Ophthalmology Investigations and Management Flashcards
Neonatal bacterial conjunctivitis
Refer all cases to ophthalmology
Bacterial conjunctivitis management
Supportive treatment
Swab (only if recurrent and suspect chlamydia)
Topical antibiotic (chloramphenicol)
Avoid chloramphenicol if history of aplastic anaemia or allergy
Bacterial keratitis management
Admission for hourly drops
Daily review
Herpes simplex keratitis
Topical aciclovir
Acanthamoeba keratitis investigation
Contact lens culture
Orbital cellulitis investigation
CT scan
Orbital cellulitis management
Broad spectrum AB and monitor closely
Sometimes an abscess will require drainage
Endophthalmitis management
Intravitreal amicakin/certazidime/vancomycin
Topical antibiotics
Maybe systemic antibiotics
Management of toxoplasmosis reactivation
Systemic treatment if sight threatening
Bacterial keratitis investigation
Corneal scrape
Endophthalmitis investigation
Aqueous/vitreous culture
Acanthamoeba investigations
Microscopy/culture
Investigations for toxoplasma/toxocara
Serology
Chlamydial conjunctivitis management
Topical oxytetracycline
Oral azithromycin for genital infection
Bacterial keratitis management
4-quinolone (ofloxacin)
Gentamicin and cefuroxime
(Think this is topical but not sure)
Diabetic retinopathy management
Optimise medical management
Laser (pan-retinal photocoagulation, macular grid)
Surgery (vitrectomy for haemorrhage)
Rehabilitation (blind/partially sighted)
For maculopathy can also do anti-VEGF injection
Thyroid eye disease management
Control thyroid dysfunction
Lubricants
Surgical decompression
Open angle glaucoma management
Prostanoids (latanoprost) Beta blockers (timiolol) CA inhibitors (dorzolamide) Alpha2 agonists (brimonidine) Parasympathomimetic (pilocarpine) Combo
Open angle glaucoma investigation
Tonometry
Eye dilation medication
Mydriatics (parasympathetic blockers e.g. tropicamide)
Sympathomimetics e.g. phenylephrine
Orbital blowout fracture investigation
CT
Orbital blowout fracture management
Fracture reduction and muscle release
Management of hyphaema
REFER
Optic nerve avulsion management
Nothing, blindness is irreversible
Penetrating injury with leak investigation
Seidels test
Intra-ocular foreign body investigation
X-ray
Chemical injury management
Thorough irrigation Quick history Check toxbase if available Check pH Irrigate with 2L of saline or until pH normal Assess at slit lamp
Idiopathic intracranial hypertension investigation
Lumbar puncture (shows raised CSF opening pressure)
Sub-conjunctival haemorrhage management
Nothing, will disappear in about 1-2 weeks
Blepharitis management
Lid hygeine (daily bathing/warm compresses) Supplementary tear drops (Oral doxycycline for 2-3 months)
Autoimmune keratitis management
Oral/topical steroids
Anterior uveitis management
Topical steroids
Mydriatics
Investigate for systemic associations if recurrent or chronic
Episcleritis management
Lubrication/topical NSAIDs/mild steroids
Scleritis management
Oral NSAID
Oral steroids
Steroid sparing agents
Acute closed angle glaucoma
Drugs to reduce aqueous humour production
Monitor IOP
When IOP reduced then laser peripheral iridectomy
Red eye affecting vision or causing marked photophobia management
Urgent referral
Transient central retinal artery occlusion (amaurosis fugax) management
Urgent referral to stroke clinic
Management of central retinal vein occlusion
Refer to opthalmology Treatment aimed at ameliorating secondary complications Anti-VEGF Intravitreal steroid Pan retinal photocoagulation
Vitreous haemorrhage management
Spontaneous reabsorption
Dense may require vitrectomy
