Opthalmic conditions

Question 1

What is the pharm treatment for bacterial conjunctivitis?

Answer 1

self-limiting usually, consider abx if symptoms not resolve in 2-5 days
1) chloramphenicol or propamidine

Abx
2) aminoglycosides (framycetin, gentamicin, tobramycin)
3) Quinolones = S4 –>ciprofloxacin, ofloxacin

Question 2

What is the pharm treatment for staph blepharitis?

Answer 2

Same as seborrheic blepharitis

Self-limiting

Symptoms persistent = chloramphenicol

Resistant or complicated case = long-term oral antibacterials

Question 3

What is the pharm treatment for bacterial keratitis?

Answer 3

Topical ciprofloxacin or ofloxacin

Other treatments = cefazolin w/ gentamicin or tobramycin

Antichol (cyclopentolate) = reduce pain

Question 4

What are the symptoms of bact conjunctivitis?

Answer 4

Rapid onset

variable redness, burning, irritation, gritty feeling tearing, purulent (yellow-white) discharge

Second eye involved in 24-48 hrs

Question 5

Discuss non-pharm treatment of bact conjunctivitis

Answer 5

Highly contagious, maintain good hygiene

Remove discharge with saline

Often resolved in 5 days

Question 6

What is the pharm treatment of bact conjunctivitis if symptoms not resolve after 1-2 days?

Answer 6

Propamidine (S2) = mild cases, anti-infective, 3-4x daily

Chloramphenicol (S3) = refer children <2yrs, 1-2 drops every 2 hrs then 6 hrsly

Question 7

Discuss key facts on chloramphenicol use for bact conjunctivitis

Answer 7

Does the patient have characteristic symptoms?

exclude other conditions/complications

Recurring symptoms/not improve –> refer

Consider = glaucoma, dry eyes, contact lenses, recent eye surgery

Safe for any age, refer is child <2

Safe in preg

Ointment can blur vision

Symptoms should improve within 48 hrs

Exclude patient from others until discharge from eye has stopped

Question 8

Discuss the symptoms of viral conjunctivits

Answer 8

Acutely red eye, water discharge, photophobia, recent URTI, gritty, swelling

Infectious until weeping/redness resolved (10-12 days)

Starts one eye, both eyes can be effected

Question 9

What is the treatment for HSV-1 mediated viral conjunctivits?

Answer 9

Aciclovir ointment, 5x a day for 14 days or 3 after corneal epithelium sac healed

Question 10

What is the general treatment for viral conjunctivits?

Answer 10

Short lived, self-limiting

Hygiene/cold compress, avoid bright light

artificial tears/lubricants –> soothe eye

Topical vasocon –> appearance

Rarely topical abx

Question 11

What are the symptoms of allergic conjunctivitis?

Answer 11

itching, watery eyes, burning, slightly red, slight oedema

both eyes

Question 12

What is the 1st line treatment for allergic conjunctivitis?

Answer 12

Antihistamines (S2)= azelastine, ketotifen, levocabstine

Question 13

What is 2nd line treatment for allergic conjunctivitis?

Answer 13

Mast cell stabilisers (S2) = cromoglycate, lodoxamide

not useful for acute symptoms, up to 2wks for full effect

Question 14

What are some S4 treatments for allergic conjunctivitis?

Answer 14

Antihistamine + mast cell stabilisers = olopatadine

also 1st line, more effective than monotherapy

adult, child >3yrs –> one drop twice daily

Question 15

What NSAIDs can be used for allergic conjunctivits?

Answer 15

Ocular NSADIs = diclofenac, ketorolac

Nepafenac = only in ocular surgery

Question 16

What corticosteroids are used to treat allergic conjunctivits?

Answer 16

dexamethasone, fluorometholone, hydrocortisone, prednisolone

Question 17

When to refer for eye conditions

Answer 17

Copious amounts of pus, sig swelling

Irritated eyelids with crusts or flakes, lower eyelid turned down or in

Dryness after new med, photophobia, blurred/distorted/reduced vision

Other associated symptoms –> dry mouth, headache, N/V

unresponsive to treatment