ophthalmology treatments Flashcards
blepharitis (3)
hot compresses twice daily
lid hygeine - removal of debris
artificial tears
bacterial conjunctivitis
chloramphenicol drops 2-3 hourly or ointment QDS
bacterial conjunctivitis in pregnant women or staph infection
fusidic acid BD
bacterial conjunctivitis pseudomonas
gentamicin
bacterial conjunctivitis chlamydia
oxytetracycline
1st line treatment allergic conjunctivitis
topical/oral antihistamine
2nd line treatment allergic conjunctivitis
topical mast cell stabiliser - sodium cromoglicate and nedocromil
tx baby with purulent eye discharge
urgent swab samples using methods to identify CT and NG
start systemic tx for gonococcal infection
bacterial keratitis
topical ofloxacin or gentamicin
viral keratitis
topical aciclovir
autoimmune keratitis
topical steroids - RULE OUT OTHER CAUSE FIRST
pain relief in keratitis
cycloplegic e.g. cyclopentolate
herpes zoster ophthalmicus
oral antiviral 10 days
anterior uveitis
topical/oral steroid + topical cycloplegic e.g. atropine, cyclopentolate
differentiating scleritis and episcleritis
phenylephrine
scleritis tx
oral steroids and NSAID
investigate for underlying cause
endopthalmitis
intravitreal antibiotics - amikacin, vancomycin
1st line dacrocystitis
chloramphenicol
2nd line dacrocystitis
oral antibiotics
ix for orbital cellutitis
CT with contrast - but dont wait for this to start abx
FBC
blood culture
tx orbital cellulitis
IV ceftriaxone, flucloxicillin, metronidazole 10-14 days
tx periorbital cellulitis
co-amoxiclav 7-10 days
investigation if periorbital cellulitis but suspicious or orbital cellulitis
contrast CT
CRAO
if < 24 hours
- ocular massage
- IV acetazolamide
amaurosis fugax
aspirin 300mg
secondary prevention after amaurosis fugax
clopidogrel
2nd line aspirin and dypyridamole
GCA ix
ESR and temporal artery biopsy
GCA tx no visual loss
60mg prenisolone oral if no visual loss
GCA with visual loss
IV methylprednisolone
ix to identify neovascularisation
fluorescein angiography
ix suspected retinal detachment
slit lamp and ophthalmoscope within 24 hours
investigation for MS with optic neuritis
MRI with contrast
tx optic neuritis
high dose steroid
1st line ix in ARMD
slit lamp microscopy
tx DARMD
visual aids, zinc and anti-oxidant
ix if suspect wet ARMD
fluorescein angiography
tx wet ARMD
anti - VEGF
ranibizumba, bevacizumab, pegaptanib
4 weekly injection
when should anti-VEGF be initiated in wet ARMD
within 2 months
cataract
phacoemulsification
ix glaucoma IOP
applanation tomography
ix glaucoma visual field defects
perimetrry
ix glaucoma optic disc cupping
fundoscopy
glaucoma drugs: mechanism of action: latanoprost
prostaglandin analgoue - increase drainage of AH by increasing uveoscleral outflow
glaucoma drugs: mechanism of action: timolol
reduce production of AH
glaucoma drugs: mechanism of action: brominidine, apraclonidine
sympathomimetic a-adrenergic agonists
reduce production of AH and increase outflow
glaucoma drugs: mechanism of action: dorzolamide, acetazolamide
carbonic anhydrase inhibitors - reduce production of AH
glaucoma drugs: mechanism of action: pilocarpine
muscarinic receptor agonist - parasympathomimetic - constricts the pupil and pulls lens away from meshwork which reduces resistant to outflow
SE - glaucoma drugs: latanoprost
change colour of iris
increased lash length
SE - glaucoma drugs: timolol
dry eyes, systemic absorption, bradycardia
when is timolol contraindicated in glaucoma
asthma/COPD
heart block
SE - glaucoma drugs: brominidine
dry mouth
lethargy
hyperaemia
SE - glaucoma drugs: Acetazolomide
peri-oral tingling
parasthesia
renal stones
metabolic acidosis
SE - glaucoma drugs: pilocarpine
miosis
dimming of vision
brow pain in first few weeks
poor vision in low light
1st line chronic open angle glaucoma
topical latanoprost
2nd line chronic open angle glaucoma
topical timolol
or topical dozolamide
or topical brimonidine
definitive treatment chronic open angle glaucoma
trabeculectomy
tx acute closed angle glaucoma 1st line
IV acetazolamide
tx acute closed angle glaucoma - add ons to IV acetazolamide
+/- timolol
+/- apraclonidine
+/- pilocarpine
(all topical)
drug tx acute closed angle glaucoma if all others fail
mannitol
surgical treatment acute closed angle glaucoma - definitive but after drug treatment
laser peripheral iridotomy
tx diabetic retinopathy
pan retinal photocoagulation
tighter glycaemic control
ix squints
cover test
tx ambylopia
cover good eye