in allergic rhinitis-Serum ANCA for Wegener's granulomatosis-Syphilis serology, if indicated-Coagulation profile, if recurrent nose bleeds with porthrombin time,

partial thromboplastin time (PTT), bleeding time, platelet count-Raised Immunoglobulin levels and presence of certain autoantibodiesmay suggest diagnosis of Sjogren's syndrome which causes a dry nose -

e.g. Rheumatoid factor, antinuclear antibodies, antimitochondrialantibodies, Anti-Ro (SSA) antibodies.

R adiological investigations-Sinus X-Ray

-CT Scan of nasal cavity and sinuses may be indicated .


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N asal smear and culture-for bacteria and fungi detection.

B iopsy of nose-may help diagnose rhinophyma, rosacea and nasal tumor.

Skin smear from the skin or nasal lining- for detecting the organism responsible for leprosy, if suspected.

Skin prick allergy testing-for specific allergens in allergic rhinitis

N asopharyngoscopy- by ears, nose and throat specialist may be indicated.

Schirmer tear test-if have dry eyes and nose, a strip of filter paper is placed on the inside of thelower eyelid and wetting of less than 10mm in 5 minutes indicated defectivetear production and thus dry eyes. This test will help diagnose Sjogren'ssyndrome.


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Nasal Polyp- it is a mass of gelatinous tissue

which usually forms from allergy. If only on one side, one must rule out acarcinoma or cancer. Allergic nasal

polyps can be treated by topical nasalsteroids or by surgical removal. Oftenendoscopic sinus surgery is needed for their removal.Sign & Symptoms:A runny nose

Persistent stuffinessPostnasal dripDecreased or no sense of smellLoss of sense of tasteFacial pain or headacheSnoringItching around your eyes


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Causes:A continuous inflammatory process within the nose and sinuses -

This is thought to be the main source of nasal polyps. Thisinflammation could be related to allergies; allergens in theatmosphere (pollution, dust etc.) or can be caused by a sinusinfection.

The overproduction of fluid in the sinus and nasal membranescause polyps to become swollen and engorged with fluid - This isreferred to as edema. These bags of fluid can enlarge and pop out

through the sinus openings into the nasal cavity. These bulgingtissues are referred to as nasal polyps.Engorged nasal membranes - Irritants such as alcohol and

tobacco may expose membranes to infection


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Management Nasal polyps are most often treated with steroids or topical, but can also betreated with surgical methods.Pre-post surgery, sinus rinses with a warm water (240 ml / 8 oz) mixed witha small amount (teaspoon) of salts (sodium chloride & sodium bicarbonate)can be very helpful to clear the sinuses. This method can be also used as a

preventative measure to discourage the polyps from growing back andshould be used in combination with a nasal steroid.The removal of nasal polyps via surgery lasts approximately 47 minutes to1 hour. The surgery can be done under general or local anaesthesia, and the

polyps are removed using endoscopic surgery. Recovery from this type of surgery is anywhere from 1 to 3 weeks.Mometasone furoate, commonly available as a nasal spray for treatingcommon allergy symptoms, has been indicated in the United States by theFDA for the treatment of nasal polyps since December 2005.


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Pathophysiology Nasal polyposis results from chronic inflammation of the nasal and sinusmucous membranes. Chronic inflammation causes a reactive hyperplasia of theintranasal mucosal membrane, which results in the formation of polyps. The

precise mechanism of polyp formation is incompletely understood.In 1990, Tos reported 10 pathogenic theories of nasal polyp formation:

Adenoma and fibroma theories Necrosing ethmoiditis theory

Glandular cyst theoryMucosal exudate theoryCystic dilatation of the excretory duct and vessel obstruction theoryBlockade theoryPeriphlebitis and perilymphangitis theory


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Glandular hyperplasia theoryGland new formation theoryIon transport theoryMultiple chemical mediators have been identified in nasal polyps but their

significance has not been completely elucidated. Some of these mediators may bereleased by the polyps themselves and others by the eosinophils found in certainsubsets of polyps. Cysteinyl leukotriene receptors and interleukin-5 (IL-5) appear to bethe most well studied.


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Epistaxis

- Also known as nosebleed.-It is the relatively commonoccurrence of hemorrhage from the

nose, usually noticed when the blood drains out through thenostrils.

T here are two types:Anterior (the most common)Posterior (less common, morelikely to require medical attention).


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CausesLocal Factors:

Blunt trauma-usually a sharp blow to the face, sometimes accompanying a nasal fracture.

Foreign bodies

-such as fingers during nose-picking.Inflammatory reaction

-e.g. acute respiratory tract infections, chronic sinusitis, allergic rhinitis or environmental irritants

Systemic Factors:

AllergiesInfectious diseases

-e.g. common coldHypertension also allergic to aspirin


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The vast majority of nose bleeds occur in the anterior front part of the nosefrom the nasal septum. This area is richly endowed with blood vesselsKiesselbach's plexus. This region is also known as Little's area. Bleedingfurther back in the nose is known as a posterior bleed and is usually due torupture of the sphenopalatine artery or one of its branches. Posterior bleeds areoften prolonged and difficult to control. They can be associated with bleedingfrom both nostrils and with a greater flow of blood into the mouth. There areconflicting opinions in the use of ice or nasal packing in the treatment of nose

bleeds. Most suggest there is no detriment to using ice or nasal packing wheninitial efforts to pinch the nose fail.


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Anatomy & Physiolgy of Throat


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W hat is the throat?The throat (pharynx and larynx) is a ring-like muscular tube that acts as the passageway for air, food andliquid. It is located behind the nose and mouth and connects the mouth (oral cavity) and nose to the

breathing passages (trachea (windpipe) and lungs) and the esophagus (eating tube). The throat also helps

in forming speech.T he throat contains the:Tonsils and adenoids - made up of lymph tissue. Tonsils are located at the back and sides of the mouth

and adenoids are located behind the nose. They both help to fight infections. Removal of tonsils andadenoids, when necessary, will not reduce your child's ability to fight infections since there are manyother tissues to perform that function. Pharynx - is the muscle-lined space that connects the nose andmouth to the larynx and esophagus (eating tube).

Larynx - also known as the voice box, the larynx is a cylindrical grouping of cartilages, muscles andsoft tissue that contains the vocal cords. The larynx is the upper opening into the windpipe (trachea), the

passageway to the lungs.

Epiglottis - a flap of soft tissue and cartilage located just above the vocal cords. The epiglottis foldsdown over the vocal cords to help prevent food and irritants from entering the lungs.

Pharynx - is the muscle-lined space that connects the nose and mouth to the larynx and esophagus(eating tube).

Larynx - also known as the voice box, the larynx is a cylindrical grouping of cartilages, muscles andsoft tissue that contains the vocal cords. The larynx is the upper opening into the windpipe (trachea), the

passageway to the lungs.

Epiglottis - a flap of soft tissue and cartilage located just above the vocal cords. The epiglottis foldsdown over the vocal cords to help prevent food and irritants from entering the lungs.


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Diagnostic TestT hroat swab-It is a laboratory test done to isolateand identify organisms that may causeinfection in the throat.-A cotton swab is rubbed against the

back of your throat to gather a sampleof mucus. This takes only a second or twoand makes some people feel a brief gagging or choking sensation. The

mucus sample is then placed on aculture

plate that helps any bacteria present inthe mucus grow, so they can beexamined and identified.


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Tonsilitis- A n inflammation of the tonsils mostcommonly ca u sed by viral or bacterialinfection. Symptoms of tonsillitis incl u de sorethroat and fever.

Symptoms:Red and/or swollen tonsils.

bad breath painful or difficultswallowing coaugh

fever


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ManagementPalliative treatments to reduce the discomfort from tonsillitis symptomsinclude:

pain relief, anti-inflammatory, fever reducing medications (acetaminophen,ibuprofen, aspirin)sore throat relief (salt water gargle, lozenges, warm liquids)hydrationrestIf the tonsillitis is caused by bacteria, then antibiotics are prescribed, with

penicillin being most commonly used. Erythromycin and Clarithromycin

are used for patients allergic to penicillin. When tonsillitis is caused by avirus, the length of illness depends on which virus is involved. Usually, acomplete recovery is made within one week; however, some rare infectionsmay last for up to two weeks. Chronic cases may treated with tonsillectomy(surgical removal of tonsils) as a choice for treatment


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Pathophysiology

Local inflammatory pathways result inoropharyngeal swelling, oedema,

erythema, and pain. Rarely, theswelling may progress to the soft

palate and uvula (uvulitis), or

inferiorly to the region of supraglottis(supraglottitis).


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Laryngitis

-An inflammation of thelarynx, manifests in both acuteand chronic forms.

Acute laryngitis has an abruptonset and is usually self-limited.Chronic laryngitis, as the

name implies, involves alonger duration of symptoms;it also takes longer to develop.


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Symptoms

ManagementThe treatment for viral laryngitis is supportive: plenty of fluids, humidified air,acetaminophen or ibuprofen for pain, and the investment of time for recovery.For patients with significant laryngitis, a short course of steroids (prednisone,

prednisolone, or dexamethasone) may be used to decrease the inflammationand shorten the course of symptoms. Dexamethasone as a single dose givenorally (Decadron, DexPak) or by intramuscular injection (Adrenocot, CPC-Cort-, Decadron Phosphate, Decaject-10, Solurex) may be used to treat croup.The treatment of chromic laryngitis will be determined by the cause of the

inflammation or loss of function. Discontinuation of smoking and alcohol usewill always have a positive effect.

The major symptoms of laryngitis are:HoarsenessSore throatWeak or absent voiceSensation of a lump in the throat or constant need to clear the throatDry cough

Fever


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Pathophysiology

Acute laryngitis is an inflammation of the vocal fold mucosa and larynx thatlasts less than 3 weeks. When the etiology of acute laryngitis is infectious,white blood cells remove microorganisms during the healing process. Thevocal folds then become more edematous, and vibration is adversely affected.The phonation threshold pressure may increase to a degree that generatingadequate phonation pressures in a normal fashion becomes difficult, thuseliciting hoarseness. Frank aphonia results when a patient cannot overcomethe phonation threshold pressure required to set the vocal folds in motion.The membranous covering of the vocal folds is usually red and swollen. Thelowered pitch in laryngitic patients is a result of this irregular thickening along

the entire length of the vocal fold. Some authors believe that the vocal foldstiffens rather than thickens. Conservative treatment measures, as outlined

below, are usually enough to overcome the laryngeal inflammation and torestore the vocal folds to their normal vibratory activity.


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Laryngealcancer -also called cancer of the larynx or laryngeal carcinoma. Most laryngealcancers are squamous cell carcinomas,reflecting their origin from the squamous

cells which form the majority of thelaryngeal epithelium. Cancer can developin any part of the larynx, but the cure rateis affected by the location of the tumor.For the purposes of tumour staging, thelarynx is divided into three anatomical

regions: the glottis (true vocal cords,anterior and posterior commissures); thesupraglottis (epiglottis, arytenoids andaryepiglottic folds, and false cords); andthe subglottis.


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SymptomsThe symptoms of laryngeal cancer depend on the size and location of thetumor. Symptoms may include the following:

Hoarseness or other voice changesA lump in the neck

A sore throat or feeling that something is stuck in the throatPersistent coughStridor Bad breathEar ache


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Diagnostic TestDiagnosis is made by the doctor on the basis of:

Medical HistoryPhysical AssessmentChest X-rayCT ScanMRITissue Biopsy

ManagementSpecific treatment depends on the location, type, and stage of the

tumour. Treatment may involve surgery, radiotherapy, or chemotherapy,alone or in combination. This is a specialised area which requires thecoordinated expertise of ear, nose and throat (ENT) surgeons(otolaryngologists) and oncologists.


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Pathopyhsiology

Laryngeal cancer arises from progressive accumulation of genetic alterationsthat lead to selection of a clonal population of transformed cells. Head andneck cancers (including laryngeal cancer) may require more genetic alterations

in their development than other solid tumours, thus explaining the often long(20- to 25-year) period of latency after initial toxin exposure. Carcinogenesis isinduced by DNA damage, mutations, and adducts. Laryngeal squamous cellcarcinoma may appear as a mucosal irregularity, erythroplasia, or leukoplakia.

guidelines for the use of eye medications

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