Lec 2 Red Eye

Question 1

Order of stepwise treatment for allergic (seasonal/Perennial) conjunctivitis

Answer 1

Stepwise approach

1) avoid allergen
2) lavage
3) cold compress
4) topical antihistamine
5) topical mast cell stabiliser
6) combination antihistamine/MCS
7) NSAIDS
8) non penetrating topical steroid
9) refer

Question 2

What topical antihistamine would you give for allergic (seasonal/perennial) conjunctivitis

Answer 2

Levocabastine 0.05% (Livostin)

Bid-qid up to 2 months

Question 3

What topical mast cell stabiliser would you give for allergic (seasonal/perennial) conjunctivitis

Answer 3

Lodoxamide 0.1% (Lomide)
Qid start prior to symptom if seasonal
- combined with antihistamine

Question 4

What combination antihistamine/mast cell stabiliser would you give for allergic (seasonal/perennial) conjunctivitis

Answer 4

1) olopatadine 0.1% (Patanol)
1-2 drops bid

Or

2) ketotifen 0.025% (Zaditen)
1 drop bid

Question 5

What NSAIDS (short term) would you give for allergic (seasonal/perennial) conjunctivitis

Answer 5

Ketorolac 0.5% (Acular)

1 drop qid for 2-4wks

Question 6

What non penetrating topical steroid (short term) would you give for allergic (seasonal/perennial) conjunctivitis

Answer 6

Fluorometholone 0.1% (Flucon)

1-2 drops bid-qid

Question 7

When would you refer an allergic conjunctivitis to an ophthalmologist

Answer 7

Non responsive cases

Atopic/Vernal KC

If need more potent steroids (pred forte)

If need other immunosuppressents (cyclosporin)

Question 8

How to treat contact lens related giant papillary conjunctivitis

Answer 8

Same as moderate to severe allergic conjunctivitis

Question 9

Treatment for bacterial conjunctivitis

Answer 9

Leave- Usually self limit 1-2wks

Artificial tears (dec bacterial load)

Broad spectrum topical antibiotics

Refer for systemic antibiotics - consider Gonococcal or Chlamydial BC

Question 10

What broad spectrum antibiotics to give for bacterial conjunctivitis

Answer 10

Fusidic Acid (Fucithalmic 1%) bid as gel

Chloramphenicol qid
(Chloroplast 0.5% drops or Chlorsig 1% ointment) 

Ciprofloxacin (Ciloxin 0.3%) q2h-qid

Question 11

How to treat Adenoviral Conjunctivitis

Answer 11

1) Self limiting so support
2) Avoid contact (contagious)
3) AT & Cold compress qid+
4) Antihistamine for itch - levocabastine 0.05% (Livostin) qid
5) Corticosteroid - FML 0.1% qid then taper
6) Povidine (Iodine) 0.8-2% Clinic Tx

Question 12

How to treat Chlamydial conjunctivitis

Answer 12

Chlamydia is an STD so comanage with GP

Azithromycin 1g po once weekly
Or?
Doxycycline 100mg po bid 2-6wks 
Or
Erythromycin 250mg qid in children

Question 13

How to treat Toxic/Allergic keratoconjunctivitis (CL related)

Answer 13

1) remove source (lavage)
2) lubricants
3) prophylactic ABs till healed (1-2 days)
- chloramphenicol 0.5% drops qid
OR
- Tobramycin if gram-ve suspected

Question 14

How to treat Punctate Epithelial Erosion AKA SPK (CL related)

Answer 14

Treatment depends on aetiology

• mechanical
• exposure
• hypoxic
• toxic/allergic
• infectious

Question 15

How to treat Marginal (Non-infective) Keratitis

Answer 15

Treat blepharitis (lid hygiene, AB ointment)

Broad spectrum ABs

• chloramphenicol 0.5% drops qid & chloramphenicol 1% ointment nocte
• Fusidic acid 1% fucithalmic drops(gel) bid

Question 16

How to treat CL related marginal keratitis

Answer 16

1) stop CL wear

2) broad spectrum ABs gram-ve
- mild-moderate tobramycin 0.3% (tobrex) q1h initially, review next day
- severe ciprofloxacin 0.3% (Ciloxan) q15min then q1h, review next day
- cont min 1wk till epithelium heals (min qid)

3) consider FML 0.1% qid once epithelium heals