Ocular Therapeutics Flashcards
Difference in pharmacokinetics in kids
Slower metabolism
Slower clearing time (4x longer)
5x more concentrated
AKA we do not need as much of drop in kids.
Goals when prescribing topical medications
Least sting- drops
Long acting- ointment
Shortest time for treatment
Cost
3 main reasons to use antibiotics
Bacterial conjunctivitis
Corneal abrasion
Corneal ulcer
When to culture?
Infants or CL wearer. Otherwise, no culture. Use broad spectrum antibiotic that covers most.
Antibiotics ointment
Erythromycin 2+mos
Tobramycin 2+mos
Ciprofloxacin 2+ years. Fluoroquinalones for ulcers.
Antibiotics drops
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.
Stevens Johnson
Life threatening skin condition.
Also affects mucous membranes- eyes, nasal passage way, throat.
Hypersensitivity to medications.
When to rx fluroquinolones
K ulcers, CL wearers. NOT bacterial conjunctivitis. Stronger antibiotic.
Difference between Vigamox and Moxeza (Both moxifloxacin)
Vigamox- TID x 7 days.
Moxeza- BID x 7 days. More viscous, less dosage.
Antifungal drops
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.
Topical antivirals for HSV
Triflurothymidine. 6+ years.
Up to 9 x per day, toxic to cornea.
Ganciclovir. 2+ years.
Dosing 5x per day. More expensive, no K damage.
Antivirals oral. What to use them for?
HSV. Acyclovir.
All TID when active then BID.
What to take for ocular allergies?
Ketitofen 3+
Olopatadine 0.7% is pazeo. 2+
Cetirizine 2+
Mast cell stabilizers
-When to Rx and what meds
Vernal conjunctivitis
Cromolyn sodium ages 4+
Steroid Antibiotic combination
Tobradex. 2+ Dexamethaone and tobramycin
Maxitrol. 2+ Dexamexasone, neomycin, polymyxin B
Steroids
Fluromethalone 0.1% FML. Only one with pediatric profile dosing.
Fluromethalone 0.25% FML Forte 2+ BID/QID
Strongest steroid
Durzol. Rx for uveitis.
88% improvement in cells/flare in anterior chamber.
Causes IOP increase in 50% of patients.
40% cataract formation.
Classes to use to tx glaucoma
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.
Bacterial conjunctivitis presentation and tx
Most commonly flu or strep pneumonia in kids.
Yellow mucopurulent discharge
Can have concurrent ear infection
Tx: Antibiotic drops
Conjunctivitis of the newborn. Ophthalmia neonatorum.
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.
Viral conjunctivitis presentation and tx
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.
HSV type 1 signs
Vesicular lesions on the lid. Tx antibiotics.
Epithelial defect- dendritic branch. Tx antiviral.
Conj injection
stromal opacities- tx steroid
Iritis- Tx steroid
HSV in children
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.
Teary eyes and no red conj?
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.
Allergic conjunctivitis tx
Remove offending agent if known
Cool compress
Anti-histamine drops/oral, mild steroid
Allergy testing
Vernal conjunctivitis appearance
Recurrent
Trantas dots above cornea, shield ulcer on K.
Papillae- cobblestone under lids.
Vernal conjunctivitis.
-more common in who
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
Limbal dermoid location when do they present? May cause what? Tx?
Limbus-limbal dermoid
Lateral cantus- dermolipoma
May cause astigmatism.
Tx: AT, surgery
Ptosis
Unilateral, bilateral.
acquired- CN III palsy, myasthenia gravis, trauma, chalazia.
Congenital- poor levator function. Absence of upper eyelid fold. Lagopthalmos. Brow elevation (using frontal)
Marcus Gunn Jaw Winking
Synkinesis between nerve supply to ptergoid muscles and levator. When jaw moves, opposite ptotic led elevates. Parents may notice when child drinks.
