Cornea Flashcards
Dry Eye Syndrome
Dryness | Tearing | Discomfort | Transient blur | Photophobia
SIGNS
Injection | Tearing | Discharge | Cornea/conjunctiva stain with NaFl/LG | Low tear meniscus
WORK-UP Thorough history. Slit lamp examination
TREATMENT
Treatment depends on the severity of the condition (non-exhaustive list)
Mild DES: Preservative-free artificial tears 1 gtt bid-qid | Hot compresses (i.e. Bruder mask)
Moderate DES: Mild DES tx PLUS: High quality omega-3 supplementation (i.e. PRN, Nordic Naturals) | Lubricating gel/ointment qhs | Xiidra 1 gtt bid | Restasis 1 gtt bid | Pulse topical steroid (Lotemax 1 gtt qid) | Punctal plugs
Severe DES: Moderate DES tx PLUS: Moisture chamber goggles qhs | Scleral lenses | Autologous serum drops | Regener-Eyes drops | Intense pulsed light therapy | Punctal cautery | Meibomian gland probing
FOLLOW-UP Follow-up depends on the severity of the condition.
Mild DES may be monitored annually.
Severe DES requires more frequent follow-up.
Herpes Simplex Keratitis
Pain | Photophobia | Tearing | Blurry vision
SIGNS
Injection | Tearing | Vesicles/dendrites | Possible geographic ulcer
WORK-UP
Thorough history. Slit lamp examination
TREATMENT
Topical antivirals: Zirgan 1 gtt 5x/day | Trifluridine 1% 9x/day
Oral antivirals:
Acyclovir 400 mg 5x/day x 7-10 days |
Valacyclovir 500 mg tid x 7-10 days |
Famciclovir 250 mg tid x 7-10 days
FOLLOW-UP Every few days
Herpes Zoster Ophthalmicus (HZO)
Photophobia | Blurry vision | Pain | Malaise
SIGNS Stromal edema | Neovascularization | Stromal infiltrates | Pseudodendrite | Possible high IOP | Vesicular skin rash respecting the midline | Possible Hutchinson sign
WORK-UP Thorough history. Slit lamp examination
TREATMENT
Oral antivirals:
Acyclovir 800 mg 5x/day x 7-10 days |
Valacyclovir 1000 mg tid x 7-10 days |
Famciclovir 500 mg tid x 7-10 days
Topical steroids (will require a long taper schedule):
Pred Forte 1% 1 gtt q2h-q6h |
Lotemax 1 gtt q2h-q6h
Topical cycloplegics may be used (cyclopentolate 1% 1 gtt tid)
** Use oral, not topical, antivirals in the treatment of zoster **
FOLLOW-UP Every 1-4 days
