Ocular Disease Treatments Flashcards
1
Q
Corneal Abrasion
A
- Cyclopentolate 1% gtts TID
Non CL-wearer:
- Erythromycin 0.5% ung q2h - q4h
- Polytrim gtts QID
CL-Wearer or Abrasions from fingernails/vegetable matter:
- Ofloxacin 0.3% gtts QID
F/U:
- non-CL central/large abrasion: 1 day
- non-CL peripheral/small abrasion: 2-5 days
- CL: 1 day
2
Q
Corneal Foreign Body
A
- Remove foreign body with jeweler’s forceps or irrigation
- If metal, remove rust ring with Alger brush
- Treat as corneal abrasion
3
Q
Traumatic Iritis
A
- Cyclopentolate 2% TID
- If no epithelial defect can add prednisolone 1% QID
F/U: 5-7 days
4
Q
Traumatic Hyphema
A
- Atropine 1% BID
- Prednisolone 1% QID
- Patient should wear protective eye glasses/shield, should avoid strenuous activities, and keep head elevated at least 30 degrees
If IOP high:
- Add glaucoma drops (avoid prostaglandin analogs/miotics, no alpha-agonists in patients under 2)
F/U: 1-2days
5
Q
Corneal Laceration
A
- Cyclopentolate 2% BID + ofloxacin 0.3% gtts QID
If positive seidel:
- add BCL
F/U: 1 day
6
Q
Ruptured Globe / Penetrating Ocular Injury
A
- Admit patient to the hospital
- Vancomycin 1g iv q12h + moxifloxacin 400 mg iv daily
- Potentially enucleation
F/U 1 day or after release from hospital
7
Q
Commotio Retinae
A
No ocular treatment as self-limiting
F/U: 1-2 weeks
8
Q
Traumatic Choroidal Rupture
A
- Patient recommended to use safety eyewear
- If CNV develops refer to retina specialist for anti-VEGF therapy
F/U: 1-2 weeks
9
Q
Purtscher Retinopathy
A
No ocular treatment
Treat underlying systemic conditions or traumatic injury
F/U: 2-4 weeks
10
Q
Superficial Punctate Keratopathy (SPK)
A
- Minor SPK: PFATs QID
- Severe SPK: PFATs q2h + erythromycin ung QID x3-5 days
F/U:
- Non-CL: no f/u unless symptoms worsen or do not improve in 2-3 days
- CL with severe SPK: 1-2 days
11
Q
Recurrent Corneal Erosion (RCE)
A
- Small defect: Cyclopentolate 1% TID + erythromycin ung QID
- Large defect: + BCL
After epithelial healing, PFATs QID and AT ung QHS x3-6 months
F/U: 1-2 days
12
Q
Dry Eye
A
Mild: PFATs QID
Moderate-Severe: PFATs q2h + lubricating ung QHS (+ punctal plugs if other treatments insufficient)
Inflammatory: Cyclosporine 0.05% BID
Dry eye signs/symptoms: Liftegrast 5% BID
MGD: Consider iLux or LipiFlow
F/U:
- Mild: 2-3 months
- Moderate: 3-4 weeks
- Severe: 5-7 days
- Very severe: 2-3 days
13
Q
Filamentary Keratopathy
A
- Treat underlying condition (dry eye, SLK, RCE, etc)
- can debride filaments with cotton-tipped applicator or forceps with topical anesthetic
- Acetylcysteine 10% QID
F/U: 2-3 weeks
14
Q
Exposure Keratopathy
A
- Treat underlying disorder (thyroid disease, neurotrophy, lid conditions)
- PFATs q2h + lubricating ung QHS
- Consider eyelid taping/patching at night if incomplete lid closure
F/U:
- Mild: 1-2 months
- Moderate: 2-3 weeks
- if severe/corneal ulcer: 1-2 days
15
Q
Neurotrophic Keratopathy
A
- Treat underlying disorder (Diabetes, VZV/HSV, etc)
- Mild-moderate punctate staining: PFATS q2h + AT ung QHS (consider punctal plugs + night patching)
- Small corneal epithelial defect: Erythromycin ung QID + PFATs q2h + AT ung QHS
- Sterile corneal ulcer: Erythromycin ung QID + amniotic membrane + tarsorrhaphy
- Infected corneal ulcer: treat as bacterial keratitis
F/U:
- Mild/Moderate: 1-2 weeks
- Corneal epithelial defect: 1-3 days
- Corneal ulcer: 1 day
16
Q
Bacterial Keratitis
A
- Cyclopentolate 1% TID + topical antibiotic
- Low-risk vision loss: Moxifloxacin 0.5% q2h (if CL wearer + polytrim q2h)
- Borderline-risk vision loss: Moxifloxacin 0.5% q1h around the clock + polytrim q1h around the clock
- Vision threatening: Alternating tobramycin 15mg/mL q1h and cefazolin 50mg/mL q1h (should receive one drop every 30 mins)
F/U: 1 day
17
Q
Fungal Keratitis
A
- Atropine 1% BID + antifungal
- Filamentous: Natacyn 5% q1h around the clock
- Non-filamentous: amphotericin B 0.15% q1h around the clock
F/U: 1 day
18
Q
HSV Epithelial Keratitis
A
- Acyclovir 400mg 5x daily x10 days
- If AC reaction: add cyclopentolate 1% TID
- If neurotrophic ulcer or keratitis doesn’t resolve in 1-2 weeks start erythromycin 0.5% ung QID
F/U: 2-3 days
19
Q
HSV Stromal Keratitis w/o Epithelial Ulceration
A
- Acyclovir 400mg BID x10 days + Prednisolone acetate 1% 6x daily tapered over 10 weeks
F/U: 2-3
20
Q
HSV Stromal Keratitis w/ Epithelial Ulceration
A
- Acyclovir 800mg QID x10 days + Prednisolone acetate 1% BID x10 days
- If needing prednisolone >10 days, continue Acyclovir 400mg BID until topical corticosteroids are discontinued
F/U: 2-3 days
21
Q
VZV/HZO
A
- Acyclovir 800mg 5x/day x10 days + erythromycin 0.5% ung BID
- If ocular involvement: Add PFATs q2h + ung QHS
- If pseudodendrites don’t heal: Start Ganciclovir 0.15% gel QID
F/U:
- mild w/ ocular involvement: 5-7 days
- moderate w/ ocular involvement: 3-4 days
- severe w/ ocular involvement: 1-2 days
- if no ocular involvement: 2-3 weeks
22
Q
Interstitial Keratitis
A
Acute: Atropine 1% BID + Prednisolone acetate 1% q3h + treat underlying disease/refer to specialist
Old/Inactive: Treat irregular astigmatism if central scarring + treat underlying disease/refer to specialist
F/U: 3-4 days
23
Q
Phlyctenulosis
A
- Loteprednol 0.5%/tobramycin 0.3% QID + PFATs QID
- If blepharitis, add lid hygiene or doxycycline 100mg BID if severe
F/U: 2-3 days
24
Q
Giant Papillary Conjunctivitis
A
- Replace/refit CLS + Reduce CL wear time or replacement schedule
- If severe: Suspend CL usage until signs/symptoms clear + start olopatadine 0.1% BID
- If very severe: loteprednol 0.5% QID x 7 days
- F/U: 2-4 weeks
25
Keratoconus
- RGPs or Scleral lenses to correct irregular astigmatism
- Corneal cross-linking to slow/reduce progression
- Acute corneal hydrops: cyclopentolate 1% TID + Brimonidine 0.1% BID + Sodium chloride 5% ung QID + consider loteprednol 0.5% gtts BID for pain
F/U:
- Mild: 8-12 months
- Moderate: 4-6 months
- Severe: 3-4 months
- Acute hydrops: 1-2 weeks
26
Fuchs Endothelial Dystrophy
- Sodium chloride 5% drops QID + ung QHS
- Treat ruptured corneal bullae as RCE
- DMEK or DSEK if VA decreases from corneal edema
F/U:
- Mild: 8-12 months
- Moderate: 4-6 months
- Severe: 3-4 months
27
Bullous Keratopathy (Pseudophakic/Aphakic)
- Sodium chloride 5% QID + ung QHS
- Treat ruptured epithelial bullae as RCE
F/U:
- Mild: 5-6 months
- Moderate: 3-4 months
- Severe: 1-2 months
- if ruptured bullae: 1-3 days
28
Viral Conjunctivitis
- Frequent hand-washing
- PFATs QID x 2 weeks
- Cool compresses BID
- If severe itching: epinastine HCl 0.05% BID
- If membrane or pseudo-membrane: gently peel with cotton-tipped applicator + loteprednol 0.5% QID and taper
- If significant tearing: fluorometholone 0.1% ung QID
- If SEIs alone: loteprednol 0.5% BID
F/U: 2-3 weeks
29
HSV Conjunctivitis
- acyclovir 400mg 5x/day x10 days + warm compresses
F/U: 3-4 days
30
Allergic Conjunctivitis
- Eliminate inciting agent
- Cool compresses BID
- Mild: PFATs QID
- Moderate: olopatadine 0.1% BID
- Severe: fluorometholone 0.1% QID and taper
F/U: 2-3 weeks
31
Vernal/Atopic Conjunctivitis
- Treat as allergic conjunctivitis + prophylactic olopatadine 0.1% BID 2-3 weeks before allergy season starts
- If shield ulcer: loteprednol 0.5% QID and taper + erythromycin 0.5% ung QID + cyclopentolate 1% TID
- If dermatitis of eyelids: tacrolimus 0.1% ung to lids BID
F/U:
- if shield ulcer: 1-3 days
- otherwise: 2-3 weeks
32
Bacterial Conjunctivitis
- Polytrim gtts QID x7 days
F/U: 2-3 days
33
Gonococcal Conjunctivitis
- Ceftriaxone 1g IM single dose + azithromycin
- Use saline irrigation QID until discharge resolves
- If cornea not involved: Ofloxacin 0.3% ung QID
- If corneal is involved: moxfloxacin 0.5% gtts q1h instead of ung
- If concern of chlamydial coinfection: add azithromycin 1g po single dose
F/U: 1 day
34
Chlamydial Inclusion Conjunctivitis
- Azithromycin 1g po single dose for patient and their sexual partners
- Erythromycin 0.5% ung BID x 2-3 weeks
F/U: 2-3 weeks
35
Superior Limbic Keratoconjunctivitis
- PFATS QID + AT ung QHS
- Consider punctal plugs
- Consider lifitegrast 5% BID if not responding to lubrication
F/U: 2-4 weeks
36
Subconjunctival Hemorrhage
- No treatment needed
- If irritation: PFATs QID
F/U: None unless does not resolve after 4 weeks or recurs
37
Episcleritis
- Mild: PFATS QID
- Moderate/Severe: Ibuprofen 800mg po TID x 10-14 days
- Treat underlying DES or blepharitis if present
- Refer to specialist for underlying systemic conditions if present
38
Scleritis
Diffuse/Nodular:
- Ibuprofen 800mg po TID
Necrotizing:
- Prednisone 60mg po daily x1 week then taper
Posterior:
- Ibuprofen 800mg po TID
- Refer to retina specialist to evaluate/treat possible resulting conditions such as RD or disc edema
Infectious:
- Moxifloxacin 400mg po QD x 10 days
F/U:
- Mild: 1-2 weeks
- Moderate: 4-6 days
- Severe: 1-2 days
39
Contact Dermatitis
- Avoid offending agents
- Cool compresses QID
- PFATs QID + tacrolimus 0.1% ung to periorbital area BID until skin clearance
- If severe: loteprednol 0.5% ung to periorbital area BID x5 days
F/U: 5-7 days
40
Ptosis
- Treat underlying etiology (Horner's, 3rd nerve palsy, MG
- Lid taping and eyelid crutches added to glasses
- Refer to oculoplastic surgeon for possible surgical intervention
F/U:
- Congenital: 3-4 months
- Based on underlying etiology
41
Hordeolum
- Warm compresses for 10 mins QID
- Doxycycline 50mg po BID x 7 days
- Lid hygiene
F/U: PRN
42
Ectropion
- Warm compresses + erythromycin 0.5% ung QID
- Treat exposure keratopathy if present
- Refer to oculoplastic surgeon for evaluation and surgical intervention
F/U:
- If mild/asymptomatic: No f/u
- If moderate/severe but no exposure keratopathy: 2-3 months
- If mild exposure keratopathy: 1-2 months
- If moderate exposure keratopathy: 2-3 weeks
- If severe exposure keratopathy: 1-2 days
43
Entropion
- PFATs + erythromycin 0.5% ung QID
- Treat blepharospasm if present
- Refer to oculoplastic surgeon for evaluation and surgical intervention
F/U:
- If mild/asymptomatic: No f/u
- If moderate/severe but no corneal involvement: 2-3 months
- If mild corneal involvement: 1-2 months
- If moderate corneal involvement: 2-3 weeks
- If severe corneal involvement 1-2 days
44
Trichiasis
- Asymptomatic: monitor
- Acute symptomatic: epilation of offending lashes
- Recurrent or severe/diffuse: refer to ophthalmology for evaluation for potential electrolysis, cryotherapy, or surgical intervention
F/U:
- Asymptomatic or acute: no f/u
- Recurrent or severe/diffuse: f/u based on SPK or corneal defect severity
45
Floppy Eyelid Syndrome
- If corneal or conjunctival involvement: erythromycin 0.5% ung BID
- Tape eyelids when sleeping
- If severe: refer to oculoplastic surgeon for evaluation and possible surgical intervention
- If sleep apnea: Refer to internist for management
F/U: 2-3 days
46
Blepharospasm
- Treat dry eye and blepharitis if present
- Refer to ophthalmologist for botulin toxin injections
F/U:
- Based on dry eye and blepharitis treatment
- If mild/asymptomatic: 6-12 months
47
Canaliculitis
- Warm compresses over punctal area 5-10 mins QID
- If bacterial: moxifloxacin 0.5% gtts QID x 2 weeks + doxycycline 100 mg po BID x 2 weeks
- If fungal: Nystatin 1:20,000 gtts TID and solution irrigation 3x per week
F/U: 5-7 days
48
Dacryocystitis
- Cephalexin 500mg PO q6h + Polytrim QID
- Warm compresses and gentle massage 5-10 mins QID
- Acetaminophen PRN for pain
F/U: 1 day
49
Preseptal Cellulitis
- Doxycycline 100mg po BID
- Pregnant women: amoxicillin/clavulanate 875/125mg po BID
- Children: amoxicillin/clavulanate prescribed at pediatric dose
- If severe: Vancomycin 0.5g IV q12h + ceftriaxone 2g iv q12h
- Warm compresses TID
50
Thyroid Eye Disease
- Prednisolone 1mg/kg po daily tapered over 6 weeks
- Smoking cessation to reduce risk of progression and severity
- Treat exposure keratopathy if present
- Refer to endocrinologist for management of systemic thyroid disease
- Refer to oculoplastic surgeon for orbital decompression if severe
F/U:
- Optic-nerve compression: 5-7 days
- According to exposure keratopathy if severe
- Mild-moderate: 3-6 months
51
Orbital Cellulitis
- Admit patient to hospital for IV antibiotics
- Refer to ophthalmology for p
F/U: 1 day in hospital
52
Dacryoadenitis
Inflammatory:
- Prednisone 1 mg/kg/d + omeprazole 40mg po daily
Viral:
- Cool compresses + acetaminophen 650mg po q4h prn
Bacterial:
- Mild/Moderate: amoxicillin/clavulanate 875mg po q12h
- Severe: Treat as orbital cellulitis
F/U:
- 1 day
53
Amblyopia
Refractive:
- Appropriate spectacle correction (if no improvement in 6-12 weeks, begin patching)
Strabismic:
- Refer for strabismus surgery after vision in 2 eyes is equal or max vison of amblyopic eye obtained
Media opacity:
- Remove opacity (i.e. cataract surgery)
Patching:
- Patch better eye 2-6 h/day
- F/U 1 week per year of age (3 weeks for 3 year old)
54
Pediatric Cataract
- Referral to pediatric ophthalmologist for cataract removal
- If bilateral: Referral to pediatrician to evaluate and treat underlying systemic disorders
- Treat amblyopia
F/U: 2-4 weeks
55
Ophthalmia Neonatorum (Newborn Conjunctivitis)
- Unknown cause of chlamydia: Erythromycin 0.5% ung QID + erythromycin liquid po at pediatric dose
- If chlamydia infection treat mother + her partners with doxycycline 100mg po BID x7 days (if mother pregnant/breast-feeding: azithromycin 1g po single dose)
- If gonorrhoeae suspected: Saline irrigation of discharge + admit to hospital for treatment + ceftriaxone at pediatric dose IM + chlamydia treatment
- Gram positive: Bacitracin ung QID x 2 weeks
- Gram negative: Tobramycin 0.3% ung QID x 2 weeks
F/U: 1 day
56
Congenital Nasolacrimal Duct Obstruction
- Digital pressure to lacrimal sac QID
- If mucopurulent discharge: Polytrim QID
- Observe as most spontaneously resolve by 1 years of age
- If persists past 1 year of age: probing to remove obstruction
F/U: 6-12 months
57
Primary Open Angle Glaucoma
- Initiate medical therapy (Latanoprost 0.005% QHS best, pregnant (not nursing): Brimonidine 0.2% BID)
- If severe: Refer to ophthalmology glaucoma specialist for evaluation and treatment and possible SLT
F/U: 1-6 weeks
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