Management cards (Slide exam) Flashcards
Name, mx (3)
Conjunctival papilloma
Patient reassurance, optional surgery for cosmesis, general ddx (check FAT, feeder blood vessels, surround tissue invasion, biopsy)
.Name, mx (2)
CIN (conjunctival intraepithelial neoplasia):
Mx: surgery for removal, general ddx
Name, mx (1)
SCN:
Mx: surgery for removal, ddx
How should you manage any unusual/unepected growth on the eye (e.g. the ones in the image) or adnexa? (4)
- Check for fast development/spread (e.g. with FAT)
- Check amount of feeder blood vessels
- Check for surrounding tissue invasion
- Refer for biopsy as needed
.Name, mx (1)
Naevus: Benign ocular pigmented lesion
Mx: refer for biopsy if suspicious
Name, mx (1)
Congenital melanocytosis
Mx: (if malignant) refer for excision + biopsy
Name, When is a biopsy indicated? (2)
Primary Acquired Melanosis (PAM):
Biopsy indicated if: - diffuse lesion found at limbus + corneal involvement; - expansive/overgrowth of diffuse lesion in one eye (which shows its pleomorphic)
Name, Biopsy appearance (1), mx (1)
Melanoma
biopsy: invasive lesion with pleomorphism and anaplasia
Mx: surgical removal
Name, mx (2)
Telangiectasia:
Mx: surgery for cosmesis, tx any assoc. systemic conditions (e.g. sturge-weber, HHT)
Name, mx (7)
Kaposi’s sarcoma:
Mx: refer for diagnostic workup if AIDS dx unknown, or for therapy (e.g. HAART - highly active anti retroviral therapy) if AIDS present.;
Tx often palliative (i.e. relieve symptoms/pain), surgery, focal radiation, anti-mitotics, AIDS protease inhibitors
Name, mx (4)
Sturge-Weber Syndrome
Mx: consider referral for ax of neurological status; follow up appt. in 3-12 months to check for glaucoma; if choroidal hemangioma present = check for signs of retinal detachment. If choroidal hemangioma grows into central vision, leaks or causes detachment: tx it by laser or radiation
.Name, define, mx (1)
Cavernous sinus fistula:
.- Break in the cavernous sinus- i.e. “fistula” = break in wall of an artery –> causing higher arterial blood to enter venous space—-
Mx: refer for closure of fistula + mx of IOP
.Name, mx (4)
Cyst of Moll/sweat glands
Excision for cosmesis
• Pouching of small hydrocystoma
• Refer for excision
• Lidnocaine as skin anaesthetic before pouching
Name, mx (3)
Cyst of Zeis Gland - Opaque lesion
Mx: pouching incision, curettage, refer for excision
(note: curretage = Removal of tissue with a curette from the wall of a cavity or another surface)
Name, mx (4)
Stye/Hordeolum
Mx: Warm compress, Most resolve 2-3 days, Topical broad spectrum antibiotic (chlorsig) if persistent, Can lead to cellulitis (indicated by fever and V.A) –> that requires antibiotics tx
Name, mx (5)
Chalazion
Mx: spontaneous resolution in few months (when fluid resorbed), Tx = heat compress (qid), lid massage (to help glands open + soften oil), incision w/curettage + steroid injection (long lasting), doxycline if recurrent (40-100mg bid) or tetracycline (500mg bid)
Name, mx (3)
Sebaceous gland carcinoma: malignant tumour of sebaceous gland
Mx: careful examination, review with referral of suspicious cases, 6-12 monthly reviews
Name, mx (1)
Viral Warts (Verruca)
Mx: refer for excision + cautery
Name, Ax (2), Mx (3)
Molluscum contagiosum
Ax: check eyebrows and evert; ensure no lymphadenopathy, check lymph nodes
Mx: counsel about hygeine, spread skin-skin contact; self-limiting, non-scarring; refer for excision + cauterisation
name, ax (1), mx (3)
Keratoacanthoma
Ax: biopsy of keratin core
Mx: refer for excision + biopsy; exclude SCC; spontaneous involuted by one year
Name, mx (4)
Xanthelasma
refer to GP to manage systemic overlay
check /control lipid levels (TGs, cholesterol),
systemic work up (fasting blood lipids)
Consider excision for cosmesis(recurrent) + refer for biopsy (to make sure it’s benign)
Name, Ax (1), Mx (1)
Seborrheic Keratosis (SK):
Ax: referral for excision and biopsy (if suspicious)
Mx: progressive, suspicious or cosmesis excise excluding BCC, SCN
Solar or Actinic Keratosis. How do you manage it? (3)
malignant potential
photos to monitor
refer for biopsy & excision (exclude BCC, SCC)
Epithelial Basement Membrane Dystrophy (EBMD): Mx (4)
Lubricants; Mx of any co-existing surface disease if there are any symptoms; mx of any pre-existing erosion;
any co-existing surface disease will increase the risk of recurrent corneal erosions.
Meesman’s dystrophy: Mx (3)
Mx is conservative; Surface lubrication to minimise discomfort; Bandage CLs
How can you manage Reis-Buckler’s Dystrophy? (3)
Treat RCEs (recurrent corneal erosions) as required; Must monitor px for decreased vision; Difficult to mx because of reoccurence; surgical intervention often required for patients over 50
How can you manage Thiel-Behnke corneal dystrophy? (3)
Same as Reis-Bucklers. So: Treat RCEs (recurrent corneal erosions) as required; Must monitor px for decreased vision; Difficult to mx because of reoccurence; surgical intervention usually for over 50yo
How do you manage Lattice Dystrophy? (4)
Mx of any surface discomfort; Mx of RCEs; May refer to GP to determine if amyloidosis is systemic; surgical intervention (refer for PTK if vision significantly reduced)
How can you manage Granular Dystrophy (4.5)
Early tx involves treating symptoms (use lubricants); Try to reduce occurrence of RCEs (reccurent corneal erosions); Soft bandage CLs; surgical (superficial keratectomy or PTK, lamellar keratoplasty, penetrating keratoplasty)
Name, mx (1)
Avenillino Dystrophy:
tx same as for other stromal dystrophies
Name, mx (3)
Macular Dystrophy
Mx: Vision usually significantly affected by 30s; referral for PK; Recurrence in graft is uncommon
Name, mx (2)
Schnyder’s Crystalline Dystrophy:
Mx: Refer for workup of blood lipids as systemic disease may be life threatening; Refer for PTK to remove superficial crystals in px with severe glare
How can you manage Fuchs Endothelial Dystrophy? (4)
6mth review recommended (work up patchy, specular microscopy, IOP); Hypertonic saline, warm hairdryer upon waking to reduce corneal oedema; Ocular lubricants/bandage CL (for bullae); Eventual referral for PK
Name, mx (3)
Posterior polymorphous corneal dystrophy
Mx: Most don’t require tx for corneal changes; check IOP at each visit (b/c increased incidence of glaucoma with epithelial overgrowth); if tx required = as per Fuch’s
Name, mx (6)
Filamentary Keratopathy
Mx: Tx underlying conditions to prevent reoccurence; Remove filaments under topical anaesthesia w/sterile forceps; Removal will cause epithelial defect (warn px it’ll feel worse before it gets better); Prescribe prophylactic antibiotics and ocular lubricants (for comfort); Topical steroids if filaments persistent (except for HSV); Bandage CL
Name, mx (5)
Superficial punctate keratopathy (SPK)
Mx: Tx underlying cause; Will typically repair within 24 hours; Ocular lubricant to promote repair (non-preserved); If severe - may require prophylactic topical antibiotics cover or steroids if underlying condition is inflammatory; Discontinue any CL wear
What’s this? How can you manage it? (3)
Subepithelial Infiltrates
Mx: If symptomatic - ocular lubricants; topical corticosteroids w/slow taper; antibiotics if significant epithelial breakdown
Name, mx (6)
Neurotrophic keratopathy
Mx: Non-preserved ocular lubricants; Withdrawal of topical medicatiosn; Risk of microbial keratitis due to incomplete epithelium (consider prophylactic tx with chlorsig); Non-preserved topical corticosteroids (?); Bandage CL (?); Refer for surgery - tarsorrhaphy
Name, mx (4)
Bullous Keratopathy:
Mx: Non-preserved ocular lubricants; Hypertonic saline (5%) to aid epithelium; Bandage CL for symptoms; Refer for surgery - graft for PTK
Name, Mx (3)
Interstitial Keratitis
Mx: Refer for tx of any assoc. systemic disease; Cogan’s = life threatening (urgent referral); Tx corneal inflammation with potent, frequent topical corticosteroids
Name, Mx (6)
Marginal Keratitis
Mx: Tx of underlying lid disease/blepharitis; Topical steroid for inflammation; Prophylactic topical antibiotic for epithelial defect and to reduce bacterial load; Monitor closely for improvement; If no improvement - consider oral doxycycline; Stop CL wear
Name, mx (3)
Phlyctenulosis
Mx: If concerned for TB - refer for chest X-ray, mantoux and sputum culture; Manage staph lid disease; Monitor closely for improvement
Name, Mx (4)
Mooren’s ulcer
Mx: Refer to establish diagnosis (to exclude ddx); Systemic steroids + other immunosuppressants; Topical steroids, prophylactic antibiotics can also be used; Conjunctival resection surgery
How can you manage Thygeson’s Superficial Punctate Keratitis? (4)
Ocular lubricants for discomfort; Mainstay = moderate strength topical steroid during exacerbation (followed by careful taper); Bandage CL use occassionally to reduce symptoms; Monitor Px IOP regularly if using steroids
Name, How would you manage the condition related this?
Vogt’s Striae (it’s me!)
It’s from keratoconus, do topo regularly check progression, RGPs, etc. You name it, it’s my condition so I know this
How can you manage Pellucid Marginal Degeneration? (4)
Similar to KC but specs are better; CL fiting more complex (need larger RGP or mini-scleral); CXL(?); Low success rate for corneal grafts
What’s this and how can you manage it? (4)
Keratoglobus: .- Globular protrusion of entire cornea—–
Mx: Difficult to mx; Specs improve vision + provide protection; Penetrating Keratoplasty (PK) = poor results; RGP = difficult to fit
What’s this? How can you manage? (7)
Band keratopathy
Mx: Identify underlying cause (Hx, ocular examination, referral); If mild - artificial tears or bandage CLs for comfort or vision; If poor comfort/VA affected: chelating agent (manual Ca removal), superficial keratectomy, PTK (laser removal of epi); Px counselling that reccurence likely if underlying cause remains
Name, Mx (3)
Salzmann’s Nodular Degeneration
Mx: Usually tear supplements for comfort; Occasionally manual removal or PTK; At worst - lamellar graft or penetrating graft
Name, Mx (4)
Terriens Marginal Degeneration
Mx: Corneal topo; Pachymetry; Astig correction; Occasionally keratoplasty (if visual status poor enough)
Name, Mx (4)
Spheroidal degeneration
Mx: Advice on UV protection; Initially ocular lubricants to enhance comfort; Referral for epithelial debridement, superficial keratectomy; Occasionally PK (penetrating keratoplasty)
Name, Mx (1)
Polymorphic Amyloid Degeneration
No treatment required
How can you manage a corneal arcus? (1)
No tx required, unless referral warranted to check blood lipids
Name, how can you manage? (1)
Lipid Keratopathy
Mx: Topical corticosteroids - reduce inflammatory response + regress vessel –> reduce lipid deposition over time
What’s this? How can you manage it? (1)
Vogt’s Limbal Girdle
Mx: No tx required, it’s totally benign
What’s this? How can you manage it? (2)
Vortex Keratopathy
Mx: Tx any associated systemic conditions (often linked to systemic conditions e.g. Fabry’s) or drug induced; Refer any younger px for 2nd opinion on systemic conditions
Can ocular siderosis affect mx of a FB? How?
Location affects mx of a FB
How can you manage Kayser-Fleischer rings? (3)
Referral for diagnosis + mx of systemic disease; Copper chelating agents; Corneal ring will disappear with systemic therapy for copper levels
Name, How can you manage? (1)
Crocodile Shagreen
No mx required
What’s this called? How can you manage? (1)
Corneal Farinata
No mx required
What is this? How can you manage it? (1)
Corneal Guttata.
Mx: Check for Fuch’s endothelial dystrophy and manage that (central guttata is associated with Fuch’s)
What is this condition? How can you manage it? (5)
Pingueculum
Mx:
Vasoconstrictors to reduce redness (?);
Ocular lubricants, cold compress if FB sensation;
NSAIDs (topical or oral) or topical steroids for severe inflammation;
Refer for cosmetic surgery if required (or if dellen persists);
Follow up at normal review or px requirest
What is this condition called? How can you manage it? (5)
Pterygium
Mx: Do NOT use vasoconstrictors (chronic use can result in rebound –> vasodilation);
Ocular lubricants for ocular irritation + corneal signs; Topical steroids or NSAIDs for severe irritation;
Follow up dependent on rate of progression (stable = 1-2 yr, progressive/new px = 3-6M);
Advise UV protection; Refer for surgery if advancing rapidly
What’s this? How can you manage? (7)
Concretions: are deposits on palpebral conj.
Mx: Monitor if asymptomatic;
Tx if symptomatic;
Review CL care + environmental factors;
Ocular lubricants;
Remove using topical anaesthesia (may result in bleeding);
Prophylactic antibiotic after removal; Follow up (if not removed = at px request, if removed = 3-5 days after)
What is this called? How can you manage it? (4)
Amyloidosis
Mx: Check if amyloid present elsewhere in eye (lids, AC, ON, cornea, iris, lacrimal glands);
Removal if FB sensation or cosmesis;
Biopsy for ddx and to rule out systemic amyloidosis;
Early review if uncertain diagnosis, or observed change in size or symptoms
Name, mx (5), When follow up (1)
Conjunctival cyst/lymphangiectasia
Mx: Monitor if aysmptomatic;
Lance cyst with needle + anaesthesia + massage closed lid to drian;
Will usually re-occur;
Prophylactic antibiotics (?);
Refer for surgical removal from base if required;
Follow up to monitor if lanced and antibiotic prescribed or at px request
What is this? How can you manage? (4) When follow up? (2)
Ecchymosis
Mx: If traumatic, mx as appropriate; Reassure px; Cold packs to stop bleeding in first 1-2 days followed by hot packs to assist with haemolysis; May take 1-3 days to resolve; Do NOT use vasoconstrictors (b/c you need WBCs to come in to mop it up)
Follow up: review at 1 week if concerned or no resolution; if more than 2 recurrences in 1 year then refer to determine if systemic cause or cauterisation
What’s this? How can you manage? (5)
Bitot’s spot
Mx: Refer for blood test to confirm VitA deficiency; Will normally disappear with high dose VitA therapy; May regress within weeks; If long standing - may have permanent epithelial metaplasia and will remain; Mx dry eye symptoms as appropriate
What’s this condition called? How can you manage it? (8)
Superior limbic keratoconjunctivits
Mx:
Refer to evaluate thyroid function;
Evaluate CLs; Tx to reduce inflammation;
Topical steroid (Flarex/Predforte iTDS to iQiD and taper); Ocular lubricant (punctal plug?);
Topical vasoconstrictors (?);
Soft bandage CL;
Surgery to cauterise bulbar conj or fuse conj and episclera
What’s this? How can we manage it? (6)
Floppy Eyelid Syndrome
Mx: Refer to investigate sleep apnoea; mx apnoea; weight loss program; ocular lubricant ointment before sleep; taping lid shut during sleep; surgical horizontal tightening of upper lid
What’s this? How to manage? (1)
Conjunctival Papillae
Mx underlying cause
What’s this? How to manage? (1)
Conjunctival Follicles
Mx underlying cause
What’s this? How to manage? (1) Why must you do this? (1) Will the conj epithelium remain intact upon doing so?
Pseudomembrane
Must remove (peel off with forceps or cotton bud) or else you’ll get scarring, blepharon, or entropion.
Conj epithelium will remain intact when you peel off the pseudomembrane
What’s this? How can you manage? How does this differ from the management of pseudomembranes? List 4 potential causes of this condition
True membrane
Remove/peel off just like pseudomembrane. Note: more bleeding will occur because of how it’s attached and it can rip off the corneal epithelium but it’s still perfectly safe to do.
Causes: e.g. strep, gonococcal, autoimmune, diptheria (corynebacterium)
What’s this? How can you manage? (4)
Bacterial conjunctivitis
Mx: Self limiting –> monitor until resolution (resolves quicker with antibiotic); If little/no corneal involvement –> may be treated with NaCl solution bathing; Broad spectrum antibiotic drops w/without ointment at night for 7-10 days (chloramphenicol or aminoglycoside); Follow up (3-5 days then 7-10 days, if no resolution then review diagnosis)
What’s this? How can you manage? (2)
Bacterial Conjunctivitis (gonococcal)
Mx: Refer - often systemic –> IM or IV antibiotics (cephalosporin and/or oral FQ); Consider co-existing chlamydia
What’s this? How can you manage it? (8)
Pharynogoconjunctival fever (PCF)
Mx: Gloves during exam/clean equipment; Educate px; GP referral for time off (contagious ~1wk); Povidone-iodine therapy (?); No antiviral agent proven effective; Supportive therapy (cold compress, artificial tears, fever relief,), Steroid if severe inflammation (Flarex BD to QiD with slow taper); Resolution within 7-14 days (check for corneal involvement in this time)
What’s all this? How can you manage? (7)
Trachoma
Mx: Try and find source of exposure to help confirm diagnosis; Refer for lab test for diagnosis; Treat active infection with oral macrolides (e.g. azithromycin), tetracyclines (e.g. doxycycline); Refer for surgery; Corneal grafts rarely succesful; Inactive scarring requires topical lubrication; Improve hygeine + education for prevention
Name, how can manage? (5.5)
Adult inclusion conjunctivitis (AIC)
Mx: Refer Px + sexual partner for lab tests to confirm diagnosis; Tx systemic macrolide or tetracycline; Identify + tx co-existing infections; Mx ocular signs + symptoms with topical tetracycline; Oral medication critical (either azithromycin 1gm PO or Erythryomycin 250mg QiD 2-6 wks)
Name, How can you manage this? (2)
Anterior blepharitis
Mx: Lid therapy = mainstay tx (scrub lid margins up to 4x a day, hot compress + lid massage for coexisting posterior bleph, follow up to see success); Tear supplements (for ocular surface problems)
What’s this? How can you manage this? (5)
Posterior blepharitis
Mx: Oral tetracyclines = mainstay of tx; Lid therapy for anterior bleph but hot compresses and lid massage essential to improve gland function; Tear supplements; Antibiotic ointment (for anterior); Mild topical steroids to reduce inflammation along lid margin
What is this called? How can you manage this? (6)
Ocular rosacea
Mx: Topical antibiotic (microbial assoc.); Metronidazole gel for skin rash; Oral tetracyclines (doxcycline) or macrolides = mainstay; Lid therapy (for bleph); Tear supplements; Mild topical steroids
How can you manage demodex? (4)
Consider removal if px has demodex +1 ocular problem; TTO (tea tree oil) kills demodex but also toxic to cornea/conjucntiva; Weekly application of 50% TTO combined with daily use of TTO shampoo or lid wipes; Ivermectin 3mg one tablet PO
What MUST you do to confirm if someone has an adenovirus infection? (1)
Lymphadenopathy
List 6 treatment options for seasonal conjunctivitis
Allergic avoidance
Topical antihistamine (e.g. patanol or zatiden)
Oral antihistamine
Cold compresses
Topical steroids
Topical NSAIDs
Topical Cyclosporin A
Topical vasoconstrictors (only in acute cases, if used chronically, will cause vasodilate eventually)
Name 2 topical antihistamines/MCSs used in treatment of seasonal conjunctivitis, GPC, VKC and AKC. What dosage are they used in? (1)
Patanol BD, Zatiden BD (BD/BID/iBD = 2 x a day)
(Note: Patanol = S4, Zatiden = S3)
Name and give the dose for a topical NSAID that is used in treatment of seasonal conjunctivitis, AKC, VKC, GPC. How commonly are NSAIDs used in GPC?
Diclofenac (Voltaren iTDS-iQ3h. i.e. 3 x a day to every 3 hours)
NSAIDs are NOT commonly used in GPC.
When giving steroids, what steroid and dosage would you generally give for the following conditions?
A: Seasonal conjunctivitis
B: Giant Papillary conjunctivitis
C: Vernal keratoconjunctivitis
D: Atopic conjuncitivitis
A: FML iBD-iQID (2x-4x a day) for 2 weeks (iQID for one week, iBD for next)
B: FML iBD-iQID short term in more severe cases of GPC
C: FML/Flarex iBD-iQID
D: Flarex/Maxidex iTDS-Q2h with aggressive taper (3xday to every 2 hours)
List 6 treatment options for Vernal Keratoconjunctivitis
Allergen avoidance
Topical mast cell inhibitors
Corticosteroids
Topical NSAIDs
Topical cyclosporin
Referral for superficial keratectomy to improve resolution of any shield ulcer
List 5 treatment options for Atopic Keratoconjunctivitis
Allergen avoidance
Topical antihistamines/MCS/NSAIDs
Corticosteroids (aggressive, short term)
Topical cyclosporin
Avoid rubbing eyes
List 5 treatment options for Giant Papillary Conjunctivitis
Mast cell stabilisers (e.g. patanol iBD)
Topical steroids (short term)
Advise on CL wear
Fit new CLs
Removal of sutures
What is Cicatricial Pemphigold? What is the main treatment option for Cicatricial Pemphigold?
A rare autoimmune disease characterised in patients by recurrent sub-epithelial blisters on the skin. Causes a conjunctivitis
Main treatment: refer - best managed in a clinic with both ophthalmologist and immunology specialists
What is the treatment option for Steven-Johnson syndrome? (an autoimmune condition causing conjunctivitis) (2)
Elimination of the causative agent
Refer - hospitalisation is often needed
When treating with topical acyclovir (presumably for viral conditions), how frequently do we always administer it?
5 x day for 14 days or 3 days after epithelium has healed, whichever is shorter
List 3 antiviral treatment options for HSV, detailing their treatment dosages and frequency. How do these dosages compare to HZV treatment?
(this table should be memorised, so know this card and the maintenance one)
Acylovir 400mg 5xday
Valacyclovir 500mg TiD for 1 week (i.e. 3xday)
Famcyclovir 250mg TiD for 1 week
**Double the dosages for HZV
List 3 antiviral treatment options for HSV, detailing their MAINTENANCE dosages. How do these maintenance dosages compare when treating HZV?
Acyclovir 400mg BD (2xday)
Valacyclovir 500mg QD (every day)
Famciclovir 250mg QD
**Double the dosages for HZV
