simple TMOD

Question 1

tosoplasmosis

Answer 1

**protozoan

pyrimethamine, sulfadiazene, folinic acid
steroid

Question 2

histoplasmosis

Answer 2

**nematode

steroids

Question 3

ectopia lentis

Answer 3

**causes: 1. trauma, Marfan’s (up + out), Homocysteinuria (down + in), weill marchesani

CL with pupil
only if super bad astigmatism or diplopia do surgery

Question 4

HZV keratitis - herpes

Answer 4

oral acyclovir 800mg PO 5x/d
OR valacyclovir 1000mg PO TID
+/- oral steroid

+conjunctivitis or episcleritis

• lubrication
• cold compress

RTC 1-7d

Question 5

HSV keratitis - herpes

Answer 5

trifluiridine 9x/d
OR ganciclovir ung 5x/d

+IK (no epi)
- topical steroid

Question 6

EKC - epidemic keratoconjunctivitis

Answer 6

Betadine

Question 7

Acanthomoeba

Answer 7

Neosporin

OR Brolene

Question 8

Pupil sparing CN3 palsy

Answer 8

observation –> daily first week, then monthly until resolves (expect in 3 months)

**if aberrant regeneration appears, pupil gets involved, does not resolve in 3 mos, or in child –> MRI/MRA needed

Question 9

Recurrent corneal erosion

Answer 9

erythromycin ointment QID and lubrication w/ PFATs q2h

can add:

• bandage CL
• NaCl drops
• stromal micropuncture / PTK / debridement / oral tetracycline

f/u 1 day

Question 10

interstitial keratitis

Answer 10

**cause: herpes S and Z, congenital/acquired syphillis, lyme, TB

topical steroid (pred forte q2h) + cyclo (homatropine TID)

treat underlying cause 
ex. herpes -->
\+ oral antiviral (Valtrex PO BID)
ex. syphillis -->
\+IV crystalline penicillin G 
ex. early Lyme disease -->
\+oral doxycycline 

f/u 3-7 days

Question 11

Horner’s

Answer 11

send for head and neck MRI + chest CT /x-ray

10% cocaine = dilation
1% hydroxyamphetamine
- dilate = pre-ganglionic
- no dilate = post-ganglionic

Question 12

DLK - post-LASIK

Answer 12

**2-5 days post

steroid q1h

if really bad –> lift flap and debride then re-float

Question 13

Epi ingrowth - post-LASIK

Answer 13

**1-2 week post

asymptomatic, <1-2mm –> observe

otherwise lift, debride and re-float flap

Question 14

staph marginal keratitis

Answer 14

treat bleph 
WC  + lid hygiene + topical antibiotic (fq QID)
\+ 
treat cornea
topical mild steroid (lotemax QID)
OR
combo AB/steroid (tobradex QID)

**self-limiting

Question 15

acute angle closure glaucoma

Answer 15

1 gtt timolol +
1 gtt apraclonidine +
1 gtt pilocaprine +
acetazolamine 500mg PO

once angle open and IOP <30

• rx pilo QID and pred QID until LPI can be done (min 2 day later)
• can also add timolol BID

F/U 1 day

Question 16

Best’s disease

Answer 16

• *AD
• *VA good till 50s then CNVM/GA
• *normal ERG, bad EOG

no tx
amsler grid and observation

Question 17

Stargardt

Answer 17

• *AR
• *Good VA till teens-20s
• *beaten bronze, bulls eye macula, pisciform flecks
• *normal ERG and EOG

no tx
low vision

Question 18

familial drusen

Answer 18

• *AD
• *good VA till 50s+ then CNVM or GA
• *normal ERG and EOG - advanced = bad EOG

no tx
low vision, amsler

Question 19

endophthalmitis

Answer 19

• *fast onset = Staph-epi
• *late onset = P. acnes

mild-mod
- intravitreal vancomycin and ceftazidime + topical ABs

severe
- pars plana vitrectomy

Question 20

macrolides

Answer 20

azithromycin
erythromycin
clarithromycin

Question 21

aminoglycosides

Answer 21

tobramycin
gentamycin
neomycin

Question 22

tetracyclines

Answer 22

tetracycline
doxycycline
minocyline

Question 23

Adie’s pupil

Answer 23

**assoc w/ loss of deep tendon reflexes

no tx but can do extra ADD and tint on glasses

Question 24

anterior non-granulomatous uveitis

Answer 24

steroid q1h +
cyclo BID

f/u 1 day

Question 25

granular dystrophy

Answer 25

**AD

lubrication, bandage CL

if symptomatic / VA affected
- superficial keratectomy / PTK / lamellar keratoplasty / PK (recurrs in 3-5yrs)

Question 26

Fuch’s endo dystrophy

Answer 26

**increases change of glaucoma

Muro128 QID

DSEK or full thickness transplant if endo decompensates

f/u 3 months

Question 27

FB

Answer 27

remove fb

topical antibiotic (erythromycin QID) +/-
topical NSAID
topical cycloplegic

add oral NSAID if pain

f/u 1 day

Question 28

interferon retinopathy

Answer 28

asymptomatic = watch closely, keep interferon

symptomatic = decrease dose or d/c interferon

retinal findings go away after cessation of tx w/o permanent sequlae

Question 29

VKC

Answer 29

1. mild steroid (lotepred)
2. BEZPOP (pataday good for kids)

f/u 1 week

then use BEZPOP prophylactically

Question 30

Phthiriasis palp

Answer 30

**lice

removal with jewler’s forceps
+ bacitracin TID

f/u next day

pt needs to clean everything on high heat and put away for 2 weeks

Question 31

CME

Answer 31

• *Irvine Gass = 6wks - 3mos post surgery
• *assoc w/ RP

casued post surgery
1. topical NSAID QID+
topical steroid QID
2. after 4-6 weeks of 1. try oral CAI

caused by RP
1. oral CAI

caused by DM/ vascular
1. focal laser / grid laser

Question 32

amblyopia

Answer 32

esoT –> push full plus of wet
exoT/no strab –> cut by 1.50-2.00 from wet

f/u 2 months

Question 33

dellen

Answer 33

PF ATs q2h + AT ointment at night

F/u 1-7 days

Question 34

hypotony after surgery

Answer 34

pressure patch w/ AB

f/u 1 day

still bad = refer for wound suturing

Question 35

sickle cell retinopathy

Answer 35

non-prolif = no tx

prolif (neo) = full scatter laser photocoagulation of neo or observation since 50% resolve

**common complication = vitreous heme, RD

Question 36

BRAO/CRAO

Answer 36

obervation every 3-6 mo

Question 37

Possner Schlossman

Answer 37

topical steroid QID

if IOP still high add: alpha2, beta-block or CAI

f/u 1-2days

Question 38

Coats

Answer 38

focal laser of the peripheral retinal telangiectasia

watch for total exudative RD –> can lead to neovasc glaucoma