Structure of the Eye The following are the major areas of the eye and its function Cornea: covers the iris and pupil Sclera is the white part of the eye and the conjunctiva is the clear membrane that covers it Iris and the pupil form the aperture that light passes through to the lens Lens focuses light by refraction to the back of the globe to the retina The retina is a collection of neurons that triggers the optic nerve and carries the “image” to the occipital lobe of the brain

The eye contains two chambers as well. The aqueous humor which is filled with water and the vitreous humor in the back of the eye The lens is controlled by the muscles of the ciliary body which adjusts the lens to control refraction of light The basic function of the eye is to focus and concentrate light waves to a focal point on the retina which converts it to electrical impulses (EI). EI are carried to the brain via the optic nerve

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Infections of the eye Style: a bacterial infection of the sebaceous glands of the eye lid. Antibiotics like ophthalmic erythromycin can be used but infection is self limited and will resolve in usually seven days Blepharitis: inflammation of the eyelids cause by usually bacteria. Tx: Blephamide® (prednisolone/sulfacetamide) is a combination Abx/steroid used to treat this disorder Conjunctivitis is an inflammation of the conjunctival membrane of the eye. Allergic conjunctivitis (red eye) Bacterial conjunctivitis Viral conjunctivitis (Pink eye)

Allergic Conjunctivitis Inflammatory condition of the conjunctiva caused by seasonal allergies and airborne allergens Called “red eye” Intensive itching Eye watering Tx: Ophthalmic antihistamines products: (Visine A® naphazoline 0.025% and pheniramine 0.03%) or Patanol®, olapadine which is Rx only antihistamine

Bacterial Conjunctivitis Caused by mixture of different bacterial Symptoms same as for allergic conjunctivitis In addition pus and mucus causes the lids to “stick together”. This is the hallmark of this infection Usually resolves on its own but antibiotics can be used Ciprofloxacin 0.3% (ciloxan®), Erythromycin Ophthalmic Ointment USP, 0.5% and others

Neonatal Ophthalmia Women infected with chlamydia or gonorrhea can pass bacteria to their infants as they pass through birth canal Erythromycin ophthalmic ointment 0.5% USP has been used to treat the infants Can cause blindness if not treated

Viral Conjunctivitis Commonly called pink eye Commonly caused by the same viruses causing the common cold (adenovirus) Other virus can include varicella and herpes simplex virus No therapy except supportive. Oral acyclovir is used for cases caused by varicella zoster virus or herpes simplex virus.

Glaucoma Glaucoma is a disease of the eye where the pressure inside the eye ball is elevated above normal Treated with drugs that reduce the pressure in the eyeball by relaxing the trabecular network and increase aqueous humor outflow.

Brand drugGenericMOA Timoptic ®TimololBeta Blocker Betagan ®LevobunololBeta Blocker Trusopt ®DorzolamideCarbonic Anhydrase Inhibitor Azopt ®BrinzolamideCarbonic Anhydrase Inhibitor Xalatan®LatanoprostProstaglandin Lumigan®BimatoprostProstaglandin Travatan®TravoprostProstaglandin

General structure of the ear The outer ear consists of the pinna and auricle Auditory canal leads from the outer ear to the tymphanic membrane (ear drum) Middle ear: the three ossicles vibrate in response to sound waves and transmit the energy of the sound waves into the inner ear Inner ear: The cochlea is a conical shape organ filled with fluid and lined with hair cells. The energy of sound waves is transmitted here and the movement of hair cells to electrical action potentials in cochlear nerve (CN VIII)

Infections of the ear are the most commonly treated malady of the ear Medications include otic antibiotics that contain a combination of antibiotics and a steroid. Example is Cortisporin Otic Solution (neomycin and polymyxin B sulfates and hydrocortisone otic solution, USP) is a sterile antibacterial and anti-inflammatory solution for otic use. Each mL contains: neomycin sulfate equivalent to 3.5 mg neomycin base, polymyxin B sulfate equivalent to 10,000 polymyxin B units, and hydrocortisone 10 mg (1%)

Middle Ear Infections Bacteria that infect the eustachian tube include: Staphylococcus pyogenes, Streptococcus pneumoniae, moraxella species, and haemophilus influenza Very common in children because of the horizontal nature of the tube position Caused intense pressure in the middle ear that can rupture the eardrum and ozze pus from the ear Myringitis is the associated inflammation of the eardrum Called Bacterial Acute Otitis Media In children, Amoxicillin is normally prescribed usually as suspension and given three times a day In refractory cases, Augmentin ® (amoxicillin/clavulunate sodium) is used

Miscellaneous Drugs Parasympathomimetics (Cholinergic drugs) MOA: agonists at the cholinergic receptor in the eye Indications: pupillary constriction and glaucoma tx Drugs Pilocarpine (Pilocar) Carbachol (Miostat) Sympathomimetics (mydriasis agents) MOA: binds to beta and alpha receptors or blocks cholinergic receptors Indications: dilate the pupil for ophthalmic exams Phenylephrine Cyclopentolate (Cyclogyl) Atropine