38.2 Ocular Anti-inflammatories and Anti-infectives

Eye problems can be a real pain, literally! Ocular anti-inflammatory and anti-infective medications are the superheroes that come to the rescue. They fight off inflammation, infections, and other eye issues, helping you see clearly again.

These meds come in various forms like drops and ointments, targeting specific eye problems. From bacterial infections to viral attacks, there's a treatment for almost everything. But remember, proper use is key to getting the most out of these eye-saving drugs!

Ocular Anti-inflammatory and Anti-infective Medications

Ocular anti-inflammatory and anti-infective medications

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• Ocular anti-inflammatory medications reduce inflammation, pain, and swelling in the eye caused by conditions such as uveitis, keratitis, and post-operative inflammation. Corticosteroids (prednisolone, dexamethasone) and ###nonsteroidal_anti-inflammatory_drugs_(NSAIDs)_0### like diclofenac and ketorolac are commonly used
• Ocular anti-infective medications treat or prevent bacterial, viral, or fungal infections of the eye such as conjunctivitis, keratitis, and endophthalmitis. Antibiotics (tobramycin, moxifloxacin), antivirals (trifluridine, ganciclovir), and antifungals (natamycin, amphotericin B) are used depending on the causative organism
• Both classes of medications are available in various forms designed for topical application to the eye or surrounding tissues, including eye drops, ointments, and gels, allowing for targeted delivery and minimizing systemic absorption

Indications, mechanisms, and side effects

• Corticosteroids suppress the immune response and reduce inflammation by inhibiting the production of pro-inflammatory mediators. However, they can cause side effects such as increased intraocular pressure, cataract formation, and delayed wound healing
• NSAIDs reduce inflammation by inhibiting prostaglandin synthesis and are used for post-operative pain and inflammation and allergic conjunctivitis. Common side effects include stinging, burning, and allergic reactions
• Antibiotics inhibit bacterial growth or kill bacteria and are used for bacterial conjunctivitis, keratitis, and endophthalmitis prophylaxis. Allergic reactions and ocular irritation are potential side effects
• Antivirals interfere with viral replication and are used for herpes simplex keratitis and cytomegalovirus retinitis. They may cause ocular irritation and superficial punctate keratitis
• Antifungals disrupt fungal cell membranes or inhibit ergosterol synthesis and are used for fungal keratitis and endophthalmitis. Side effects include ocular irritation and allergic reactions

Nursing considerations

1. Assess the patient's eye condition and review the medication order to ensure appropriate treatment
2. Verify the patient's identity and explain the procedure to promote understanding and cooperation
3. Wash hands and put on gloves to maintain aseptic technique and prevent contamination
4. Check the medication label for name, strength, and expiration date to ensure accuracy and safety
5. Inspect the medication for discoloration or particulate matter to detect any signs of deterioration
6. Position the patient with their head tilted back and eyes looking up to facilitate proper administration
7. Gently pull down the lower eyelid to create a pocket for the medication
8. Instill the prescribed number of drops or apply a thin strip of ointment into the lower conjunctival sac, avoiding contact with the eye or surrounding tissues
9. Instruct the patient to close their eye gently and apply pressure to the nasolacrimal duct for 1-2 minutes to minimize systemic absorption
10. Wait at least 5 minutes before administering additional eye medications to prevent dilution or interactions
11. Document the medication administration, including the time, dose, and patient response for accurate record-keeping and monitoring

Patient education strategies

• Teach patients the correct technique for instilling eye drops or applying ointments, emphasizing hand hygiene, avoiding contact with the eye or surrounding tissues, and applying gentle pressure to the nasolacrimal duct after administration
• Emphasize the importance of completing the full course of treatment, even if symptoms improve, to prevent relapse or development of drug resistance
• Advise patients to store medications as directed (refrigeration, protecting from light) to maintain potency and stability
• Instruct patients to report any adverse effects (stinging, burning, allergic reactions) or worsening symptoms to their healthcare provider for timely intervention
• Educate patients on the signs and symptoms of eye infections (redness, discharge, pain, vision changes) and when to seek medical attention to prevent complications
• Encourage patients to maintain good eye hygiene and avoid sharing personal items (towels, eye makeup) to prevent the spread of infections
• Provide written instructions and demonstrate the proper administration technique to ensure understanding and compliance, promoting successful treatment outcomes