EENT Instillation and IrrigationObjectives:

After 8 hours of varied teaching- learning activities, the level III students will be able to:

1. define the following terms:eye instillationeye irrigationear instillationear irrigationnasal instillationmouthwash

2. review the anatomy and physiology of the following:eyeearnosemouth

3. discuss the purpose of the following:eye instillationeye irrigationear instillationear irrigationnasal instillationmouthwash

4. explain the principles involving the following:eye instillationeye irrigationear instillationear irrigationnasal instillationmouthwash

5. cite the indications and contraindications of the following:eye instillationeye irrigationear instillationear irrigationnasal instillationmouthwash

6. explain the procedures of the following:eye instillationeye irrigationear instillationear irrigationnasal instillationmouthwash

7. state the guidelines of the following:eye instillationeye irrigationear instillationear irrigationnasal instillationmouthwash

8. discuss the nursing responsibilities of the following:eye instillationeye irrigationear instillationear irrigationnasal instillationmouthwash

9. enumerate the common ocular, otic, nasal and mouthwash solutions and discuss them according to the following:general classification

mechanism of actionside effectsdiscuss the nursing responsibilities before, during and after giving the medication

10. demonstrate beginning skills in performing the following:eye instillationeye irrigationear instillationear irrigationnasal instillationmouthwash

EENT Instillation and IrrigationTHE EYE

The human eye is the organ which gives us the sense of sight, allowing us to observe and learn more about the surrounding world than we do with any of the other four senses.  We use our eyes in almost every activity we perform, whether reading, working, watching television, writing a letter, driving a car, and in countless other ways.  Most people probably would agree that sight is the sense they value more than all the rest.

The eye allows us to see and interpret the shapes, colors, and dimensions of objects in the world by processing the light they reflect or emit.  The eye is able to detect bright light or dim light, but it cannot sense objects when light is absent.

Light waves from an object (such as a tree) enter the eye first through the cornea, the clear dome at the front of the eye.  The light then progresses through the pupil, the circular opening in the center of the

colored iris.Fluctuations in incoming light change the size of the eye’s pupil.  When the light entering the eye is bright enough,

the pupil will constrict (get smaller), due to the pupillary light response.Initially, the light waves are bent or converged first by the cornea, and then further by the crystalline lens (located immediately behind the iris and the pupil), to a nodal point (N) located immediately behind the back surface of the lens.  At that point, the image becomes reversed (turned backwards) and inverted (turned upside-down).

The light continues through the vitreous humor, the clear gel that makes up about 80% of the eye’s volume, and then, ideally, back to a clear focus on the retina, behind the vitreous.  The small central area of the retina is the macula, which provides the best vision of any location in the retina.  If the eye is considered to be a type of camera, the retina is equivalent to the film inside of the camera, registering the tiny photons of light interacting with it.

Within the layers of the retina, light impulses are changed into electrical signals.  Then they are sent through the optic nerve, along the visual pathway, to the occipital cortex at the posterior (back) of the brain.  Here, the electrical signals are interpreted or “seen” by the brain as a visual image.

Eye Irrigation- washing out of the conjunctival sac with a stream of liquid

Purpose:- to irrigate or remove chemicals or foreign bodies from the eyes- to remove secretions of conjunctival sac- to treat infections- to relieve itching- provide moisture on the surface of the eyes of an unconscious patient- to prepare eye for surgical procedure- place antiseptic or other solutions in contact with conjunctiva

Indications:- allergic conjunctivitis- bacterial eye infection- unconscious patients- eye inflammation, draining or crusting in the eyes

Contraindications:- hypersensitivity reactions- eye surgery-

Principles involved in Eye irrigation

1. Anatomy and Physiology

- The conjunctiva is a continuous, thin transparent layer of mucous membrane lining the eyelids covering the anterior surface of the eyeball. It has a rich supply of blood vessels and lymphatics. An abundant nerve supply makes the conjunctiva sensitive to minute irritations.

2. Microbiology- Handwashing deters the spread of microorganisms

- You should not flow down the lacrimal duct to the nose as this might spread infection.

3. Chemistry- Cleansing the eyes simply involves washing with a clean washed cloth moistened with water or saline

solution, soap may cause burning and irritation- If irrigations are for mechanical cleaning, use NaCl solution which is non-irritating. Irrigations are most

comfortable if given or near body temperature. In treatment of inflammatory condition that may be prescribed

as hot as the patient can tolerate them.

4. Pharmacology- Solutions used or eye irrigation are made from sodium bicarbonate, bovic acid or sodium chloride

- Weak solutions are used so that they will not be irritating

- Drugs used in the eyes may be classed or anti anti-septic, astringents, mydriatic and miotic.

- Antiseptic solutions should choose their effect upon the causative organism.5. Physics

- Function is needed between nurse’s fingers and eyelids in opening them for irrigation

- During the procedure, gravity will aid the flow of solution6. Psychology

- The eye is a very sensitive part of the body and the patient is often very fearful about the simplest procedure, therefore he or she be treated with kindness and more patience than usual.

Guidelines:- place patient lying toward site to be irrigated to prevent fluid from flowing to other eye- a 5cc syringe is used unless very large amounts of fluids are needed- direct the irrigating fluid along the conjunctiva from inner to outer canthus- avoid directing a forceful stream on the eyeball- avoid touching any eye structure with irrigation equipment- a piece of gauze may be wrapped around the index finger to raise upper lid for better cleansing of heavy

discharges are present- place an emesis basin at side of face to collect irrigating fluid- light causes pain in many eye conditions, the light should be arranged in a position to provide optimal

illumination of the working area without shining directly to patient’s eyes- the lids should be gently separated with the thumb and fingers of the left hand to expose the conjuntival sac.

Pressure is exerted in the tiny prominences of the cheek and brow, never on the eyeball- movement of the eye, when lids are closed, helps moves secretions from upper to lower conjuntival sac; the

patient should close his eyes periodically throughout the procedure- the patient may have the urge to rub or wipe his eyes with his fingers; to minimize this problem the nurse

should dry the eye and surrounding area with a sterile cotton ball on completion of irrigation

Nursing Responsibilities:

Before:1. Verify order for the eye to be irrigated and solution and amount of irrigation.2. Explain procedure to the patient.3. Don gloves.4. Instruct patient to sit or lie in a supine position with head tilted toward the side of the affected eye5. Let patient hold kidney basin and place on the side of the eye to be irrigation.

During:

1. Expose the conjunctival sac and hold upper lid open with non-dominant hand.2. Instruct patient to look up.3. Hold the syringe about 1.5cm above the inner canthus.4. Allow irrigating fluid to flow from the inner canthus to outer along the conjunctival sac.5. Occasionally have the patient close his eyes.

After:1. Pat eyes dry and dry patient’s face with a cotton ball.2. Let patient open and close his eyes.3. Record kind and amount of fluid used as well as its effectiveness.

Eye Instillation-administration of therapeutic agents such as ointments and creams into the eye

Purpose:- to dilate or constrict the pupil when examining the eye- relieve pain, discomfort, itching and conjunctivitis- to act as an antiseptic in cleansing the eye- to combat infection- to lubricate the eye

Principles involved in Eye Instillation:

1. Anatomy and Physiology – For the eye drops, the drops should be instilled into the everted lower eyelid. The drops

should not be instilled directly into the cornea to prevent startling the patient or cause any unnecessary pain. For

ointments, it is applied from the inner canthus of the eye toward the outer canthus.

2. Pharmacology – Medications for the eye are instilled in the forms of liquid or ointments usually diluted with less

than 1% strength.

3. Psychology – Explaining the procedure to the patient to gain patient’s cooperation and reduce anxiety.

Guidelines:- wash hands before putting on gloves- offer the patient paper tissues to remove solution and tears that may spill from eye during the procedure- clean the eyelids and eyelashes of any drainage with cotton ball or gauze- tilt the patient’s head slightly if sitting or place the patient’s head over a pillow if lying down- place the thumb or two fingers near the margin of the lower eyelid immediately below the eyelashes, exert

pressure downward over the bony prominence of the cheek- hold the dropper close to the eye, but avoid touching the eyelids or lashes- squeeze the container and allow the prescribed number of drops to fall in the lower conjunctival sac- release the lower lid after the eyedrops are instilled, ask patient to close his eyes gently- apply gentle pressure over the inner canthus- do not apply medications to the cornea since it can cause injury since it richly supplies with sensitive nerve

endings- moving the eyes after instillation distributes the solution over the conjunctival surface and anterior eyeball

Indications:- glaucoma- papillary dilation for surgery and examination- ophthalmic infections- patients requiring local anesthesia for tests- keratitis- conjunctivitis- eye discomforts

Contraindications:- hypersensitivity to drug used in instillation

Nursing responsibilities:Before:

1. Check doctor’s order for amount, no. of drops of solution and eye to be treated.2. Explain procedure to the patient.3. Prepare drug to be administered according to the 5R’s of administration.4. Warm hands.5. Don gloves.6. Let patient sit with head tilted backward or to lie in supine position.

During:1. Pull lower lid down gently.2. Instruct patient to look up.3. Drop medication amount into center of lower lid and never in the cornea.4. If using an ointment, apply from inner to outer canthus.5. Instruct patient to close eyes and not to squeeze or rub the eyes.

After:1. Wipe off excess solution with sterile gauze or cotton balls.2. While closing his eyes, let patient roll his eyes.3. Record time, type, strength and amount of medication and the eye into which medication was instilled.

THE EAR

The ear is the organ of hearing. The parts of the ear include:

external or outer ear, consisting of:

o pinna or auricle - the outside part of the ear.o external auditory canal or tube - the tube that

connects the outer ear to the inside or middle ear.

tympanic membrane - also called the eardrum. The tympanic membrane divides the external ear from the middle ear.

middle ear (tympanic cavity), consisting of:o ossicles - three small bones that are connected and transmit the sound waves to the inner ear. The

bones are called: malleus incus stapes

o eustachian tube - a canal that links the middle ear with the throat area. The eustachian tube helps to equalize the pressure between the outer ear and the middle ear. Having the same pressure allows for the proper transfer of sound waves. The eustachian tube is lined with mucous, just like the inside of the nose and throat.

inner ear, consisting of:o cochlea (contains the nerves for hearing)o vestibule (contains receptors for balance)o semicircular canals (contain receptors for balance)

How do we hear?

Hearing starts with the outer ear. When a sound is made outside the outer ear, the sound waves, or vibrations, travel down the external auditory canal and strike the eardrum (tympanic membrane). The eardrum vibrates. The vibrations are then passed to three tiny bones in the middle ear called the ossicles. The ossicles amplify the sound and send the sound waves to the inner ear and into the fluid-filled hearing organ (cochlea). Once the sound waves reach the inner ear, they are converted into electrical impulses which the auditory nerve sends to the brain. The brain then translates these electrical impulses as sound.

Ear Instillation

- introduction of medication into the ear; applying eardrop to treat an ear disorderPurpose:

- soften earwax so that it can be readily removed at a later time- provide local therapy to reduce inflammation or destroy infective organisms in external ear canal- relieve pain

Indications:- chronic supporative otitis media- accumulation of earwax- external otitis media

Guidelines for ear instillation

Verify doctor’s order. Know the action of the medication to be given and its purpose. Assess the ear before and after performing the technique. Position the patient in side lying position on the unaffected side. Straighten patient’s ear canal by pulling down and back (for infants) and up and back (for adults). Patient should remain on side lying position for 5 minutes. A small piece of cotton fluff should be inserted loosely at the meatus of the auditory canal for 15 minutes, do not

press. Assess after the 15 minutes. Assess patient’s response. Do recording and observation. Assist patient in a comfortable position.

Nursing responsibilities:Before:

1. Check doctors’ order2. Wash hands3. Gather needed equipments.4. Check medication and compare label with the medication chart.5. Before preparing the medication for administration, warm the medication bottle to body temperature.6. Take medication to the patient’s room and check patient’s identification band and ask patient to state his

name.7. Explain procedure to the patient.8. Warm the medication in your hand or place it in a warm water for a short time.

During:1. Assist the client to a side lying position with ear being treated uppermost.2. Clean the pinna of the ear and meatus of the ear canal.3. Fill the medication dropper with prescribed amount of medication.4. Straighten the auditory meatus

For infants: pulling pinna down and backFor adults: pulling pinna up and back

5. Press gently but firmly a few times in the tragus of the ear.

After:1. Ask patient to remain in side lying position for about 5 minutes.2. Insert a small piece of cotton loosely at the meatus of the auditory canal for 20 minutes. Do not press it into

the canal.3. Assess client’s response. 4. Document all relevant information.

Ear Irrigation-washing by a stream of water or other fluid; if a wax plug is present in the auditory canal, irrigation is ordinarily

done for cleansing purposes

Purpose:- to clean the auditory canal- to apply heat to the tissues of the canal- to remove discharges from the ear canal- to facilitate removal of foreign bodies such as organic substances- to soften wax- to destroy organism or insects lodging the canal which can cause almost intolerable discomfort

- for hygiene purpose

Indications:- cerumen impaction- ear infections- ear obstructions- hearing difficulties

Contraindications:- tympanic membrane perforation- tympanostomy with tubes- hypersensitivity

Complications:- dizziness- perforation or damage of the eardrum

Guidelines for irrigation:

-Warm the solution 35-40 degree Celsius.-Wear gloves.-straighten the auditory canal-be sure not to occlude the meatus.

Nursing responsibilities:

Before :

-Read/check physicians order-Explain procedure-Do medical hand washing-Assist patient in sitting position/Head tilt.

During:

-Place a towel under the shoulder-Support a basin under the patient ear.

After:

Document:

-Time of irrigation-Effect of treatment.-Kind and amount of solution used.-Nature of the returned flow.-Do after care.

THE NOSE

The nose is the organ of smell located in the middle of the face. The internal part of the nose lies above the roof of the mouth. The nose consists of:

external meatus - triangular-shaped projection in the center of the face. external nostrils - two chambers divided by the septum. septum - made up primarily of cartilage and bone and covered by mucous membranes. The cartilage also gives

shape and support to the outer part of the nose. nasal passages - passages that are lined with mucous membranes and tiny hairs (cilia) that help to filter the air. sinuses - four pairs of air-filled cavities, also lined with mucous membranes.

What are sinuses?

The sinuses are cavities, or air-filled pockets, near the nasal passage. As in the nasal passage, the sinuses are lined with mucous membranes. There are four different types of sinuses:

ethmoid sinus - located inside the face, around the area of the bridge of the nose. This sinus is present at birth, and continues to grow.

maxillary sinus - located inside the face, around the area of the cheeks. This sinus is also present at birth, and continues to grow.

frontal sinus - located inside the face, in the area of the forehead. This sinus does not develop until around 7 years of age.

sphenoid sinus - located deep in the face, behind the nose. This sinus does not develop until adolescence.

Nasal Instillation- process of administering medications by spray or drops into the nasal cavity to help resolve symptoms of

sinus congestion and colds

Purpose:- to shrink swollen nasal mucous membrane- to loosen secretions and facilitate drainage- to treat infections of nasal cavity sinuses- to reduce blood flow by using tampons containing vasoconstrictors such as epinephrine

Indications:- nasal problems- sinus congestion

Contraindications:- neck and spine injury- increase ICP-

Principles involved in Nasal Instillation:

1. Anatomy and Physiology - The head of the patient is positioned slightly tilted backward.

The medication is instilled into the nostrils onto the nasal membranes where it is absorbed by the body.

2. Microbiology – Avoid touching the tip of the medicine dropper to the nose to prevent contamination of the drug.

3. Physics – To treat the opening of the Eustachian tube, have the patient assume a back lying position, the drops

will flow into the nasal pharynx, where the Eustachian tube opens. To treat the ethmoid and sphenoid sinuses,

place patient in a back lying position with the head over the edge of the bed on pillow under the shoulders so that

the head is turned backward. To treat the maxillary and frontal sinuses, position patient to back lying position with

the head turned toward the side.

4. Psychology – Explain the procedure to the patient to relieve anxiety and gain cooperation of the patient

Guidelines:- nasal instillation of therapeutic agents maybe administered to shrink edematous tissues, to prevent or control

bleeding, provide topical anesthesia or treat infectious process- administration of nasal drops requires hyperextension of the neck. Because this position places strain on the

neck muscles, the client’s comfort should be assured- although the nose is considered clean (not sterile) cavity because its connection to the sinus, the nurses uses

medical asepsis when performing nasal instillation- protect dropper with a piece of soft tubing when the client is an infant or young child- avoid touching the nose with the dropper because it may cause the client to sneeze- the patients should be positioned over a pivot on the edge of the bed during nasal instillation; if the head is

only tilted back, the medication will run into the throat and be swallowed, making the medication ineffective

- nasal instillation preparations should be fro single patients only- before giving any new medications, assess patient for allergies- clients must be cautioned to avoid abuse of medications because overuse can lead to a rebound effect in

which the nasal congestion worsens- having the client remain in a supine position for 5 minutes; after insertion of the nose drops prevents drainage

of the drug and facilitates its action

Position types according to affected area:1. Ethmoid or sphenoid sinuses- place patient in a flat position (supine) with shoulders supported with a pillow to

hyperextend the neck2. Maxillary and frontal sinuses- place patient in a flat position (supine) with shoulders supported with a pillow

and head hyperextended and turned toward affected side3. Eustachian tube- flat position (supine) with head tilted slightly to the affected side

Nursing responsibilities:Before:

1. Check the doctor’s order.2. Assemble all materials needed.3. Explain the procedure to the patient and instruct patient to avoid movement during the procedure to facilitate

instillation4. Do medical handwashing.5. Assume patient in supine position.

During:1. Instruct patient to blow nose. Provide patent with a disposable tissue.2. Elevate nares slightly.3. Withdraw the appropriate amount of prescribed medication into the dropper and instill the medication by

counting the drops toward the midline to the superior of the ethmoid bone4. Instruct patient to breath through the mouth and maintain position for 5 minutes to prevent the escape of

medication5. Absorb the excess medication with disposable tissue but instruct patient that nose blowing should be avoided

After:1. Assist patient in a comfortable position.2. Return the medication and the dropper to its designate container.3. Document the procedure done, type, dosage and route of administration of medication instilled as well as

patient’s reaction

THE MOUTH

The mouth (oral cavity, buccal cavity) is where food enters the digestive tract. The following features are found in the mouth:

The vestibule is the narrow region between the cheeks and teeth and between the lips and teeth.

The tongue defines the lower boundary of the mouth. It helps position the food during mastication (chewing) and gathers the chewed food into a ball, or bolus, in preparation for swallowing. The tongue is covered with papillae, small projections that help the tongue grip food. Many of the papillae bear taste buds.

The palate defines the upper boundary of the mouth. The forward portion is the hard palate, hard because bone (maxillae and palatine) makes up this portion of it. Further back in the mouth, the soft palate consists of muscle and

lacks any bone support. A conical muscular projection, the uvula, is suspended from the rear of the soft palate.

Saliva contains water (99.5 percent), digestive enzymes, lysozyme (an enzyme that kills bacteria), proteins, antibodies (IgA), and various ions. Saliva lubricates the mouth, moistens food during chewing, protects the mouth against pathogens, and begins the chemical digestion of food. Chemical digestion is carried out by the digestive

enzyme salivary amylase, which breaks down polysaccharides (starch and glycogen) into short chains of glucose, especially the disaccharide maltose (which consists of two glucose molecules). Saliva is produced by the following glands:

o Three pairs of salivary glands, the parotid, submandibular, and sublingual, lie outside the mouth. They deliver their secretions to the mouth via ducts.

o Buccal glands are located in the mucosa that lines the mouth.

The teeth are embedded within sockets of the upper and lower jawbones (maxillae and mandible). Each tooth is surrounded by gum, or gingival, and held in its socket by a periodontal ligament. The 20 deciduous teeth (baby teeth or milk teeth) are eventually replaced by 32 permanent teeth. There are three types of teeth, based on shape and function:

o Incisors have a chisel-shaped edge suitable for biting off food.

o Canines (cuspids) are pointed fangs and are used for tearing food.

o Premolars (bicuspids) and molars have flat surfaces used for grinding and crushing.

A tooth has the following structural features:

o Dentin is a calcified tissue (like bone) that composes the bulk of the tooth.o The crown is the portion of the tooth embedded in the bone.

o The neck is the region at the gum line where the crown and root meet.

o Enamel is the hard, nonliving material that covers the crown. Calcium compounds make the enamel the hardest substance in the body.

o Cementum is the bonelike substance that covers the root and binds it to the periodontal ligament.

o The pulp cavity is the central cavity inside the tooth. It contains blood vessels, nerves, and connective tissue (collectively called pulp).

Mouthwash- antiseptic which is fluoride compound added to drinking water to prevent dental cavities or carries.

Purpose:- to freshen the mouth and relieve it of offensive odor- to keep teeth, mouth and gums in good condition- to decrease cavities and mouth diseases- to provide a sense of well being and comfort- to improve appetite and taste of food- to formulate circulation to oral tissues, tongue and gums

Importance of Mouthwash:

1. To give fresh feeling

2. To prevent halitosis

3. To prevent dental carries

4. To increase confidence

Goals:- removal of excessive secretions- stimulation of salivary glands- prevention of bacterial build-up that causes infection

Indications:- halitosis, stomatitis, gingivitis, glossitis and parotitis- periodontal disease-

Contraindications:- allergies to mouthwash

Principles involved in Mouthwash:

1. ANATOMY AND PHYSIOLOGY- plaque is formed when bacteria in the mouth feed on food residue particularly sugar residue and dead epithelial tissues.

2. PHYSICS- position the patient in side lying position with pillow under his head so he could spit or rinse in sitting position.

3. MICROBIOLOGY- place a towel under the chin to protect the patient’s clothes. Using separate applications for each area of the mouth prevents the transfer of microorganisms from one area to another.

Guidelines:- establish a regular routine that the client can easily follow at home; good dental hygiene; requires brushing

after every meal and flossing at least once a day; even a client who works daily can learn to brush his teeth during meal breaks

- encourage clients to continue yearly visits to their dentists; a dentist should screen for serious dental or periodontal problems

- use dental hygiene products of the client’s choice whenever possible; this allows the nurse to provide a more individualized plan of care

- remember that dental hygiene can be a means of providing the client’s level of comfort- use the time spent providing mouth care to teach clients- mouthwash used in a concentrated form may injure oral tissue and additional odor may result

Nursing Responsibilities:

Before:1. Explain and discuss the procedure to the patient.2. Prepare solutions required.3. Wash hands with bactericidal soap and water.

During:1. Inspect the patient’s mouth with the aid of a torch and spatula.2. Using a soft, small toothbrush, brush the patien’s natural teeth, gums and tongue.3. Hold the toothbrush against the teeth with the bristles at 45 degree angle.4. Encourage patient to rinse mouth vigorously.

After:1. Discard remaining mouthwash solutions.2. Clean and thorougly dry the toothbrush.3. Wash hands with soap and water.

THE COMMON OCULAR, OTIC , NASAL and MOUTHWASH SOLUTIONS:

Commonly used ocular medication:1. Topical Anesthetics

- are local anesthetic ophthalmic drugs are local anesthetics that are used to alleviate eye pain.- Mechanism of action:

Local anesthetics stabilize the membranes of the nerves, resulting in a decrease in the movements of ions into and out of the nerve endings. When nerves are stabilized in this way, they cannot transmit signals about painful stimuli to the brain. Usually, the application of topical anesthetic drugs to the eye results in local anesthesia in less than 30 seconds.- Indications:

contact lens fittingminor conjunctival surgeryparacentesis (surgical procedure of the eye to remove fluid for diagnostic or therapeutic reasons)examination of painful eye injuries

removal of foreign bodiesany other uncomfortable short procedure

Examples:- Proparacaine hydrochloride (Alcaine)- Tertracaine hydrochloride (Tetracaine)

2. Mydriatrics cycloplegies- Mechanism of action:

They dilate the pupil (mydriasis) and paralyze the ciliary muscle (cycloplegic refraction), which prevents accommodation. Such drug action is needed for either eye examination or uveal tract inflammatory states that benefit from papillary dilation.

Examples: - Phenylephrine- Atropine sulfate- Cyclopentolate solution (Cyclogyl)- Scopolamine- Homatropine- Tropicamide

3. Anti infective- A variety of infections can occur in the eye; many are self- limiting. These infections seldom result in harm.

However, some infection may require the use of ocular antimicribials to be eliminated.

- Aminoglycosides- Destroys bacteria by interfering with protein synthesis in bacterial cells by bind-

ing to ribosomal subunitis, which eventually leads to bacteria death- examples: gentamicin (Genoptic, Garamycin)

tobramycin (Tobrex)- Macrolides

- it inhibits the growth of an organism but does not destroy it.- Examples: erythromycin (Ilotycin)

- Quinolones- are bactericidal, destroying a wide spectrum of organisms that are often very difficult to treat- examples: Ciproflaxin (Ciloxan)

- Sulfonamides- are synthetic bacteriostatic antibiotic that work by blocking the sunthesis of folic acid in susceptible

bacteria.- Examples: sulfacetamide (Bleph- 10)

4. Anti inflammatoryExamples:NSAIDs:- bromfenac (Xibrom)- diclofenac (Voltaren)- flurbiprofen ( Ocufen)- ketorolac (Acular)- suprofen (Profenal)

Corticosteroids:- dexamethasone (Decadron, others)- fluocinonide (Retisert)- fluorometholone (Fluor- Op, others)- loteprednol ( Lotemax, others)- medrysone (HMS)- prednisolone (Pred Forte, others)- rimexolone (Vexol)

- Corticosteroids and NSAIDs both act to reduce inflammatory responses that arise from the body’s metabolic pathway for the naturally occurring biochemical arachidonic acid.

5. Cholinergic drugs- Mechanism of action:

Acetylcholine is the endogenous neurochemical mediator of the nerve impulses in the parasymphatetic nervous system. It stimulates parasymphatetic or cholinergic receptors located in the brain and throughout the

body along PNSS nerve branches. This results in several effects on the eye: miosis (papillary constriction), vasodilation of blood vessels in and around the eye, contraction of ciliary muscles, drainage of aqueous humor and reduced IOP. The ciliary muscle contraction itself promotes aqueous humor drainage by widening the space where the drainage occurs. Miosis promotes aqueous humor drainage by causing the iris to stretch, which also serves to widen thus space. The action of Acetylcholine is normally short lived. - Indications:

- open angle glaucoma- angle closure glaucoma- ocular surgery- convergent strabismus

- Examples:- Acetylchlorine chloride- Carbachol- Pilocarpine Hydrochloride- Pilocarpine nitrate

6. Ocular irrigants- NSS- Dacriose

Commonly used otic agents:1. Antibacterial drugs

- treatment of bacterial otitis externa and/ or otitis media caused by susceptible bacteria such as Staphylococcus aureus, E.coli, Klebsiella spp.

- Examples:- Cortisporin Otic- Ciprodex- Cipro HC Otic- Floxin Otic

2. Anti fungal drugs- Cortic- Acetasol HC

3. Earwax emulsifier- these drugs help soften and help eliminate earwax- example: Carbamide Peroxide

Commonly used mouthwash1. Peridex (Chlorhexidine gluconate)2. Oral- B Amusan 3. Listerine4. Bactidol