Ocular Therapeutics

Question 1

Difference in pharmacokinetics in kids

Answer 1

Slower metabolism
Slower clearing time (4x longer)
5x more concentrated
AKA we do not need as much of drop in kids.

Question 2

Goals when prescribing topical medications

Answer 2

Least sting- drops
Long acting- ointment
Shortest time for treatment
Cost

Question 3

3 main reasons to use antibiotics

Answer 3

Bacterial conjunctivitis
Corneal abrasion
Corneal ulcer

Question 4

When to culture?

Answer 4

Infants or CL wearer. Otherwise, no culture. Use broad spectrum antibiotic that covers most.

Question 5

Antibiotics ointment

Answer 5

Erythromycin 2+mos
Tobramycin 2+mos
Ciprofloxacin 2+ years. Fluoroquinalones for ulcers.

Question 6

Antibiotics drops

Answer 6

Polymxin B+, 2+mos, stings
Tobramycin
NEVER use sulfaetamide. Stevens Johnson.
Fluoroquinolones- K ulcers, CL wearers
Azithromycin- bacterial conj. BID x 2 days then qd 5 days.

Question 7

Stevens Johnson

Answer 7

Life threatening skin condition.
Also affects mucous membranes- eyes, nasal passage way, throat.
Hypersensitivity to medications.

Question 8

When to rx fluroquinolones

Answer 8

K ulcers, CL wearers. NOT bacterial conjunctivitis. Stronger antibiotic.

Question 9

Difference between Vigamox and Moxeza (Both moxifloxacin)

Answer 9

Vigamox- TID x 7 days.

Moxeza- BID x 7 days. More viscous, less dosage.

Question 10

Antifungal drops

Answer 10

use for organic matter or non-healing abrasion.
Natamycin. Dose every hour for 1 day then taper. 4-6 weeks.
Safety in peds is not established, but you still have to rx.

Question 11

Topical antivirals for HSV

Answer 11

Triflurothymidine. 6+ years.
Up to 9 x per day, toxic to cornea.

Ganciclovir. 2+ years.
Dosing 5x per day. More expensive, no K damage.

Question 12

Antivirals oral. What to use them for?

Answer 12

HSV. Acyclovir.

All TID when active then BID.

Question 13

What to take for ocular allergies?

Answer 13

Ketitofen 3+
Olopatadine 0.7% is pazeo. 2+
Cetirizine 2+

Question 14

Mast cell stabilizers

-When to Rx and what meds

Answer 14

Vernal conjunctivitis

Cromolyn sodium ages 4+

Question 15

Steroid Antibiotic combination

Answer 15

Tobradex. 2+ Dexamethaone and tobramycin

Maxitrol. 2+ Dexamexasone, neomycin, polymyxin B

Question 16

Steroids

Answer 16

Fluromethalone 0.1% FML. Only one with pediatric profile dosing.
Fluromethalone 0.25% FML Forte 2+ BID/QID

Question 17

Strongest steroid

Answer 17

Durzol. Rx for uveitis.
88% improvement in cells/flare in anterior chamber.
Causes IOP increase in 50% of patients.
40% cataract formation.

Question 18

Classes to use to tx glaucoma

Answer 18

Beta blockers- Timolol and betaxolol (save for peds pts)

Alpha Adrenergic agonist. Brimonidine causes extreme sleepiness. Use apraclonidine.

Carbonic anhydrase inhibitors- brinzolamide. dorzolamide. Safe in peds pts.

Prostaglandin analogs AGES 16!!!! May cause pigment changes.

• Brimatoprost
• Travaprost
• Latanoprostene
• Tafluprost (not recommended in peds pts)

Rho Kinase inhibitors
50% have red eyes. No safety info.

Question 19

Bacterial conjunctivitis presentation and tx

Answer 19

Most commonly flu or strep pneumonia in kids.
Yellow mucopurulent discharge
Can have concurrent ear infection
Tx: Antibiotic drops

Question 20

Conjunctivitis of the newborn. Ophthalmia neonatorum.

Answer 20

occurs in the first 4 weeks after birth.

Chemical conjunctivitis
N gonorrhoeae (1-3 days after birth)
Chlamydia trachoma’s (5-25 days after birth)

Tx ocular, systemic, and mother.

Question 21

Viral conjunctivitis presentation and tx

Answer 21

red, teary eye.

Mild- unilateral but will spread in 1-2 days.
Epidemic keratoconjunctivitis. Adenovirus. Can get subconj hemes and sub epithelial infiltrates. VERY contagious. Whole fam might get it. HSV keratitis. Check for pre-auricular nodes.

Question 22

HSV type 1 signs

Answer 22

Vesicular lesions on the lid. Tx antibiotics.
Epithelial defect- dendritic branch. Tx antiviral.
Conj injection
stromal opacities- tx steroid
Iritis- Tx steroid

Question 23

HSV in children

Answer 23

48% of children have recurrence
61% of people who have epithelial AND stromal disease develop recurrence. Pts with just dendrite don’t show recurrences as much.
Stromal scarring causes amblyopia.

Question 24

Teary eyes and no red conj?

Answer 24

Nasolacrimal duct obstruction.
5% of infants - more common in down syndrome
Lower end of duct obstructed by mucous membrane of the nose (valve of Hasner)
Tx with massage.
Recurrent? Antibiotics.

Question 25

Allergic conjunctivitis tx

Answer 25

Remove offending agent if known
Cool compress
Anti-histamine drops/oral, mild steroid
Allergy testing

Question 26

Vernal conjunctivitis appearance

Answer 26

Recurrent
Trantas dots above cornea, shield ulcer on K.
Papillae- cobblestone under lids.

Question 27

Vernal conjunctivitis.

-more common in who

Answer 27

young males during warm months.
Tx with mast cell stabilizer for papillae. Cromolyn sodium.
Steroid for trantas dots- FML
Tx with mast cell stabilizer before season

Question 28

Limbal dermoid 
location 
when do they present?
May cause what?
Tx?

Answer 28

Limbus-limbal dermoid
Lateral cantus- dermolipoma

May cause astigmatism.

Tx: AT, surgery

Question 29

Ptosis

Answer 29

Unilateral, bilateral.

acquired- CN III palsy, myasthenia gravis, trauma, chalazia.

Congenital- poor levator function. Absence of upper eyelid fold. Lagopthalmos. Brow elevation (using frontal)

Question 30

Marcus Gunn Jaw Winking

Answer 30

Synkinesis between nerve supply to ptergoid muscles and levator. When jaw moves, opposite ptotic led elevates. Parents may notice when child drinks.