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Pediatric Optometry > Therapeutics > Flashcards

Therapeutics Flashcards

1
Q

Goal of Drops for Peds

A

least sting, long-acting for shorter treatment time and lowest cost

ointments are longer lasting and sting the least compare to drops

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2
Q

Drop Instillation

A

90% to lacrimal ducts to mucous membrane of nasopharyngeal (systemic)

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3
Q

Metabolism in Kids

A

children have a longer clearance time and higher concentration in blood (lasts longer in kids) vs adults with the same dosage

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4
Q

Antibiotics Usage

A

bacterial conjunctivitis, corneal abrasion, and corneal ulcers

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5
Q

Antibiotic Ointments

A

Erythromycin: 2+ mos

Tobramycin: 2+ mos

Gentamicin: more toxic (safety is not established)

Bacitracin: gram +

Ciprofloxacin: 2+ years

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6
Q

Antibiotic Drops

A

Polymxin B and Trimethoprim: 2+ mos (stings)

Aminoglycosides: Tobramycin + Gentamicin

Sulfacetamides: rarely used bc it can cause Steven Johnson Syndrome (mucus membranes affected)
- allergy as well

Fluoroquinolones: 1+ yr + for corneal ulcers

Azithromycin: 1+yr for bacterial conjunctivitis and posterior blepharitis

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7
Q

Antifungals

A

fungal infection: non-healing abrasion with organic matter

Natamycin: no safety profile

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8
Q

Herpes Simplex Virus

A

oral antiviral: Acyclovir

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9
Q

HSV Epithelial

A

Topical Antiviral

Trifluorothymidine: 6+ year old
- toxic to cornea (keratitis)

Ganciclovir: 2+ years

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10
Q

Vernal Conjunctivitis

A

use a mast cell stabilizer

Cromolyn: 4+ year old

Lodoxamide: 2+ year old

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11
Q

Ocular Allergy

A

OTC: antihistamine, mast cell stabilizer, combos

Ketitofen
Olapatadine
Cetirizine (oral and more gentle on eye)

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12
Q

FML

A

steroid: 2+ year old

anterior seg issues

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13
Q

FML Forte

A

steroid: 2+

only one with safety profile

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14
Q

Durezol

A

Steroid

88% improved uveitits BUT caused increase in IOP and cataract development in 50% patients

must monitor use!

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15
Q

Glaucoma

A

Beta Blockers: TImolol + Betaxolol (safe in peds)

Alpha Adrenergic Agonists: Apraclonidine, Brimonidine (safe in peds, 2+, crosses BBB, cause excessive sleepiness)

CAI: Dorzolamide: safe in meds but no profile

Prostaglandins: 16+ with pigment changes (blue eyes turn brown/darker)

Rho Kinase Inhibitors: Netarsudil: 53% get conjunctivial hyperemia (red eye)

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16
Q

Bacterial Conjunctivitis

A

most common pathogen in kids from H. flu or s. pneumoniae

Tx: clean lids + antibiotic drops (tobramycin)

mucopurulent discharge + concurrent ear infection

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17
Q

Ophthalmia Neonatorum

A

newborn conjunctivitis that occurs within first 4 weeks of birth

Tx: ocular, systemic and including mom on antibiotics

chemical conjunctivitis from gonorrhea (1-3 days after birth) or chlamydia (5-25 days after birth)

CULTURE AND GRAM STAINS NECESSARY DURING NEONATAL PERIOD (INFANT CULTURES!!)

c-section is likely not to pass infection

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18
Q

Viral Conjunctivitis

A

many types but check pre-auricular nodes (if inflamed, it is confirmed viral)

red, teary eye with discharge

Mild Viral: unilateral but will spread in 1-2 days

Epidemic Keratoconjunctivitis (EKC): adenovirus, very contagious, can get subconjunctival hemorrhages and subepithelial infiltrates 
- does not clear for a few weeks
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19
Q

Herpes Simplex Virus

A

Type 1: above the waist
- 48% of children have recurrence within 15 mos

Vesicular lesions on lid: antibiotic ointment

Epithelial Defect: antibiotic

Conjunctival Injection: resolves on its own

Stromal opacities and iritis: steroid

6% epithelial/stromal disease will develop recurrence

48% stromal scarring led to Amblyopia

26% OU - concomitant or sequential

20
Q

Nasolacrimal Duct Obstruction

A

5% infants and more common in down syndrome

absent or anomalous duct where the lower duct obstructed my mucous membrane of nose (valve of hasner)

90% clear spontaneously by 1 year old

Tx: observe and massage (eye to nose and back)

  • if recurrent infection, treat with antibiotics (topical)
  • probing is sx (anesthetic used)
21
Q

Allergic Conjunctivitis

A

cool compress and antihistamine and then mild steroid, oral antihistamine, allergy testing (find cause)

remove the offending agent if known

usually systemic so OU is affected

22
Q

Vernal Conjunctivitis

A

young males, warm months (spring), and recurrent

Cornea: Tranta Dots + Shield Ulcers: steroids for dots
- FML

Evert Lids: Papillae (use mast cell stabilizer)

Tx: educate and treat with mast cell stabilizer before spring season

23
Q

Limbal Dermoid

A

choristoma (normal tissue in abnormal area) and often present at birth

does not grow much, no progression; variable size and color

Limbus: limbal dermoid vs Lateral Canthus: dermolipoma

associated with DC if affects cornea

Tx: artificial tears or sx if serious

24
Q

Ptosis

A

unilateral or bilateral

Acquired: CNP III, MG, Trauma, Chalazia/Hemiangioma

Congenital: poor levator function, absence of upper lid fold, lagophthalmos on down gaze, and brow elevation

Tx: correct RE, patch for amblyopia, Sx consult

  • head tilt or cosmesis
  • levator resection or frontalis sling (pull eyelid up)
25
Q

Marcus Gunn Jaw Winking

A

synkinesis between nerve supply to pterygoid muscles and levator palpebrae superioris

not serious; when jaw moves to opposite side of ptotic lid, the ptotic lid elevates

26
Q

Capillary Hemangioma (strawberry birthmark)

A

benign soft tissue tumor composed of blood vessels
- most common orbital tumor in childhood

located usually on palpebral conjunctiva or upper lid
- superficial bright red mass that will blanch with pressure, bleed spontaneously, and enlarge when crying

100% by 6 months + most spontaneously regress
- 30% by 3 years old and 75% by 7 years old

concerned with amblyopia if occlusion of visual axis by lid or induced corneal astigmatism

Eval: cardiac/neuro work up and CT/MRI orbit

  • Posterior Fossa Malformation
  • Hemangioma
  • Arterial Anomalies
  • Cardiac Defects
  • Eye abnormalities
27
Q

Chalazion (Chronic) vs Hordeolum (acute)

A

inflammation of blocked meibomian gland

swollen lid + oily MG

can recur with children

Tx: topical, oral, sx (>10mm) and hot compress

if chronic: omega-3 supplements

28
Q

FDA Dosing

A

1kg = 2.2 lbs and 1 tsp = 5 ml

need to know kids weight and dose formulations for drugs (on label)

1) find the min + max range
2) pick closest to middle out of the formulations

29
Q

Preseptal Cellulitis

A

infection of anterior portion of lid (septum)
- should still have normal VA, EOM, Pupils

due to insect bite, chalazion, sinus infection, trauma
- s. pneumoniae most common

30
Q

Orbital Cellulitis

A

infection of lid but more serious because decreased VA, restricted EOMs, abnormal pupils seen with proptosis (bulging eyes)

Tx: go to hospital for IV antibiotics

31
Q

Information about a Pediatric Cataract

A

location in eyes, location in lens, size, shape, duration

  • more posterior = poor prognosis
  • > 3mm is significant in vision
  • congenital or acquired (duration)
32
Q

Bilateral Cataract

A

60% idiopathic

30% hereditary without systemic disease

5% metabolic syndrome

3% maternal infection

2% ocular anomalies

Meds (steroids, radiation)

Bilateral: more work up if no family history
- CBC, BUN, TORCHS, ca/P, urine

33
Q

Unilateral Cataract

A

80% idiopathic

20% ocular anomalies like Uveitis

10% traumatic

Unilateral: may not require systemic work up
- hx, lens eval, maybe TORCHS to find cause

34
Q

Galactosemia

A

oil droplet cataract
- galacitol in lens leads to refractive lens change

if you remove galacitol from diet, lens will clear up (not TRUE cataract)

35
Q

Anterior Polar Cataract

A

small (<3mm), central, abnormal separation from lens vesicle and surface ectoderm

36
Q

Anterior Pyramidal Cataract

A

conical, surrounding cortical changes

usually bilateral

37
Q

Nuclear Cataract

A

located in the embryonic/fetal nucleus between y sutures

unilateral or bilateral

often Autosomal Dominant + poor VAs

38
Q

Posterior Lenticonus

A

Congenital thinning of posterior capsule with bowing of thinned area and becomes opacified over time

usually unilateral

may get irregular astigmatism - ambylopic

39
Q

Cerulean (Blue Dot)

A

blue/white opacities in lens cortex

autosomal dominant (genetic mutation)

associated with down syndrome

40
Q

Eval of Cataracts

A

HISTORY (family, duration, meds, trauma, health, prematurity)

VA visual preference

RE + DFE (IOP + lens assessment)

41
Q

Infant Aphakia Study Results

A

114 infants (1-6 mos) with unilateral cataracts sx

81% IOL got glaucoma vs 56% CLS got glaucoma

children should be left aphakic and treat with cls until IOL implant is necessary

42
Q

Cataract Tx

A

Infants: the earlier the intervention the better outcome
- if no treatment: can lead to deprivation amblyopia
if unilateral: sx by 4-6 weeks (ASAP) vs if bilateral (6-8 wks)

Toddler: sx only if severe
- VA worse than 20/50, RE, patch, dilate with PEP for improvement

School-Age: 8+ year old

  • if congenital and no prior tx: poor prognosis
  • if acquired, more conservative tx

Aphakia gls/ BIFOCAL TX NECESSARY

monitor for glaucoma!!

43
Q

Ectopia Lentis

A

lens subluxation due to disorders that disrupt the microfibrils of the zonules

remain attached usually but can detach

Caused by Homocystinuria + Marfan’s Syndrome

44
Q

Homocystinuria

A

methionine catabolism disorder which leads to developmental delays and blood clots and pupil Block glaucoma

Dx: urine test

Tx: B6 + diet changes

45
Q

Marfan’s Syndrome

A

mutation in gene for fibrillin-1

tall stature, MVP, aortic root dilation – cardiac defects

Myopia (>3D), Ectopia Lentis, FMHx, and genetic tests

46
Q

Primary Infantile / Congenital Glaucoma

A

onset 1-2 year olds where angle structures seen at 7-8 mos of gestation are now seen as congenital glaucoma
- they do not develop fully

CB and Iris positioned more anteriorly and overlap TM causing decrease in aqueous outflow

Caused by: cataract removal (up to years later) or Juvenile Onset Open Angle Glaucoma (autosomal dominant)

66% bilateral

86% dx by 1 year old

Signs: tearing, photophobia, blepharospasm (eye twitch), megalocornea (>12mm), Buphthalmos (enlarged eye), Myopia, corneal opacities, increased IOP (>21mmHg) 
- reproducible VFD
- increased corneal diameter 
    :newborn >11mm
    :infant >12mm 
    :1+year >13mm 
- increasing cupping and diff of 0.2 or more 
- focal rim thinning 
- progressive myopic shift

Work up: IOP, Gonio, Dilation/ON, EUA (under anesthetic)

Tx: sx or meds

Pediatric Optometry (14 decks)

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