Clinic: Medication Regimes (dosage, frequency)

Question 1

Seasonal conjunctivitis (2)

Answer 1

Topical AH/MCS: Patanol 0.1% BiD or Zatiden 1% BiD
if that doesn’t work:
FML iBD-iQiD for 2 weeks (iBD 1st week, iQD 2nd)

Question 2

GPC (2)

Answer 2

Topical AH/MCS: Patanol BiD or Zatiden BiD for several months
if that doesn’t work:
FML iBD-iQD in short term for more severe cases

Question 3

VKC (2)

Answer 3

Topical AH/MCS: Patanol BiD or Zatiden BiD

FML/Flarex iBD-iQiD

Question 4

AKC (2)

Answer 4

Topical AH/MCS: Patanol BiD or Zatiden BiD

Flarex/Maxidex iTDS-Q2h with aggressive taper (3x day to every 3 hours)

Question 5

Bacterial conjunctivitis (non-GC) (3)

Answer 5

Update: this should be chlorsig 0.5% gtt or 1% ung QID for 5 days then rev on 5th day.

Generally self limiting/monitor.

Faster with antibiotics (Chlorsig 0.5% NOCTE 7-10 days, or aminoglycoside - e.g. neomycin)

Follow up 3-5 days, then 7-10 days

Question 6

GC conjunctivitis (3)

Answer 6

REFER: Often systemic so IM Cephalosporin and/or oral fluoroquinolone

Adjunct tx z topical fortified aminoglycoside or fluoroquinolone (e.g. ofloxacin)

Oral azithromycin for co-existing chlamydia if present

Question 7

EKC (viral, no resp, haemorrhagic, fine spk, epi opacities @ 7 days, SEI) (2)

Answer 7

If infectious: supportive (vasoconstrictors, cold compress, povidine-iodine, possibly steroids if severe enough)

If non-infectious: Flarex 0.1% Bd to QiD z slow taper

Question 8

PCF (viral, URTI, may have keratitis) (4)

Answer 8

Optom hygiene + educate px
GP referral to stay home
Supportive (povidone-iodine, cold compress, lubricants, nurofen)
Steroid if sever infl [Flarex 0.1% BD to QiD z slow taper]

Question 9

AIC (chlamydia D-K. Follicles, superior pannus, chemosis) (4)

Answer 9

Px + partner sex clinic lab tests
Identify co-existing infections
Topical tetracyclin (won’t tx full extent)
Oral azithromycin 1gm PO or Erythromycin 250mg QiD 2-6 weeks

Question 10

Trachoma (chlamydia A-C)

Answer 10

ID source of exposure
Lab tests
Sx for trichiasis
Topical lubricants + dry eye mx for scarring
Hygiene
Tx active infection: oral macrolide (azithromycin 1gm PO), tetracycline (doxycycline)

Question 11

Anterior Blepharitis (4)

Answer 11

Lid therapy + warm compress + lid masage
Tear supplements for ocular surface problems
Follow up 2-4 weeks
If no improvement, consider: 
Mild topical steroids
Tetracyclin ointment

Question 12

Posterior Blepharitis (5)

Answer 12

Oral tetracyclines (Oral Doxy 250mg)
Lid therapy + warm compress + lid massage
Tear supps
Antibiotic ointments (for coexisting anterior)
Mild topical steroids

Question 13

Ocular Rosacea

Answer 13

Topical antibiotic: metronidazole gel for skin rash
Oral tetracyclines (doxy) or macrolides - mainstay
Lid therapy for bleph
Tear supps
Mild topical steroids (tx of conj infl + keratitis)

Question 14

OAG 1st choice

Answer 14

Xalatan 0.005% NOCTE

Question 15

OAG when 1st PGA doesn’t work

Answer 15

Swap to another PGA: Travatan 0.004% NOCTE (binds better to PGF2alpha)

Or add adjunct if small change needed (e.g. CAI drop)

Question 16

Possible Glaucoma medications

Answer 16

PGA: Xalatan 0.005% NOCTE or Travant 0.004% NOCTE
BB: Timolol 0.5% qD (once daily) or BiD, Betaxolol 0.5% BiD instead if asthmatic as its the safer bb for asthmatics out of the two
CAI drops: Trusopt 2% BiD, Brinzolamide 1% BiD (adjunct)
AAs: Alphagan 0.2% TiD (max) or BiD (adjunct)
Apraclonidine (for IOP spikes) 0.5% TiD
Muscarinics: Pilocarpine gtt 2% qiD (good for low dose PDS/PDG, where miosis + reduced iris movement is desired)

Question 17

Possible glaucoma medications (oral)

Answer 17

Oral diamox 2 x 250mg + 500mg KCl: initial dose for AACG patient

Question 18

AACG first aid:

Answer 18

1 drop each of BB + AA + CAI + pilo (pilo 2% to reverse dilation from tropicamide)
Oral diamox 2 x 250mg + 500mg KCl if kidneys ok
1 Steroid drop if inflammation

Question 19

Diamox contraindications (3)

Answer 19

Kidney diseease
Allergy to it
COPD (get GP advice)

Question 20

CAI drop benefits (4)

Answer 20

Reduces diurnal fluctuations
Good vascular + nocturnal profile
Fast effect (1 hr)
Good adjunct to PGAs (b/c PGAs secondarily promote CA)

Question 21

CAI drop contraindications (1)

Answer 21

Corneal graft (b/c cornea needs CA to pump)

Question 22

Are beta blockers effective at night?

Answer 22

No

Question 23

Beta blocker contraindications (6)

Answer 23

LTG
Bradycardia (<50bpm)
Asthma/COPD (use betaxalol with caution)
MG (can worsen)
Diabetes
Depression (B blockers reduce melatonin = sleep + mood disorders)

NB: Caution with – asthma, concurrent calcium channel blocking drugs (heart meds)

Question 24

Alpha agonist contraindications (4)

Answer 24

Tricyclic anti-depressants
MAO inhibitors
Severe cardiovascular disease
Don’t use while driving/machinery

Question 25

CMO (3)

Answer 25

NSAIDS (500mg ibuprofen PO) can be good for some (give as 4 week trial)
IV steroid (aVEGF)
Scatter/Grid photocoagulation around macula

Question 26

Anterior Uveitis (4)

Answer 26

Pred Forte 1% q1h
Tropicamide 1% TiD (to break synechiae)
Can add cyclosporin if severe
IOP medication considered if raised

Question 27

Episcleritis (3)

Answer 27

Often self limiting:
Hot compress q3-4h for several days + lubricants and vasoconstrictors for symptomatic relief
If necessary:
Mild topical steroid (pulsed) (e.g. FML qid, Flarex qid)
Oral NSAID (ibuprofen)
More severe cases:
Try Prednisolone 1% qid for short duration

Question 28

Scleritis

Answer 28

REFER

+ Similar mx plan to more severe episcleritis as well

Question 29

Conjunctival abrasion (3)

Answer 29

Generally self limiting (2 weeks)
Lubricants
Could try antibiotic ointment (e.g. erythromyin) perhaps if huge (but generally we just leave it

Question 30

Corneal abrasion

Answer 30

Debride edges
Topical antibiotic: Broad spectrum Chlrosig QiD (consider loading dose to get to therapeutic level faster)
For CL wearers/related: Broad spectrum Ciprofloxacin, Ofloxacin or Tobramcyin
Use antibiotic for 2 weeks, continue 3 days after healed

Symptomatic: Oral analgesic (panadol), ocular lubricant q1-2h, mydriatic if severe AC reaction and discomfort (atropine 1% in office tx)
Soft bandage CL if loose tissue

Question 31

Should you patch abrasians? Why/why not?

Answer 31

NEVER patch abrasions because it slows epithelial healing and increases pain

Question 32

RCEs (3)

Answer 32

Preservative free lubricant ointment (esp @ night, but also frequently in day) (@ night for many months to stop recurrence)
Bandage CL (+ prophylactic chlorsig) (3 months)
Oral pain relief e.g. ibuprofen (can help during acute episodes) + also ice packs to tx pain too.

Question 33

Chemical injury

Answer 33

Immediate 30 minute irrigation
Topical anaesthesia (also during irrigation): 2-3 drops through and ON lids (b/c lids can be hard to open) +_ makes consult easier
Prophylactic topical broad antibiotic (chlorsig 0.5 qid or tetracycline qiD)
Cycloplegia (1% cyclopentolate) for pain and AC reaction (homatropine qID)
Analgesia + artificial tears
Topical steroid for more severe damage if AC reaction present (Flarex q2h)
Manage IOP (timolol 0.5% biD)

If grade 3-4, need to REFER.

Question 34

Bacterial keratitis

Answer 34

Empirical monotherapy with fluoroquinolones e.g. ofloxacin or ciprofloxacin. – ciprofloxacin 0.3%

1-2-3 guideline:
1 = if 1+ or less AC response
2 = if infiltrate <2mm in diameter
3 = if ulcer >/= 3mm from visual axis

Question 35

Ciprofloxacin dosage scheme for keratitis

Answer 35

The recommended dosage regimen for the treatment of corneal ulcers is: Two drops into the affected
eye every 15 minutes for the first six hours and then two drops into the affected eye every 30 minutes
for the remainder of the first day.
On the second day, instill two drops in the affected eye hourly.
On the third through to the fourteenth day, place two drops in the affected eye every four hours.
Treatment may be continued after 14 days if corneal re-epithelialization has not occurred.

https://www.medsafe.govt.nz/profs/Datasheet/c/ciprofloxacintevadrops.pdf

Question 36

Epithelial HSV keratitis

Answer 36

Topical acyclovir ung 3% 5xdaily for 1-2 weeks

Question 37

List 4 different options for prostaglandin analogues, including their dosage percentages

Answer 37

Latanaprost [Xalatan 0.005% NOCTE]
Travaprost [Travatan 0.004% NOCTE]
Bimatoprost [Lumigan 0.03% NOCTE]
Tafluprost [Zioptan 0.0015% NOCTE]

Question 38

List 2 topical CAI options for reducing IOP

Answer 38

Dorzolamide [Trusopt 2% TiD]

Brinzolamide [Azopt 1% BiD]

Question 39

List 2 options for beta-blockers to reduce IOP

Answer 39

Timolol 0.5% QD (once daily) or BiD (BiD proven more effective)
Betaxolol 0.5% sol BiD [safest b-blocker for asthmatics[

Question 40

List 2 alpha agonist options for treating glaucoma

Answer 40

Alphagan [Brimonidine 0.2% Tid (max) or BiD (adjunct)]

Apraclonidine [Iopidine 0.5% Tid (max) or BiD (adjunct)]